healthy4u

Google Latitude on your iPhone

Earlier this year we <a href="http://googleblog.blogspot.com/2009/02/see-where-your-friends-are-with-google.html">announced</a> <a href="http://www.google.com/latitude/intro.html">Google Latitude</a>, a service that lets you and your friends share your locations with each other. You control who gets to see your location and where on the map you appear to others. Today, we're releasing Google Latitude for iPhone and iPod touch, available in the Safari browser.<br /><br />Visit <span style="font-weight: bold;">google.com/latitude</span> from your device to start using Latitude. Add a bookmark to your home screen to quickly launch Latitude. Just open Latitude in Safari and tap the <span style="font-weight: bold;">+ icon > Add to Home Screen > Add</span>.  For more details, check out the <a href="http://googlemobile.blogspot.com/2009/07/google-latitude-now-for-iphone.html">Google Mobile Blog</a>.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhociaygOlsf0nkKy-dIv9FRN-8vsn-si6yCbbqZUw-lBd4BKnfcrcClSFyxssJ-3CBQeBppcTBQ1571lMCZlB_slAJGCJVPBColar0SpItrsohjjywXTUQS47yT1gwQRHfkpvpeA96MK0e/s1600-h/IMG_0076.PNG"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5361745202591056882" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhociaygOlsf0nkKy-dIv9FRN-8vsn-si6yCbbqZUw-lBd4BKnfcrcClSFyxssJ-3CBQeBppcTBQ1571lMCZlB_slAJGCJVPBColar0SpItrsohjjywXTUQS47yT1gwQRHfkpvpeA96MK0e/s400/IMG_0076.PNG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 267px; height: 400px;" /></a><br /><span class="byline-author">Posted by Marc Wilson, Software Engineer</span>

Google Latitude on your iPhone

Earlier this year we announced Google Latitude , a service that lets you and your friends share your locations with each other. You control...

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It's a bird...it's a plane...it's iGoogle comics themes!

