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Translating the world's information with Google Translator Toolkit

At Google, we consider translation a key part of making information universally accessible to everyone around the world. While we think <a href="http://translate.google.com/">Google Translate</a>, our automatic translation system, is pretty neat, sometimes machine translation could use a human touch. Yesterday, we launched <a href="http://translate.google.com/toolkit">Google Translator Toolkit</a>, a powerful but easy-to-use editor that enables translators to bring that human touch to machine translation. For example, if an Arabic-speaking reader wants to translate a <a href="http://www.wikipedia.org/">Wikipedia</a>™ article into Arabic, she loads the article into Translator Toolkit, corrects the automatic translation, and clicks publish. By using Translator Toolkit's <a href="http://translate.google.com/support/toolkit/bin/answer.py?hl=en&answer=147838">bag of tools</a> — translation search, bilingual dictionaries, and ratings, she translates and publishes the article faster and better into Arabic. The Translator Toolkit is integrated with Wikipedia, making it easy to publish translated articles. Best of all, our automatic translation system "learns" from her corrections, creating a virtuous cycle that can help translate content into 47 languages, or over 98% of the world's Internet population. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVUgirudPjlpNWYbq5lZ265a7ohJE_I6llq2XIEARWDLz2dAKUhH9vQyWwmLRuxEuELnZStTRs9urr58sjAO02x20p5tWZb8lLY_-l2BYm9_-8CiwkBJvsCGpZrQ1aqgWLTGVOOKXVP7KK/s1600-h/cycle.PNG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5345332671139597682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVUgirudPjlpNWYbq5lZ265a7ohJE_I6llq2XIEARWDLz2dAKUhH9vQyWwmLRuxEuELnZStTRs9urr58sjAO02x20p5tWZb8lLY_-l2BYm9_-8CiwkBJvsCGpZrQ1aqgWLTGVOOKXVP7KK/s400/cycle.PNG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 201px;" /></a> Besides Wikipedia, we've also integrated with <a href="http://knol.google.com/">Knol</a>, and we support common document types including Word and HTML. For translation professionals, we provide advanced features such as <a href="http://translate.google.com/support/toolkit/bin/answer.py?hl=en&answer=147859">terminology</a> and <a href="http://translate.google.com/support/toolkit/bin/answer.py?hl=en&answer=147863">translation memory</a> management. For more information, check out our introductory video below. And if you're a professional translator or just a linguaphile, try <a href="http://translate.google.com/toolkit">Google Translator Toolkit</a> for easier and faster translations. Be sure and <a href="http://translate.google.com/support/toolkit/bin/request.py?hl=en&contact_type=contact_us">let us know what you think</a>. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/C7W2NJFdoIg&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/C7W2NJFdoIg&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object> Posted by Michael Galvez and Sanjay Bhansali, Google Translator Toolkit team

Translating the world's information with Google Translator Toolkit

At Google, we consider translation a key part of making information universally accessible to everyone around the world. While we think Goog...

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Another Episode in the Series: HIT Failure

