healthy4u

Mr. HISTalk has a pair

I've been somewhat concerned about the <a href="http://histalk2.com/">HISTalk</a> blog site becoming HIT ad revenue-beholden in recent years, perhaps diluting its critique of HIT industry dysfunction. However, after seeing <a href="http://histalk2.com/2009/06/09/news-061009/">these posts</a> today, I am reconsidering that impression (comments in red are mine). On why physicians are ignored in HIT decisions: <blockquote>... Because that’s what IT executives do (no offense to those CIOs who really do give physicians a strong voice in decision-making). I’ve been on that IT side and the working assumptions where I’ve been were that doctors and nurses (a) don’t understand organizational strategy; (b) are too easily swayed by demo eye candy and insincere vendor promises; (c) understand only products themselves and not the big picture IT world of vendor stability, product positioning, and integration; and (d) don’t appreciate IT’s technology, support, and organizational challenges. [In other words, are basically stupid; see my 1999-ish piece on doctor stereotypes <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/informaticsmd/tactics.htm" style="font-style: italic; font-weight: bold;">here</a> - ed.] I’ve worked in three places where users were invited to review and recommend clinical systems. In every one, the first choice of doctors and nurses wasn’t the one that was purchased because we IT folks (some of whom were held in very high regard, mostly by themselves and their easily influenced peers) were so much more knowledgeable that we had the right … no, the obligation … to override them to buy what we thought was the best system. Their resulting adoption was about what you would expect. CIOs are often fixated on buying whatever will cause them the fewest headaches or that carries the lowest organization risk. [I would not dismiss the potential influence of conflict of interest as well - ed.] </blockquote>on CCHIT: <blockquote>Some anonymous blog commenters (not here) are demanding that Mark Leavitt step down from his role as CCHIT chairman, claiming his history with HIMSS will always taint CCHIT. My thoughts: I agree. HIMSS wisely used its clout to create CCHIT in its image and nurture it through general acceptance to advance its own agenda, but the strings need to be cut now (including replacing Steve Lieber as CCHIT board chair). I predicted when CCHIT was created that it wouldn’t really change the industry because the interoperability changes CCHIT was supposed to certify (and nothing more) weren’t capabilities customers cared about anyway. That’s what has happened, at least from my cheap seat. Now that CCHIT indirectly affects billions in stimulus dollars, I’d rather see it run by people with no trade group or vendor connections. If it isn’t willing to do that, I’d say choose or form another group to run the certification program. Some of what CCHIT wants to measure, report, or certify (functionality, security, specialty capabilities) is going way beyond what the government should be mandating anyway, although this particular government seems to enjoy telling carmakers and banks how to run their affairs (kind of like letting the Mafia buy into your business). It’s funny that the industry has fought tooth and nail to avoid FDA oversight that it couldn’t control, but seems to like CCHIT because it removes some competitors and sends innovation to the back of the line. [I largely agree with the caveat that the #1 issue for me is clinical IT safety -- primum non nocerum -- and also recently found part of CCHIT leader Mark Leavitt's <a href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html" style="font-style: italic; font-weight: bold;">response to my pointed questions</a> patronizing and a bit hysterical. Sign of a leader who can't handle the pressure of public scrutiny and controversy without blowing up? My early mentor, cardiovascular surgeon Dr. Victor P. Satinsky, had a rule in medicine - "If you don't like it, don't come" - i.e., if you can't take the heat, get out of the kitchen - ed.] </blockquote> Regarding Mr. HisTalk's comments: wow. -- SS

Mr. HISTalk has a pair

I've been somewhat concerned about the HISTalk blog site becoming HIT ad revenue-beholden in recent years, perhaps diluting its critiqu...

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Wind Cripples Hospital's EHR Systems - But These Things "Just Happen"