We have always been excited to introduce design flair and whimsy to our user experience, especially on our homepage. Be it through our special <a href="http://www.google.com/logos">holiday logos</a> or special themes for our iGoogle users, we like to open up our homepage as a canvas for artists to express themselves and reach their fans and Google users around the world. Today, I'm particularly excited to announce the new comics themes for iGoogle, just in time for <a href="http://www.comic-con.org/">Comic-Con's 40th anniversary</a>.<br /><br />The themes showcase the amazingly diverse world of comics. Browse our gallery (<a href="http://www.google.com/comicsthemes">www.google.com/comicsthemes</a>) to choose from nostalgic comic strips like <a href="http://www.google.com/help/ig/comicsthemes/#peanuts">Peanuts</a>, iconic heroes like <a href="http://www.google.com/help/ig/comicsthemes/#batmanreborn">Batman</a> and <a href="http://www.google.com/help/ig/comicsthemes/#ironman">Iron Man</a>, or alternative comics greats like <a href="http://www.google.com/help/ig/comicsthemes/#clowes">Dan Clowes</a>, author of the graphic novel, "Ghost World."   The dozens of themes represent talented artists from around the world including <a href="http://www.google.com/help/ig/comicsthemes/#rinne">Rumiko Takahashi</a> from Japan and <a href="http://www.google.com/help/ig/comicsthemes/#trondheim">Lewis Trondheim</a> of France.<br /><br />To offer his unique perspective as one of the world's most accomplished comics artists, I'm pleased to introduce guest author Jim Lee. In addition to being a recognized industry veteran, he also drew today's beautiful <a href="http://www.google.com/">homepage logo</a> incorporating some of <a href="http://www.dccomics.com/">DC Comics</a>' most famous characters.<br /><br />During his 20 year career, Jim has worked with DC and <a href="http://marvel.com/">Marvel Comics</a>, co-founded <a href="http://www.imagecomics.com/">Image Comics</a> and also <a href="http://www.dccomics.com/wildstorm/">WildStorm Comics</a> – one of our iGoogle themes. His Batman, Superman, X-Men, Iron Man, Fantastic Four and WildC.A.T.s issues have sold millions of copies. Jim is a recipient of the <a href="http://www.harveyawards.org/">Harvey Award</a>, Golden Panel Award and is widely respected for his contributions as an artist, a creator and a publisher of comics.     <br /><br /><span style="font-weight: bold;">An artist's POV by <a href="http://en.wikipedia.org/wiki/Jim_Lee">Jim Lee</a></span><br /><br />Even as the world of comics evolves and embraces a new digital era, it doesn't change the universal,  international appeal of the unique art form that is created through the simple marriage of word and picture.  I'm excited to have been chosen to help launch this wonderful project. But I'm more elated, both as a professional and as a fan, that so many <span style="font-style: italic;">different</span> types of comics have been chosen to be part of the iGoogle comics themes launch. From the mainstream superhero world of DC that I work in to the mainstays of the newspaper funnies from my childhood, to the <a href="http://www.google.com/help/ig/comicsthemes/#kawaii">Tokyopop</a> manga titles I collect with my teenage daughters to the esoteric and more literary works of <a href="http://www.google.com/help/ig/comicsthemes/#clowes">Dan Clowes</a> and <a href="http://www.google.com/help/ig/comicsthemes/#yang">Gene Yang</a>, two of my favorites; I think the breadth of choices available demonstrates the amazing diversity and the fundamental vitality of the stories comics can tell.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQzTwW-01ZaLGFIiyVXauyMbeWeNDsfO9Vq2YUez97HVZMeAei8LzaDWGtP0N05kVbct0PWNBfUe6wGxYm22RboHosPuLPg1K7mL9MZHzUA0eXzsoEaY96Zg6PvGppwJv91OmX3eQ2r1tJ/s1600-h/blogpost.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5361682876346821090" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQzTwW-01ZaLGFIiyVXauyMbeWeNDsfO9Vq2YUez97HVZMeAei8LzaDWGtP0N05kVbct0PWNBfUe6wGxYm22RboHosPuLPg1K7mL9MZHzUA0eXzsoEaY96Zg6PvGppwJv91OmX3eQ2r1tJ/s400/blogpost.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 316px;" /></a><br /><span class="byline-author">Posted by Marissa Mayer, Vice President of Search Products and User Experience, and Jim Lee, Comics Creator/Publisher</span>

It's a bird...it's a plane...it's iGoogle comics themes!

We have always been excited to introduce design flair and whimsy to our user experience, especially on our homepage. Be it through our speci...

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Pseudo-Evidence Based Medicine Threatens Health Care Reform Based on "What Works"