At "<a href="http://hcrenewal.blogspot.com/2009/06/hospital-computing-backwater-and-need.html">Indiana Power Surge</a>" I wrote about the dangers of EHR "glitches" that do, but should not, cause catastrophic failure of clinical IT systems that clinicians are increasingly dependent upon to deliver healthcare. <div> </div><div>Heart-lung machines, for example, do not generally have "unscheduled downtime" during surgery. It would not be tolerated. With EHR's, though, here we go again: <blockquote>June 6, 2009 <a href="http://www.concordmonitor.com/apps/pbcs.dll/article?AID=/20090606/NEWS01/906060351/1043">Hospital stricken by computer glitch</a> Staff forced to keep records by hand By CHELSEA CONABOY Monitor staff Concord Hospital CEO Mike Green said the hospital has been struggling for a week with computer system failures but, as of yesterday, everything was working again. Green said the hospital was adding memory to its storage area network on May 28 and something went wrong - possibly because of faulty hardware or a bad installation. [It is remarkable that the cause seems unknown - ed.] In the days that followed, the systems that access that network began to fail. Those used by nurses and pharmacists in the hospital and by providers to make orders for lab work [i.e., CPOE - ed.] and other tests crashed. "People had to revert to paper processes," Green said. "It was a lot of work, particularly for pharmacists who had to do things manually that are ordinarily done by the electronic system." [The increased risk of error in the mayhem is not insignificant - ed.] The systems that handle electronic medical records and financial information in physicians' offices weren't affected. The hospital financial system, which processes about $1.5 million in charges each day, was briefly offline but quickly repaired, Green said. He said staff members were working around the clock to correct the problems and to ensure that the quick shift to manual processes posed no safety concerns for patients [as I've written before, HIT crashes NEVER, EVER seem to present safety concerns - see "<a href="http://hcrenewal.blogspot.com/2009/05/health-it-failure-never-puts-patients.html">Health IT Failure Never Puts Patients at Risk</a>" - ed.] The systems are new, some installed within six months, and are state of the art for the industry. "It's remarkable how quickly you become reliant on that technology," he said. [I'm not so sure what's remarkable about it when you get rid of paper. Clinicians have to record their orders, findings and observations, etc. somewhere - ed.] Green said the issues highlighted the fact that some nurses at the hospital have only ever used electronic processes for keeping patient charts and don't have the experience of using manual systems to fall back on when the systems crash. The hospital plans to create training and procedural standards for what to do in case that this happens again. [Why in god's name wasn't it done before?- ed.] Green did not have an estimate for how much the computer crash would cost the hospital, though he said it was something that would be accounted for through minor adjustments in the organization. He said patients were not likely aware of the problems. "This was a painful learning experience," he said. "Between dealing with H1N1 and dealing with this, I am very confident in saying we are the best prepared hospital in the state to deal with any disaster." [This seems a bit of a non-sequitur. They apparently don't really know what went wrong with the IT, and they claim they're prepared to deal with any disaster? - ed.]</blockquote> This organization recently won an award for IT excellence: <blockquote><a href="http://www.concordhospital.org/news/news.php?shownews=true&id=842&artid=842&arttype=1">Concord Hospital’s Michael Green nationally awarded for leadership and commitment to utilize information technology to enhance patient care</a> January 22nd, 2009 Michael B. Green, president and CEO of Concord Hospital, has been selected as one of three winners of the CEO IT (Information Technology) Achievement Award by Modern Healthcare magazine and Healthcare Information and Management Systems Society. [HIMSS - ed.] A panel of judges consisting of two CEOs and three chief information officers or IT experts chose three winners from a pool of 48 nominees. This year’s winners will be spotlighted in the February 16th issue of Modern Healthcare. Green is one of 18 winners of the award since its creation in 2003. Concord Hospital’s Michael Green nationally awarded for leadership and commitment to utilize information technology to enhance patient care</blockquote> This hospital is an IT award winner. I fear what's going to happen at hospitals with far less IT savvy deal when they deal with this increasingly complex and critical technology in coming years. -- SS 6/19 Addendum: I've had an exchange with Concord Hospital's CIO, Deane Morrison RPh, which I am posting here with permission. He wrote me a polite letter expressing concern that my post was downplaying Concord's HIT accomplishments. We had this exchange: <blockquote> Deane, I believe you misconstrue my post. I am an HIT supporter - but in recent years have concerns the field has moved too fast. I am pointing out that your hospital won an award for IT excellence, reproducing a paragraph about that, yet still has problems with the technology. I do this in the context of my concerns about what will happen at hospitals without the IT savvy yours has in future years. In that sense, I am complimenting your organization, with a few nitpicks that, believe me, are relatively minor compared to your competitors. I am an HIT expert going back many years (see my bio page in the link below), was a CMIO in both hospital and pharma serttings, and know that there are universal problems in both clinical IT and research IT. I also spent time at Comdisco working on disaster recovery and business continuity solutions for hospitals and know the complexities of that. As to risk/benefit, I have written volumes at the 10-year-old website now hosted at Drexel, again at the link below [<a href="http://www.tinyurl.com/hit-misadventure">link</a> -ed.] My concerns are that HIT can finally produce the benefits long claimed (decades!) for it, and in fact have achieved those benefits in projects I led - with a caveat - only if done well. There is a lot of meaning as I'm sure you well know behind those two words, from vendor origins to implementation to lifecycle management. It sounds like you've done HIT very well (I hear really terrible stories from my colleagues and grad students in operational HIT positions almost daily these days), but yet you are still faced with the unexpected events predicted by those in the field of social informatics with any ICT (information & communication technology) - the unthinkable and chaotic things that find a way to happen despite good planning. Again, my concern is about the hospitals who are not award winners and yet who are being rushed into HIT by the provisions in the ARRA. If you would like me to add a comment or address some specific concern, please let me know.</blockquote> CIO Morrison then wrote me back: <blockquote>Scot, Thank you for your reply. I clearly misconstrued the intent of your blog. I very much agree with you that our society as a whole and the leadership of our country do not understand how hard it is to successfully implement clinical IT technology. At Concord I've never contended that what success we've had has been related to the systems we have choosen. Rather I've tried to emphasize for our leadership that its the people (It & clinicians) who work on the projects that make the difference. We have invested in a CMIO (Dr. Joel C. Berman). He has three other MD's working part time. We have a 4 person nursing informatics team. And we have a very large IT department. And even with that we are still vulnerable to the hiccups that come with increasong reliance on technology. So all in all I believe that well installed IT technology will result in a better healthcare system but I aslo very much agree with you that we can not underestimate the amount of hard work its going to take to get us there. Deane Morrison, RPh CIO Concord Hospital Concord, NH </blockquote> It is a pleasure to communicate with CIO's who understand what's strategic and what's tactical in healthcare and HIT. I replied: <blockquote>Deane, Thanks. You've made an interesting comment: "... Rather I've tried to emphasize for our leadership that its the people (IT & clinicians) who work on the projects that make the difference." Indeed. I expressed this years ago by observing that "healthcare IT projects are complex medical/social projects that happen to involve computers, as opposed to complex IT projects that happen to involve clinicians." You are way ahead of many of your competitors in pointing out to your leadership what's strategic in IT (the right people with the right skills) vs. what's transient and tactical (the right package, platform etc.). Technologic determinism prevails (i.e., computers solve problems, automatically, and people are interchangeable cogs in an IT project).</blockquote> In my opinion we as a nation need more CIO's in hospitals who share these insights about people. -- SS </div>

Another Episode in the Series: HIT Failure

At " Indiana Power Surge " I wrote about the dangers of EHR "glitches" that do, but should not, cause catastrophic failu...

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Yale, Van Gogh's "The Night Cafe" and Personal Property: What's Mine is Mine, and What's Yours is Mine