I would like to pretend these incidents don't occur, but alas, they do. Of course, we only know about the ones that are reported. 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. At "<a href="http://hcrenewal.blogspot.com/2009/06/another-episode-in-series-hit-failure.html">Another Episode in the Series: HIT Failure</a>" I wrote about yet another hospital whose clinical IT suffered a "glitch" that caused the hospital to struggle for a week with computer failures. Here we go again, this seems almost daily now. Wait until hospitals and offices really try to push the envelope to get onboard the ARRA EHR gravy train by 2014: <blockquote><a href="http://www.kswo.com/Global/story.asp?S=10498210">Strong winds damage Indian Hospital systems</a> Posted: June 8, 2009 05:48 PM LAWTON Okla. - The Lawton Indian Hospital is trying to recover from damaging winds that came with a severe storm Sunday night, leaving the hospital without air-conditioning and severely crippled in their computer systems. The storm damaged a coil to a $200,000 cooler that provides air conditioning for the hospital. The power went off for a short time around 8:30. The power outage affected all their medical records, charts, everything that held patients' information. The only way to overcome the glitch was to resort to an old filing system. A system that used colors to match up what kind of care a patient needed. And with 55,000 files to pour through, the hospital has severely slowed down. Rows and rows of thousands of files. Each one containing a patient's history. </blockquote>Of course, there is the traditional disclaimer about how such outages NEVER, EVER jeopardize patient safety (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>"): <blockquote>Despite this setback hospital officials remain optimistic. "The staff knows a lot of the folks, they know what's going on with them," said hospital Chief Executive Officer Hickory Starr.</blockquote> I can attest to memory not being an optimal way to practice medicine ... The outage has repercussions beyond inpatients: <blockquote>Even if the hospital could call all of the existing patients to let them know the hospital's system is down, he says that would not solve everything. "We have a lot of folks that show up here. Some that have appointments and a lot that do not." Then there are those who need refills on their prescriptions. "And we can not do refills because we can not pull up that electronic chart."</blockquote> Finally, the prevailing attitude that safety is an Act of Providence (in reality, safety is not an accident): <blockquote>Despite it all, most people remain pretty cheery. "Generally they are. There is always some frustration but this is one of those situations that just happens."</blockquote> One of those situations that "just happens" is days of EHR failure due to a power outage? It'll all be fixed soon: <blockquote>Hospital officials expect the computer systems back online late Monday or early Tuesday morning.</blockquote> Real soon. I repeat my oft-stated observation that IT culture will need to be reformed before IT will be able to "reform medicine." -- SS

Wind Cripples Hospital's EHR Systems - But These Things "Just Happen"

I would like to pretend these incidents don't occur, but alas, they do. Of course, we only know about the ones that are reported. At ...

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The state of cloud computing

Earlier today at the Clift Hotel in San Francisco, we convened a group of journalists, partners and customers for a discussion on <a href="http://www.google.com/apps/intl/en/business/index.html#utm_medium=et&utm_source=us-en-ogb&utm_campaign=en">Google Apps</a> in the enterprise. We're pleased to report that the "state of <a href="http://googleenterprise.blogspot.com/2009/04/what-we-talk-about-when-we-talk-about.html">the cloud</a>" is strong, and we've taken a number of steps to make it stronger. At the event we discussed the growth of our business, introduced some new customers, and announced a feature that makes switching to Apps even easier. The Clift was a particularly appropriate venue because it's a member of the <a href="http://www.morganshotelgroup.com/">Morgans Hotel Group</a>, which is deploying Google Apps to its 1,750 employees. <a href="http://www.johnsondiversey.com/cultures/en/default.htm">JohnsonDiversey</a>, a global provider of commercial cleaning and hygiene products and solutions, has also gone Google. Choosing Apps helped JohnsonDiversey migrate its 12,000 employees to one communications platform while lowering its IT costs and furthering its commitment to sustainability through the elimination of a number of energy-intensive email servers. Of course, when big companies like Morgans move all their employees from Microsoft Exchange to Google Apps, there are often a few folks who aren't ready to give up Microsoft Outlook right away. To help them make the transition, today we also introduced <a href="http://www.google.com/apps/intl/en/business/outlook_sync.html#utm_medium=et&utm_source=us-en-ogb&utm_campaign=en">Google Apps Sync for Microsoft Outlook</a> to our Premier and Education edition customers. It lets Outlook work easily with Apps and — like <a href="http://googleenterprise.blogspot.com/2009/01/announcing-offline-access-in-gmail-labs.html">offline Gmail</a> and the <a href="http://www.google.com/apps/intl/en/business/mobile.html#utm_source=en_US-blog-gbes&utm_medium=blog&utm_campaign=gbes">Google Apps Connector for BlackBerry® Enterprise Server</a> — is another example of how we're making it dead simple to switch to Google Apps. To read more about Google Apps Sync for Microsoft Outlook and hear why 1.75 million companies are now running their business on Google Apps, check out the <a href="http://googleenterprise.blogspot.com/2009/06/use-microsoft-outlook-with-google-apps.html">Google Enterprise Blog</a>. Posted by Matthew Glotzbach, Product Management Director, Enterprise team

The state of cloud computing

Earlier today at the Clift Hotel in San Francisco, we convened a group of journalists, partners and customers for a discussion on Google App...

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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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