As I <a href="http://hcrenewal.blogspot.com/2009/07/what-health-care-reformers-dont-discuss.html">posted</a> yesterday, the increasingly noisy debate about health care reform in the US has not dealt much with the issues we often discuss on Health Care Renewal. These include problems in how health care organizations are led which threaten physicians' and other health care professionals' core values using tactics including perverse incentives, deception, and intimidation.<br />Last night, however, President Obama held a news conference mostly devoted to health care issues, in which he stressed the importance of changing not just how health insurance works, but how health care decisions are made. As Newsweek's "The Gaggle" blog <a href="http://blog.newsweek.com/blogs/thegaggle/archive/2009/07/23/obama-presser.aspx">reported</a>,<br /><blockquote><br />Can I guarantee that there are going to be no changes in the health care delivery system? No. The whole point of this is to try to encourage changes that work for the American people and make them healthier. The government already is making some of these decisions. More importantly, insurance companies right now are making those decisions. <em><strong>And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works, because that's not how it's working right now.</strong></em><br /></blockquote><br /><br />So what the President seems to be advocating is making health care more evidence-based, perhaps in the formal sense of evidence-based medicine.<br /><br />As a card-carrying evidence-based medicine advocate, I certainly agree, but let me reiterate that evidence-based medicine is not just medicine based on some sort of evidence. As Dr David Sackett, and colleagues wrote [Sackett DL, Rosenberg WM, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine; what it is and what it isn't. BMJ 1996; 312: 71-72. Link <a href="http://www.bmj.com/cgi/content/full/312/7023/71">here</a>. ]<br /><blockquote><br /><em>Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.</em> The practice of evidence based medicine means integrating individual clinical expertise with the <em>best available external clinical evidence from systematic research</em>. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in <em>more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions</em> about their care. <em>By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens</em>. </blockquote><br />Furthermore,<br /><blockquote><br />Evidence based medicine is not 'cookbook' medicine. Because <em>it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients' choice,</em> it cannot result in slavish, cookbook approaches to individual patient care. External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.<br /></blockquote><br />One can find other definitions of EBM, but nearly all emphasize that the approach is designed to appropriately apply results from the best clinical research, critically reviewed, to the individual patient, taking into account that patient's clinical characteristics and personal values.<br /><br />So far, so good. I believe the proper application of "real" (as described above) evidence-based medicine has the potential to improve patient outcomes while moderating health care costs. However, we have pointed out how problems arising from concentration and abuse of power in health care threaten the evidence-based medical ideal.<br /><br />First, there are major problems with the development of the sort of clinical research evidence required by the EBM process. We have discussed how clinical research is frequently <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">manipulated</a> by those with vested interests in producing results that favor the products or services that they sell. The critical review process inherent in EBM is meant to cope with less than optimally designed and implemented research. However, the process was designed to cope with honest mistakes and inevitable trade-offs, not deliberate manipulation by vested interests.<br /><br />Worse, we have discussed how vested interests may engineer the <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">suppression of research </a>when manipulation fails to produce the desired results. The EBM process assumes that the research on which decisions should be based is an unbiased sample of research that was done (and done to advance science, not commercial or ideological interests). When research whose results are unwanted by vested interests is suppressed, the resulting distortion of the evidence base may irretrievably bias the EBM process.<br /><br />Finally, we have posted about how vested interests have distorted the discussion, dissemination, and teaching of the results of clinical research. They may develop systematic <a href="http://hcrenewal.blogspot.com/search/label/stealth%20marketing">stealth marketing </a>campaigns, often employing supposed "<a href="http://hcrenewal.blogspot.com/search/label/key%20opinion%20leaders">key opinion leaders</a>," who are paid on the side by marketers, and using "<a href="http://hcrenewal.blogspot.com/search/label/medical%20education%20and%20communication%20companies">medical education and communication companies</a>"as marketing fronts whose publication strategies include deceptive tactics such as "<a href="http://hcrenewal.blogspot.com/search/label/ghost%20writing">ghost-writing</a>."<br /><br />Thus, a rising tide of "<a href="http://hcrenewal.blogspot.com/search/label/pseudo-evidence%20based%20medicine">pseudo-evidence based medicine</a>" threatens to overwhelm even the most conscientious physicians trying to practice evidence-based medicine.<br /><br />So, while I applaud President Obama's advocacy of reforming health care to emphasize what the best evidence suggests really works, I do not think this effort will get far unless we deal with the rising tide of pseudo-evidence based medicine. As a minimum, we need full and detailed disclosure of all the relationships among vested interests and medical research and education, and a much greater role for research and education that is not subsidized by corporations bent on using research and education to market their products and services.

Pseudo-Evidence Based Medicine Threatens Health Care Reform Based on "What Works"

As I posted yesterday, the increasingly noisy debate about health care reform in the US has not dealt much with the issues we often discuss...

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State, City Settle Case Alleging Medicaid Fraud