At Healthcare Renewal and at numerous other healthcare blogs, we write about academic and industry conflicts of interest, malfeasance, and other topics in the hopes that there are leaders within organizations who might correct the wrongs that result from such conflicts and behaviors. (That is, when it is not those same leaders behind the scandals in question.) Our efforts are based on the assumption (perhaps, more correctly, a hope) that the problems within organizations are not organic and ideological, and that they are in some fashion amenable to correction internally and externally via exposure to sunlight. What if we're wrong? A story caught my eye about my Medical Informatics alma mater. A Frenchman, Pierre Konowaloff, is suing Yale for return of a famous Van Gogh painting that was confiscated from his family in the early 1900's by totalitarians, psychopaths who created what proved to be one of the most oppressive and murderous regimes in history (the Soviet Union). In return, Mr. Konowaloff was countersued by Yale. Yale alleges that the confiscation of the painting by the Soviets was A-OK because "international law was not violated" [by the confiscation - ed.], therefore Yale has legitimate and unchallengeable dibs on the painting. "International law" was not violated? This response is beyond stunning. I had to retrieve my jaw from the floor after reading the story: <blockquote>Wall Street Journal June 3, 2009 <a href="http://online.wsj.com/article/SB124406037069082321.html">Yale Sued Over Van Gogh Painting Seized by Soviets</a> By JOSEPH PEREIRA A descendant of the onetime owner of a famed Van Gogh painting has sued Yale University in an effort to reclaim the artwork from the Ivy League school. In a lawsuit filed in U.S. District Court in New Haven, Conn., Pierre Konowaloff alleged that the university should have known the painting—"<a href="http://en.wikipedia.org/wiki/The_Night_Caf%C3%A9">The Night Café</a>"—had been confiscated from his great-grandfather, Ivan Morozov, a Russian industrialist and aristocrat, during the Communist takeover of Russia in the early 1900s. The 1888 painting was subsequently sold by the Soviet government to a European gallery. Stephen Carlton Clark, a Yale alumnus, bought the painting from a gallery in New York in the early 1930s and bequeathed it to Yale in 1961. In his suit, Mr. Konowaloff, who lives in France, accuses the university of engaging "in a policy of willful ignorance" that amounts to "art laundering," and asks the court to declare him the rightful owner. Aware of Mr. Konowaloff's intention to claim the painting, Yale filed a lawsuit of its own last March in federal court in New Haven. In its suit, Yale asserted ownership of "The Night Café," claiming that the nationalization of the painting by Communist Russia -- while at odds with capitalism -- did not violate international law. Yale stated in its lawsuit that "it was accepted at the time, as it is now, that the sales by the Soviet government were valid, as were later acquisitions of the paintings."</blockquote> In other words, rather than doing the right thing, Yale is claiming that the theft of personal property by the Soviets was OK by them. (While Yale is well known to have a culture far to the left and many of its leaders and faculty probably sympathize with communists, Hitler also "nationalized" the artwork and other property of individuals. Would Yale find those actions in accordance with "International law?" One can only wonder.) <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrSXZnfYXp1v75BtZHvc3nSFhg2zA9wb0vwtvfwCd3Hji13Ohnq78KunpBqHyaVGrhA_qkzf5VYOPgy2Hogq-3ViaaG43moo04CMNqY-6Ux7xjF0UjZie76n0B_q1NDAJn4n_u5VVPV7Wv/s1600-h/the_night_cafe.jpeg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5345054562162009938" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrSXZnfYXp1v75BtZHvc3nSFhg2zA9wb0vwtvfwCd3Hji13Ohnq78KunpBqHyaVGrhA_qkzf5VYOPgy2Hogq-3ViaaG43moo04CMNqY-6Ux7xjF0UjZie76n0B_q1NDAJn4n_u5VVPV7Wv/s320/the_night_cafe.jpeg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 313px; height: 254px;" /></a>Van Gogh's "The Night Cafe" </div> Now, if this were a one-off event, it would not be as illustrative of a systematic ethical decay that I fear exists in the hallowed Ivy halls. However, Yale has recently been fined $7.6 million after an investigation by NIH, NSF, DOD and others into misuse of research money by faculty. I wrote about that event at "<a href="http://hcrenewal.blogspot.com/2008/01/lux-et-veritas-or-trust-but-verify-yale.html">Lux et Veritas, or Trust But Verify? Yale discovers eDiscovery</a>", and the <a href="http://www.educause.edu/ir/library/powerpoint/csd5020.pps">powerpoint</a> from within Yale outlining the issues was eye-opening. Here is a synopsis of the outcome: <blockquote><a href="http://orda.siuc.edu/rm/36-02.pdf">Yale University Pays $7.6 Million to Resolve False Claims Act Allegations</a> (PDF) —excerpted from U.S. Dept. of Justice press release, Dec. 23, 2008 Yale University has entered into a civil settlement agreement with the federal government in which it will pay $7.6 million to resolve allegations that it violated the False Claims Act and the common law in the management of federally-funded research grants awarded to the university between January 2000 and December 2006. The grant awards were made by approximately 30 federal agencies and entities, including NIH, NSF, DOE, DOD, and NASA. The investigation focused on allegations involving two types of mischarges to federal grants. Both types of mischarges arose as violations of the basic principle that recipients of federal grants are allowed to charge to each grant account only “allocable” costs, which are costs that relate to the specific objectives of that grant project. The first allegation involved cost transfers and the requirement that costs transferred to a federal grant account must be allocable to that particular grant account. The settlement resolves allegations that some Yale researchers at times improperly transferred charges to a federal grant account to which those charges were not allocable. Researchers allegedly were motivated to carry out these wrongful transfers when the federal grant was near its expiration date and they needed to spend down the remaining grant funds. Federal regulations require that unspent grant funds be returned to the government. The second allegation involved salary charges and the requirement that charges to federal grant accounts for researcher time and effort must reflect actual time and effort spent on a particular grant. It was alleged that some Yale researchers submitted time and effort reports, for summer salary paid from federal grants, that wrongfully charged 100 percent of their summer effort to federal grants when, in fact, the researchers expended significant effort on unrelated work. Researchers allegedly were motivated to carry out these wrongful salary charges by the fact that they are not paid their academic-year salary by Yale during the summer. The only salary received by these researchers during the summer was the result of the effort they charged to federal grants. Absent the alleged grant mischarges, the researchers would not have been paid. The $7.6 million payment comprises two components: $3.8 million in actual damages for the false claims, and $3.8 million assessed as penalties for the false claims. </blockquote> Taxpayer money was used as they pleased until caught. What's mine is mine, and what's yours is mine.<div> </div><div>Yale's clinical operations have seen federal investigation once before which I wrote about at "<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Insufficient%20IT%20management">Insufficient IT Management Depth Results in Justice Dept. Investigation, Millions of Dollars in Fines</a>." That story was more about IT incompetence rather than malfeasance, however. I've had my own personal experiences with these "what's mine is mine, and what's yours is mine" property-rights attitudes at Yale. Perry Miller, Director of Informatics, Kenneth Kidd, Professor of Genetics, and Carolyn Slayman, Deputy Dean for Academic and Scientific Affairs, waged a rather one-sided and extortionary battle to misappropriate my intellectual property, a computer program I'd authored as faculty, assisted by a lawyer in Yale's Office of General Counsel -- who for good measure was in fact unauthorized to practice law in Connecticut at that time. Ex-colleague faculty Richard Shiffman "purged" me, Stalin style, by telling recruiters who called that I didn't exist - one of those recruiters, unfortunately for him, happened to be a <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/informaticsmd/protocol.jpg">detective I retained</a>. I wrote up the story in detail <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=%5Eyaleinf">at this site</a>. Dr. Kidd in particular was a principal in the now-defunct <a href="http://en.wikipedia.org/wiki/Human_Genome_Diversity_Project">Human Diversity Genome Project</a> in which he and others promised indigenous tribes their genetic materials would not be misappropriated for others' gain and profit. (I found that position risible considering my circumstances. Kidd's research raised further issues as I wrote at "<a href="http://hcrenewal.blogspot.com/2007/07/informed-consent-and-developing-snp.html">Informed consent, exploitation and developing a SNP panel for forensic identification of individuals</a>.") University officials right up to President Richard Levin (in the WSJ recently <a href="http://online.wsj.com/article/SB124425383780391015.html">lamenting the decrease in the value of Yale's endowment</a> from $24 billion to $17 billion), said they could do nothing to help me, even though I was being badgered for my software and actually blackmailed (through denial of confirmation of my training and faculty time at Yale to potential employers).<div> You would think a university with an endowment in the billions of dollars could have protected its own junior faculty from senior faculty predators, and you'd also think it could return a Van Gogh to the heir of a man who had it stolen by thugs who later murdered tens of millions of their own citizens.<div> </div><div>Ironically, when I was Yale School of Medicine junior faculty in Yale Center for Medical Informatics, I was charged with teaching postdoctoral fellows about NIH ethics guidelines. The tenured senior faculty I was working for just didn't have the time.</div><div> </div><div>Now, I may simply be a "disgruntled former Yale faculty member" after nearly having my career destroyed by these people in what was the most disappointing experience in my life, bar none, but the pattern of "what's mine is mine, and what's yours is mine" seems to be all too commonplace in Yale's case. From Bloomberg's coverage of the same Van Gogh story:<div><div><div> <div style="margin-left: 40px;"> <a href="http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aqq9FKuy9sk8">Yale Sued Over Van Gogh Work By Man Claiming to be Russian Heir</a> </div> <div style="margin-left: 40px;">June 4, 2009 By Cary O’Reilly </div> <div style="margin-left: 40px;"> </div> <div style="margin-left: 40px;">... Konowaloff’s claim is the latest litigation accusing Yale of improperly possessing artwork or historic artifacts. The Republic of Peru sued Yale in December seeking a collection of artifacts excavated from Machu Picchu and other sites by university scientists and researchers. </div> <div style="margin-left: 40px;"> </div> I'd written about Machu Picchu <a href="http://hcrenewal.blogspot.com/2007/07/informed-consent-and-developing-snp.html">here</a>: <blockquote>... Peripherally related in the scientific sense but perhaps closely related in the ethical and ideological sense, I've just discovered via a recent newspaper that Yale has some additional problems of late regarding property: "<a href="http://www.miamiherald.com/579/story/180105.html">Peru demands return of Machu Picchu treasures by Yale</a>", Miami Herald, July 25, 2007, by Tyler Bridges (now a Peruvian resident). Yale apparently went so far as to interpret the laws of a foreign nation, which is, of course, Yale's right as a sovereign entity, the People's Republic of Yale, it would seem: <blockquote style="font-family: arial;">Key documents include a 1912 Peruvian decree stating that Peru reserved the right to request the objects' return, and a 1916 letter that [Yale professor/explorer Bingham] wrote to the National Geographic Society about the artifacts from the 1914-15 expedition. ''Now they do not belong to us, but to the Peruvian government, who allowed us to take them out of the country on condition that they be returned in 18 months,'' Bingham wrote. Yale officials have said that Peruvian law in force in 1912 does not require the university to return objects from Bingham's expedition that year.</blockquote></blockquote> Perhaps less credible is this additional allegation from Bloomberg: <blockquote>... Yale and a secretive student society known as the Order of Skull & Bones were sued in February by the descendants of the 19th century Apache Indian warrior Geronimo. The family claims a group of Yale students may have stolen some of Geronimo’s remains in 1918 and taken them to Yale’s campus. The university denies the allegation and says it has no connection to Skull & Bones.</blockquote> Then there's Yale's <a href="http://www.opinionjournal.com/diary/?id=110008051">Taliban Man</a> incident per John Fund at the WSJ. The former deputy foreign secretary of the Taliban was taken as a student at Yale in 2006 while at the same time the school blocked ROTC training from its campus and argued for the right of its law school to exclude military recruiters. I fear other Ivy universities also lack a sense of basic ethics, both at the individual faculty level and collectively, i.e., including the leadership. I'd written about the ghastly events regarding the Duke lacrosse team affair at "<a href="http://hcrenewal.blogspot.com/2008/01/truly-disturbing-lawsuit-against-duke.html">A Truly Appalling Lawsuit Against Duke University</a>." Harvard Medical Schools's own ombud had written an article in JAMA in the late 1990's entitled "<a href="http://jama.ama-assn.org/cgi/content/full/280/3/216">Authorship: the coin of the realm, the source of complaints</a>", outlining the commonality of fights over IP between faculty and students, and admitted in a response to my <a href="http://jama.ama-assn.org/cgi/content/extract/281/2/135-a">Letter to the Editor</a> that this could not be prevented by administration (which in my view translates to, "the administration's worse than the faculty in this regard.") Others at Healthcare Renewal and related blogs have written about ethical lapses at other major universities as well. In summary, if both the majority of the faculty as well as the administration of our major universities never learned as children about respecting others' property, and pass these attitudes along to future academics and future captains of industry, the bloggers will be unable to teach them very much. We will continue on a course of periodic academic and industry healthcare (and other) scandals of increasing scale, along with the wasted talent, resources and opportunity these scandals represent. -- SS</div><div> </div><div>Addendum: after such a grim report, I thought I'd throw in something pleasant. Here is a friend I feed at the nearby park, one of six, in fact, Mute Swan cygnets (babies). The parents like me so much, they've offered me food in return - lovely clumps of fresh tender grass, which to them is a delicacy:</div><div> </div><div> </div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih9VEKA4EPHbKAP_rYRLgo_L3UTXzuHBzr2iDzO9N_HJLh-TQ7IF5FgD6DDLUM2QUGPyW5OHmEHCSb21648a7m34yveSXK34niMUVNwKJAgh1VoJuVGmIT4h5KkCFPbYkpwwiQNX2hRse6/s1600-h/IMG_0482.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5345126862280228034" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih9VEKA4EPHbKAP_rYRLgo_L3UTXzuHBzr2iDzO9N_HJLh-TQ7IF5FgD6DDLUM2QUGPyW5OHmEHCSb21648a7m34yveSXK34niMUVNwKJAgh1VoJuVGmIT4h5KkCFPbYkpwwiQNX2hRse6/s320/IMG_0482.JPG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 340px; height: 255px;" /></a></div><div style="text-align: center;">Cygnus olor - click to greatly enlarge these adorable fuzzballs <div style="text-align: left;">It's a great picture, but it's not a Van Gogh. Since I once worked at Yale, however, let's hope they don't claim the photo is theirs. -- SS 6/10/09 Addendum: Remarkably, there is apparently someone in the health IT community who was offended by the posting of the photo of the cygnet I feed (done, of course, as "comic relief"), as I have been informed. One can only wonder if violations of intellectual property and civil rights by universities, or patent safety concerns by faulty EHR's cause equal offense. </div></div></div></div></div></div></div>