We have posted on a variety of settlements of cases alleging health care fraud, but this one has a new twist, as <a href="http://www.nytimes.com/2009/07/22/nyregion/22whistle.html">reported </a>by the NY Times,<br /><br /><blockquote><br />New York State and New York City officials agreed this week to repay the federal government for more than half a billion dollars in improper Medicaid claims, averting a potential court battle but adding more red ink to the state’s and city’s finances.<br /><br />The settlement, which federal officials said was the largest recovery of Medicaid funds in history, ends a lengthy dispute with the federal government over whether school districts around the state improperly sought Medicaid payments for speech therapy and other services dating to the early 1990s.<br /><br />Under the agreement, which was announced Tuesday, the city will repay about $100 million. The state will pay about $332 million in 10 installments over the next five and a half years and will also give up $107.9 million worth of Medicaid claims now owed by the federal government.<br /><br />Though neither city nor state officials are required to admit wrongdoing under the agreement, it does require the state’s Department of Education to submit to independent monitoring of its Medicaid-financed programs.<br /><br />Since the 1980s, Medicaid has helped school districts pay for the cost of services like speech therapy and psychological counseling for schoolchildren, including the cost of transportation to therapists’ offices. School districts in New York have been among the most aggressive in the country in seeking such aid: one federal study found that New York accounted for 44 percent of all student health services.<br /><br />Those lawsuits, filed under the federal False Claims Act, spurred several audits by the Department of Health and Human Services of city and state programs that finance speech therapy and other programs for disabled children. Those audits found substantial potential for fraud, reporting that a vast majority of the claims submitted did not meet federal requirements, and that in many cases there was no evidence that the services had actually been provided.<br /></blockquote><br /><br />This may be the first settlement of health care fraud allegations we have discussed in which all the involved parties were government agencies.<br /><br />The current fervent debate in the US about health care reform has focused on ever rising health care costs.  However, this debate has largely ignored the ethics of health care, and the sorts of leadership of health care organizations that has lead to rampant and costly mischief, of which this case is just the latest example.  How can we control costs while so many health care leaders are seeking every angle to make more money, whatever the consequences?

State, City Settle Case Alleging Medicaid Fraud

We have posted on a variety of settlements of cases alleging health care fraud, but this one has a new twist, as reported by the NY Times, N...