Yale, Van Gogh's "The Night Cafe" and Personal Property: What's Mine is Mine, and What's Yours is Mine

At Healthcare Renewal and at numerous other healthcare blogs, we write about academic and industry conflicts of interest, malfeasance, and o...

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Design It Shelter Competition: Unleash your inner architect

Today, <a href="http://en.wikipedia.org/wiki/Frank_Lloyd_Wright">Frank Lloyd Wright</a>'s 142nd birthday, we're excited to announce the <a href="http://www.guggenheim.org/shelter">Design It: Shelter Competition</a>. Held by the <a href="http://www.guggenheim.org/">Guggenheim Museum</a> and <a href="http://sketchup.google.com/">Google SketchUp</a>, the competition is inspired by Wright's assignment for his apprentices at <a href="http://www.taliesin.edu/">Taliesin</a>: If you wanted to study to be an architect with Wright, you had to design and build a shelter in the desert outside of Phoenix, Arizona. Then you had to live and study in it. Unlike the Taliesin assignment, the shelters in this competition are virtual. To enter, use <a href="http://sketchup.google.com/">Google SketchUp</a> to design a small structure where someone might sleep and work. Your shelter should be created for a specific site anywhere in the world and geo-located in <a href="http://earth.google.com/">Google Earth</a>. It also should conform to <a href="http://www.guggenheim.org/new-york/education/sackler-center/design-it-shelter/how-to-enter">size constraints</a> and must not include running water, gas or electricity. When you're done with your design, upload it to the <a href="http://sketchup.google.com/3dwarehouse">Google 3D Warehouse</a>, then fill out the <a href="http://www.guggenheim.org/new-york/education/sackler-center/design-it-shelter/designit-competition-entry-form">submission form</a> on the Guggenheim website. Check out the video below to learn more: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/KIfC5zEAs4k&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/KIfC5zEAs4k&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> The deadline for submissions is August 23rd. You can find more details, including information about judging and prizes, on the the <a href="http://sketchupdate.blogspot.com/2009/06/announcing-design-it-shelter.html">Google SketchUp Blog</a> or the <a href="http://www.guggenheim.org/shelter">competition website</a>. Good luck! Posted by Aidan Chopra, SketchUp Product Evangelist

Design It Shelter Competition: Unleash your inner architect

Today, Frank Lloyd Wright 's 142nd birthday, we're excited to announce the Design It: Shelter Competition . Held by the Guggenheim M...

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Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-"Certified" HIT

A remarkable Bill (ASSEMBLY, <a href="http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM">No. 3934</a>, STATE OF NEW JERSEY, 213th LEGISLATURE) has appeared in NJ that would prohibit the sale or use of healthcare IT not "certified" (i.e., feature-qualified) by the industry-founded and connected group "Certification Commission for Healthcare Information Technology" (CCHIT). The Bill calls for monetary <a href="http://en.wikipedia.org/wiki/Civil_penalty">civil penalties</a> for such sale or use: <blockquote>A civil penalty or civil fine is a term used to describe when a state entity or a governmental agency seeks monetary relief against an individual as restitution for wrongdoing by the individual. </blockquote> I previously wrote about CCHIT in a series of linked posts that start here: <a href="http://hcrenewal.blogspot.com/2009/02/very-troubling-post-about-cchit.html">A very troubling post about the CCHIT (Certification Commission for Healthcare Information Technology)</a>. I have now written the following open letter to Mark Leavitt, MD, PhD, Chairman, Certification Commission for Healthcare Information Technology. <blockquote>To: <a class="Addr" href="javascript:noop()" onclick="BuK('%22Mark%20Leavitt%22%20%3Cmleavitt%40cchit.org%3E')" title="Create new mail memo with this address">"Mark Leavitt"</a> <script> if (window.s_IsEditPrint && window.s_IsEditPrint == "1") wM(window.s_DocCreated);else wM(window.s_DisplayDate);</script>Date: Sunday, June 07, 2009 02:10PM<a class="Addr" href="javascript:noop()" onclick="BuK('%22Mark%20Leavitt%22%20%3Cmleavitt%40cchit.org%3E')" title="Create new mail memo with this address"><mleavitt@cchit.org></mleavitt@cchit.org></a> Cc: Robert O'Harrow, Jr., Washington Post, and various AMIA working group mailing lists (CIS - clinical info systems, POI - people & organizational issues, OS - Open Source, and ELSI - Ethics, Legal & Social Issues) June 7, 2009 Mark Leavitt, MD, PhD Chairman, Certification Commission for Healthcare Information Technology www.cchit.org [6/8/09 - contact info from www.markleavitt.com removed per critique in response below -ed.] <div style="margin-left: 40px;">Re: NJ HIT Bill at http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM by Assemblyman Harb Conaway, Jr., District 7, and Upendra Chivukula, District 17 </div> Dear Mark, The NJ Bill at <a href="http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM" target="blank">http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM </a> by Assemblyman Harb Conaway, Jr., District 7, and Upendra Chivukula, District 17, calls for making it a violation of law to sell HIT not "certified" by CCHIT . Penalties are called for. The bill states: <div style="margin-left: 40px;">... No person or entity, either directly or indirectly, shall sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by the Certification Commission for Healthcare Information Technology. </div> As used in this section, "health information technology product" means a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information. b. A person or entity that violates the provisions of subsection a. of this section shall be liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). I and others find this bill remarkable. It really calls into focus the HIT community's concerns about CCHIT and its political connections, especially pursuant to the article " <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid=topnews">The Machinery Behind Healthcare Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records </a>" of May 16, 2009 in the Washington Post by Robert O'Harrow Jr. I therefore seek answers to the following questions: 1. Do you approve of the proposals in the bill at http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM ? 2. Did you, or anyone in a governance or leadership position at CCHIT, play a role in sponsorhip of this bill, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT? 3. Did anyone with governance or leadership roles in CCHIT's founding or affiliated organizations (e.g,, HIMSS, CITL, and others) or business associates of such people, play a role in the bill's sponsorhip, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT? 4. Did anyone (person or company) in the HIT industry, broadly speaking, who could directly profit from such a bill becoming law play a role in sponsorhip of, or advocacy for this bill? I believe candid and transparent answers to these questions are important in giving the HIT community confidence that CCHIT primarily serves the public interest, not interests of an HIT lobby. </blockquote> -- SS 6/8/09 Dr. Leavitt has candidly responded. I take his word on these issues at face value, having done business with him a bit over a decade ago (supporting the purchase of his company's EHR, Logician, for Christiana Care over the opposition of the IT department which preferred another vendor): <blockquote> From: "Mark Leavitt" <mleavitt@cchit.org> Date: 06/08/2009 02:51AM cc: cis-wg@mailman.amia.org, poi-wg@mailman.amia.org, os-wg@mailman.amia.org, els-wg@mailman.amia.org, oharrowr@washpost.com,sreber@cchit.org<cis-wg@mailman.amia.org><poi-wg@mailman.amia.org><os-wg@mailman.amia.org><els-wg@mailman.amia.org><oharrowr@washpost.com><sreber@cchit.org> Subject: RE: Bill to make illegal the sale or use of non-CCHIT "certified" systems </sreber@cchit.org></oharrowr@washpost.com></els-wg@mailman.amia.org></os-wg@mailman.amia.org></poi-wg@mailman.amia.org></cis-wg@mailman.amia.org></mleavitt@cchit.org><div dir="ltr" align="left">Scot, </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">Here are the answers to your questions: </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">1. No, I do not approve of this legislation -- which I'm reading for the first time in your email. Our goal, stated in almost every presentation I've given, and to which I've adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. The bill does not fit that model at all, and it is a bad idea. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">2. Neither I personally, nor CCHIT as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">3. Trustees, Commissioners, and Work Group members serve in a volunteer capacity at CCHIT. We require disclosure of conflicts of interest, but we do not monitor all activities in their 'day jobs' or other volunteer roles. "HIMSS, CITL, etc" are not affiliated with CCHIT, and we don't know about all their advocacy activities. I'm not privy to the information you seek. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">4. This question presumes that I would know everything that "anyone in the HIT industry, broadly speaking" has done regarding the bill. Naturally I do not have that knowledge either. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">Now that I've responded, the AMIA listserve members can stop reading here, while I go on to chat with Scot. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">Scot, in 15 years of medical training and practice followed by 25 years of healthcare informatics, I've encountered very few people -- and certainly no university professors -- who acted so disrespectfully toward me. Being a veteran of health IT, it's easy to find people who have worked with me or know me well, and to ask them about my integrity. Or to talk to some of the other 50 or so Commissioners who've served or the hundreds of work group volunteers. Shouldn't an informatics scientist do a modicum of research before undertaking a potentially harmful procedure such as attacking a person's or organization's reputation? Reading a news article by Mr O'Harrow does not qualify as due diligence. Would you let your informatics students get away with that before recommending a major, potentially disruptive or destructive IT project? </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">From your own blogging I see that your "early medical mentor, cardiothoracic surgery pioneer Victor P Satinsky, MD, believed in public embarrassment as a tool to fight bureaucracy and discrimination ." Well, that helps me understand. And your blogging about your frustration when you sought employment with a commercial EHR vendor <a href="http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html">http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html </a> explains even more. Knowing that, I forgive you for your tone and for inappropriately disclosing my home address and cell phone to everyone on these lists. I would be pleased to engage in a civil, rational debate with you along the lines of "EHRs -- do the benefits outweigh the risks?" C'mon out to the farm here sometime -- you know the address, and the dog's friendly -- or we could do it on the web. </div> <div dir="ltr" align="left"> </div> <div dir="ltr" align="left">Finally, my apologies to everyone on the mailing lists that Dr. Silverstein chose to include in his investigative journalism broadcast. If you object to his use of AMIA mailing lists for this kind of activity, you could let him know. </div> <div> </div> <div>Mark Leavitt, MD, PhD Chairman, CCHIT </div></blockquote> My response was simple: <blockquote>To: "Mark Leavitt" <mleavitt@cchit.org> Date: 06/08/2009 05:24PM cc: <cis-wg@mailman.amia.org>cis-wg@mailman.amia.org, poi-wg@mailman.amia.org, os-wg@mailman.amia.org, els-wg@mailman.amia.org, oharrowr@washpost.com,sreber@cchit.org<poi-wg@mailman.amia.org><os-wg@mailman.amia.org><els-wg@mailman.amia.org><oharrowr@washpost.com><sreber@cchit.org> Subject: RE: Bill to make illegal the sale or use of non-CCHIT "certified" systems Mark, I thank you for the answers to my questions. > Knowing that, I forgive you for your tone and for inappropriately disclosing my home address and cell phone to everyone on these lists. Mark, that information came from your page at <a href="http://www.markleavitt.com/">http://www.markleavitt.com/</a> which I found on a google seach for "Mark Leavitt." Image attached. I believed that to be your professional contact info. As to the rest of your response, you appear to attempt to discredit my arguments through ad hominem. I refer you to this page: <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html" target="blank">http://www.nizkor.org/features/fallacies/ad-hominem.html </a> <div style="margin-left: 40px;">Translated from Latin to English , "Ad Hominem" means "against the man " or "against the person." An Ad Hominem is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting <input name="IL_MARKER" type="hidden">the claim or argument. Typically, this fallacy involves two steps. First, an attack against the character of person making <input name="IL_MARKER" type="hidden">the claim , her circumstances, or her actions is made (or the character, circumstances, or actions of the person reporting the claim ). Second, this attack is taken to be evidence against <input name="IL_MARKER" type="hidden">the claim or argument the person in question is making (or presenting). This type of "argument" has the following form: </div><ol style="margin-left: 40px;"><li>Person A makes claim X. </li><li>Person B makes an attack on person A. </li><li>Therefore A's claim is false. </li></ol> The reason why an Ad Hominem (of any kind) is a fallacy is that the character, circumstances, or actions of a person do not (in most cases) have a bearing on the truth or falsity of <input name="IL_MARKER" type="hidden">the claim being made (or the quality of the argument being made). Ad hominem, sadly, is not debate. Neither is <a href="http://www.nizkor.org/features/fallacies/appeal-to-authority.html" target="blank">appeal to authority </a>. Scot</sreber@cchit.org></oharrowr@washpost.com></els-wg@mailman.amia.org></os-wg@mailman.amia.org></poi-wg@mailman.amia.org></cis-wg@mailman.amia.org></mleavitt@cchit.org></blockquote> Truth be told, I actually offered no arguments in my email message. I was asking very probing questions with concern they would be ignored, or responded to with "spin" as <a href="http://www.hcrenewal.blogspot.com/2009/02/cchit-dissolved-involuntarily-in-april.html">here</a>, and their tone offended him. Fair enough. I was a bit disappointed, however, by the "<a href="http://www.quotationspage.com/quote/25317.html">The lady doth protest too much, methinks</a>" ad hominem embellishments to an otherwise candid and convincing response. Such are the risks of directness and <a href="http://hcrenewal.blogspot.com/2009/03/disruptive-innovators-at-healthcare.html">disruptive innovation</a>, however. -- SS 6/9 Addendum: Additional views on the NJ Bill are at ePatients.net at "<a href="http://e-patients.net/archives/2009/05/david-kibbe-mark-leavitt-openness-vs-opacity.html">David Kibbe & Mark Leavitt:Openness vs. Opacity</a>" and "<a href="http://e-patients.net/archives/2009/06/dossia-microsoft-healthvault-google-healthillegal-in-nj.html">Dossia, Microsoft HealthVault & Google Health: Illegal in NJ?</a>". There are some now-familiar themes regarding CCHIT civility in those posts. 6/10 Addendum: As a result of a link sent by a commenter, I am adding the post "<a href="http://www.hcplive.com/mdnglive/The_HIT_Realist/Kibbe_Leavitt">The Kibbe/Leavitt Rumble in the High Tech Jungle!</a>" to the list of interesting views in the 6/9 addendum above.

Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-"Certified" HIT

A remarkable Bill (ASSEMBLY, No. 3934 , STATE OF NEW JERSEY, 213th LEGISLATURE) has appeared in NJ that would prohibit the sale or use of h...

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Indiana Power Surge: The Hospital Computing Backwater And The Need to Reform IT Before IT Reforms Medicine

In the three part series "<a href="http://hcrenewal.blogspot.com/2009/02/hospital-it-backwater-20-billion-abyss.html">Healthcare IT Backwater: The $20 Billion Abyss?</a>" I lamented that hospitals are often an IT backwater, and the backwater mentality would severely hamper efforts to "reform healthcare" via IT: <blockquote><dl><dt class="hwrd"><a href="http://www.merriam-webster.com/dictionary/backwater">Merriam-Webster</a>:</dt><dt class="hwrd"> </dt><dt class="hwrd">Main Entry: back·wa·ter <a class="audio" href="http://www.merriam-webster.com/cgi-bin/audio.pl?backwa04.wav=backwater%27" onclick=" popWin('/cgi-bin/audio.pl?backwa04.wav=backwater'); return false; "><img alt=" Listen to the pronunciation of backwater" src="http://www.merriam-webster.com/images/audio.gif" title=" Listen to the pronunciation of backwater" /></a></dt><dt class="pron">Pronunciation: \-ˌwȯ-tər, -ˌwä-\</dt><dt class="pron">Function: noun</dt><dt class="func">Date: 1629</dt></dl>- an isolated or <a class="formulaic" href="http://www.merriam-webster.com/dictionary/backward">backward</a> place or condition</blockquote> Computing is not a hospitals' core competency, salaries for IT personnel are usually lower than in other industries, and talent mismanagement in hospitals is far worse than in other sectors where IT is critical (e.g., health IT recruiters retained by hospitals have traditionally been generalists, or worse, recruiters with attitudes <a href="http://hcrenewal.blogspot.com/2008/09/correcting-historical-misinformation.html">such as this</a>): <blockquote>I don't think a degree gets you anything," says healthcare recruiter Lion Goodman, president of the Goodman Group in <st1:place st="on"><st1:city st="on">San Rafael</st1:city>, <st1:state st="on">California</st1:state></st1:place> about CIO's and other healthcare MIS staffers. Healthcare MIS recruiter Betsy Hersher of Hersher Associates, <st1:place st="on"><st1:city st="on">Northbrook</st1:city>, <st1:state st="on">Illinois</st1:state></st1:place>, agreed, stating "There's nothing like the school of hard knocks." In seeking out CIO talent, recruiter Lion Goodman "doesn't think clinical experience yields [hospital] IT people who have broad enough perspective. Physicians in particular make poor choices for CIOs. They don't think of the business issues at hand because they're consumed with patient care issues," according to Goodman.</blockquote><o:p></o:p> <o:p> </o:p> The end result of the hospital IT backwater mentality is stories such as this: <blockquote>Indystar.com <a href="http://www.indystar.com/apps/pbcs.dll/article?AID=/20090603/LOCAL18/906030346">Hospital is forced to turn away patients</a> Methodist Hospital went "on diversion" early Tuesday for the first time in its 100-plus years, sending ambulances that came to its doors to other hospitals.The diversion lasted until about 3 a.m., Wide said. A power surge knocked out Clarian Health's computer system Monday afternoon, derailing the hospitals' ability to access electronic health records for patients, said Clarian spokesman James Wide. Staff members at Methodist and Indiana University Hospital had to enter patients' records by hand. By about 1 a.m. Tuesday, a backlog of paperwork led Methodist and IU hospitals to stop accepting patients who arrived by ambulance. Walk-in patients were still accepted. The diversion lasted until about 3 a.m., Wide said.</blockquote> This raises a number of questions: <ul><li>Which power system "surged?" Shouldn't hospitals be protected from such "surges?" </li><li>Was any other equipment "knocked out?" CCU/ICU monitors? Ventilators? Heart-lung machines? If so, why were they not protected? If they were not knocked out but the EHR was, why? </li><li>What computers, exactly, were knocked out? Does not sound like the workstations, which would be rebooted quickly. Therefore must have been data center servers...and if so... </li><li>Why were the EHR servers vulnerable to "power surges"? </li><li>Or was this EHR a remote hosted ASP arrangement and did the surge occur at the service provider...in which case, the above question also applies? </li><li>Where were the backup systems? Were there backup systems? </li><li>Who performed the "backlog of paperwork?" Was it clinicians backloading the paper data into the system? -- in which case a power surge would have turned doctors into the world's most highly trained data entry clerks? </li></ul><div> </div>Of course, there was the usual refrain by non-clinical management, as I wrote at "<a href="http://hcrenewal.blogspot.com/2009/05/health-it-failure-never-puts-patients.html">Health IT Failure Never Puts Patients at Risk</a>", that such outages are just minor blips on the radar. In another account of this story: <blockquote>WTHR.com Eyewitness News <a href="http://www.wthr.com/Global/story.asp?S=10461766&nav=menu188_2">Power surge forces hospitals to divert new patients</a> Updated: June 2, 2009 07:57 AM Indianapolis - Methodist and Indiana University Hospitals are back open and accepting new patients. Monday around 3:45pm a massive power surge hit the hospitals crashing their computer system. IPL responded quickly to assist with bringing the system back online. In the meantime, the hospitals began doing things on paper, like patient charting, that had been done by computer. There was no disruption in patient care, however, around 1am Tuesday both hospitals decided to stop taking new patients [that's not a "disruption in patient care?" - ed.] As of 3:15am most of the primary care system was back up and running and Methodist starting taking some new patients. I.U. Hospital continued to divert patients for some time. As of 7:00am all patient primary care systems were up and running and both hospitals were completely open to new patients. Officials say there will be no impact on elective surgery Tuesday.</blockquote> Here is the candid translation of the statement that "There was no disruption in patient care" by a total EHR crash, making records and probably CPOE unavailable and forcing clinicians and administrative assistants back to paper and pencil (fortunately, paper charts and pencils require at most only a flashlight and hand-cranked sharpener for read and write access): <blockquote>"By the grace of God, no patients were harmed (that we know about in the confusion right now, or will admit to even if we did know) among our own patients or those diverted, in the chaos that ensued after the HIT systems went down from a power surge that we should not have been susceptible to in the first place."</blockquote> As I wrote in Part 2 of the aforementioned series, I reiterate that HIT should be treated as experimental, not as a drop-in panacea for healthcare's ills. In its present state is is perhaps as likely to exacerbate those ills. This is probably not technology that should be deployed en masse at present. We cannot afford as a society to learn how to do this by trial and error. -- SS

Indiana Power Surge: The Hospital Computing Backwater And The Need to Reform IT Before IT Reforms Medicine

In the three part series " Healthcare IT Backwater: The $20 Billion Abyss? " I lamented that hospitals are often an IT backwater, ...

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Was a Private Equity Takeover of Bausch and Lomb Meant to Conceal Its Legal Settlements of Cases of Eye Infections?

This week, the Associated Press <a href="http://www.google.com/hostednews/ap/article/ALeqM5jz3TMuH6bomvVkjjZcYoABBjQYGgD98HAO4G1">reported</a> on yet another way health care corporations may keep information that reflects poorly on their products out of public view. The story involved fungal eye infections that particularly afflicted users of a specific contact lens cleaning solution: <blockquote> More than 700 lens wearers in the United States and Asia say they were exposed to a potentially blinding infection known as Fusarium keratitis while using ReNu with MoistureLoc, a new-formula multipurpose solution for cleaning, storing and moistening soft contact lenses. Sometimes, the damage was irreparable. Seven people in Florida, Maryland, New York, Oregon, Tennessee and West Virginia had to have an eye removed. At least 60 more Americans needed vision-saving corneal transplants. The U.S. Centers for Disease Control and Prevention confirmed 180 cases in 35 states from June 2005 through September 2006, when the agency's dedicated surveillance stopped, according to Dr. Benjamin Park, a CDC epidemiologist. CDC continued to hear of sporadic, unconfirmed cases in the months after MoistureLoc was withdrawn, Park said. 'Surveillance usually captures the tip of the iceberg and sometimes it captures a larger tip than other times,' Park said in an interview. Among out-of-court settlements reached in May was a potential bellwether case brought by Andrea Martin, a Broadway actress and comedienne whose eye was scarred. In Colorado, a corneal transplant ended a race-car driver's career. In Baltimore, a chimney-sweep business owner who lost an eye got hooked on painkillers. Leading eye doctors and government scientists concluded that MoistureLoc, launched in 2004 with novel disinfectant and moisturizing ingredients, was the only lens solution that contributed to the outbreak. Yet the mechanics of how it caused the problem are still not fully clear. </blockquote> AP alleged that Bausch and Lomb kept the cases out of public view by using a previously unknown (at least to me) strategy: <blockquote> Contact lens maker Bausch & Lomb Inc. had an overriding reason for going private in 2007: It wanted to handle a devastating recall of its flagship lens cleaner, its chief executive said, 'without a lot of outside distraction.' Over the past year, away from the glare of public scrutiny, the optical products company has quietly settled nearly 600 fungal-infection lawsuits — with dozens more individual claims yet to be resolved. The cost so far: Upward of $250 million. With some fungal lawsuits still unresolved, the prospect of Bausch & Lomb's health care nightmare being aired in court has not entirely faded — which heartens some lawyers and doctors. 'The truth has been very carefully buried, and it appears to have been buried going back to the beginnings of the outbreak,' said Dr. Arthur Epstein, who was chairman of the American Optometric Association's contact lens and cornea section during the highly publicized crisis. 'All settlements were predicated on silence about the clinical findings and blame and so forth. My hope was that what actually happened would become part of public record in a courtroom. That way, we'd be able to learn from it and move on and make sure it never happened again.' When Bausch & Lomb was acquired by private equity firm Warburg Pincus for $3.67 billion in October 2007, Chief Executive Ronald Zarrella said the deal would allow the company 'to pursue the growth path we were on ... without a lot of outside distraction.'Zarrella retired last year. 'hey can do all this out of the public eye — guys like me aren't sitting there scrutinizing the financial impact of every single settlement,'said analyst Jeff Johnson of Robert W. Baird & Co. in Milwaukee. 'you can completely focus on your brand and on doing what's right by the patient.'</blockquote> So, if I understand this correctly, after Warburg Pincus took the company private, it was no longer required to file certain reports with the US Securities and Exchange Commission (SEC), including reports that would have had to acknowledge the multiple settlements the company made of cases alleging adverse effects of its contact lens solution. What is striking is the allegation by the AP that "taking the company" private was a strategy meant to conceal the settlements of these cases, (rather than a strategy implemented to fulfill other aims, which had the side effect of diminishing reporting of these cases' results.) Again, I am hardly an expert, but relatively opaque private equity firms like Warburg Pincus seem to have become increasingly influential in the US economy, and to have an increasing role in health care. In 2007, we had <a href="http://hcrenewal.blogspot.com/2007/09/web-of-deception-ensnares-us-nursing.html">posted</a> how private equity firms running nursing homes, including Warburg Pincus, seemed to contribute to the opacity of their operations. More recently, we <a href="http://hcrenewal.blogspot.com/2009/04/hedge-fund-u.html">posted</a> about how leaders of private equity, and of other kinds of firms in the finance arena, seem to also increasingly be leaders to which medical schools report. One final note... A quick tour through the Warburg Pincus website reveals how involved the firm is in health care. The firm <a href="http://www.warburgpincus.com/industries/healthcare/Default.aspx">claimed</a> that as a "direct equity investor in healthcare for more than 30 years, Warburg Pincus has invested more than $4 billion in approximately 120 healthcare companies." Furthermore, the firm seems quite intertwined with the leadership of academic medicine. It has a Life Sciences Advisory Board, of which three of four members are current leaders in academic medicine. The most prominent, Dr Michael Rosenblatt, Dean of the Tufts University School of Medicine, did not disclose this relationship in several versions of his biography published on the university web-site. (See the Tufts administration version <a href="http://provost.tufts.edu/1174149600661/Provost-Page-prov2w_1174149601058.html">here</a>, and the Tufts Medical Center version <a href="http://www.tuftsmedicalcenter.org/OurServices/EndocrinologyandDiabetes/MichaelRosenblattMD">here</a>.) Oh, what a tangled web we have weaved in health care, a web that continually frustrates transparency and makes it hard to figure out who was responsible for what when things go wrong.

Was a Private Equity Takeover of Bausch and Lomb Meant to Conceal Its Legal Settlements of Cases of Eye Infections?

This week, the Associated Press reported on yet another way health care corporations may keep information that reflects poorly on their pro...

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