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Digital activism on YouTube

<span style="font-size:85%;"><span style="font-style: italic;">(This is the second of a series of posts from YouTube's news and politics blog, <a href="http://www.citizentube.com/">Citizentube</a>. -Ed.)</span></span><br /><br />Activism today isn't limited to picket lines and marches on the Mall — people have taken their movements to the web, and <a href="http://www.youtube.com/">YouTube</a> has become an important platform for exposure. Every day, people use YouTube to fight for causes, whether they're hunger-striking celebrities like <a href="http://www.citizentube.com/2009/05/mia-farrow-fasts-for-darfur-vlogs-on.html">Mia Farrow</a>, or <a href="http://www.citizentube.com/2009/05/9-year-old-uses-youtube-to-save.html">9-year-olds trying to save the neighborhood kickball lot</a> from destruction. On <a href="http://www.citizentube.com/">Citizentube</a>, our YouTube blog that chronicles the way people use video to change the world, we've seen digital activists use YouTube in three basic ways: to shine a light on issues that need more exposure, to drive action around causes they care about, and to create connections between people and organizations that share their desire to make a difference.<br /><br />Some of the most compelling videos we see are those that spotlight important issues that aren't being covered in the mainstream media. <a href="http://www.youtube.com/witness">Witness</a>, a nonprofit organization whose mission is to document human rights abuses around the world through video, offers an excellent example — <a href="http://www.youtube.com/watch?v=z2EEJkyntV4">this video</a> from their YouTube channel chronicles the clashes between the Burmese military and rural ethnic minorities. <a href="http://www.citizentube.com/2009/07/invisiblepeopletv-giving-voice-to.html">Invisiblepeople.tv</a>, a relative newcomer to YouTube, is taking a similar approach by tackling a more domestic issue: homelessness. This summer, the group is traveling across America to document the real, unedited stories of people living on the streets, in tent communes and in cars — and posting all of the footage to <a href="http://www.youtube.com/user/invisiblepeopletv">their YouTube channel</a>. And of course we've seen protesters in <a href="http://www.citizentube.com/2009/07/new-round-of-protests-in-iran.html">Iran</a>, <a href="http://www.citizentube.com/2009/07/violent-riots-in-urumqi-china.html">China</a> and elsewhere use YouTube to amplify their causes far beyond national borders.<br /><br />Other individuals and nonprofits are using YouTube as a direct advocacy tool, experimenting with ways to drive action from their videos to a particular cause. And we're building new products to make it even easier for them to do this effectively. For example, in March, we <a href="http://www.citizentube.com/2009/03/youtube-nonprofit-raises-10000-for.html">launched</a> a tool called "Call to Action," which allows nonprofit organizations to drive traffic from an <a href="http://www.google.com/support/youtube/bin/answer.py?hl=en&answer=150471">in-video overlay</a> to an off-site page where they can collect donations, signatures or email addresses. Shortly after launch, to commemorate World Water Day, we featured a video from charity:water on the YouTube homepage that used a call-to-action overlay to encourage YouTube users to donate money to build wells and provide clean, safe drinking water for those who don't have it. Through YouTube, <a href="http://www.youtube.com/charitywater">charity:water</a> was able to raise over $10,000 in one day — enough to build two brand-new wells in the Central African Republic and give over 150 people clean drinking water for 20 years.<br /><br />Yet some of the most innovative uses of YouTube for digital activism are those that leverage the communities that exist on YouTube around particular causes. YouTube is inherently a social experience and many of our users are hungry to partner and collaborate with others who share their passions. Last December, popular YouTube users the <a href="http://www.youtube.com/vlogbrothers">Vlogbrothers</a> launched the "<a href="http://www.youtube.com/watch?v=f4hqWfp3374">Project for Awesome</a>," a campaign which asked fellow budding change-makers to make videos about their favorite charities. Over 1,200 people joined the effort to promote their cause of choice. And just a few weeks ago, in partnership with President Obama's launch of serve.gov, we created "<a href="http://www.citizentube.com/2009/06/announcing-service-20-video-volunteers.html">Video Volunteers</a>", a new platform on YouTube which connects nonprofits that lack video resources with proven video-makers who want to use their skills to do good. There are already hundreds of posts from nonprofits seeking help on the <a href="http://www.youtube.com/videovolunteers">Video Volunteers YouTube channel</a>, so if you're interested in creating a video for an organization, head over to the channel now and find a cause you care about.<br /><br />Activism is constantly evolving on YouTube, so we'll keep posting fresh accounts of how citizens and nonprofits are changing the world, one video at a time, on Citizentube.<br /><br /><span class="byline-author">Posted by Ramya Raghavan, YouTube Nonprofits & Activism</span>

Digital activism on YouTube

(This is the second of a series of posts from YouTube's news and politics blog, Citizentube . -Ed.) Activism today isn't limited to ...

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What Health Care Reformers Don't Discuss

Health care reform is now the big health care story in the US. Discussion of various health care reform proposals regularly lead in print and electronic media. Yet we have been very quiet here on Health Care Renewal about health care reform.<br /><br />I personally have written little, because it seems to me that hardly any of the discussion swirling around relates to the concerns we discuss on this blog. We write about the bad effects of continuing concentration and abuse of power in health care on physicians' and other health care professionals' core values. We note instances of ill-informed, incompetent, self-interested, conflicted, or even corrupt leaders of health care organizations. We discuss how problems with the governance of health care organizations allow such leadership. We comment on instances in which bad leaders use tactics such as deception, creation of perverse incentives, and intimidation. And we address how all this can lead to higher costs, decreasing access, poor patient outcomes, and demoralized professionals.<br /><br />For example, just in this month, July, 2009, we posted about:<br /><br /><em>How Trusted Health Care Institutions are Lead by the Conflicted</em><br /><ul><li>One of the largest and most respected medical societies gets three times as much income from the pharmaceutical, biotechnology and device industries as from membership dues, and its current generously salaried president just asks the public to "trust us, we're doctors" (link <a href="http://hcrenewal.blogspot.com/2009/07/again-logical-fallacies-in-defense-of.html">here</a>); </li><li>The White House health care reform czar just stepped off the board of directors of a health care corporation accused of "ruthless" behavior and making patients feel they are only equivalent to "dollars" (link <a href="http://hcrenewal.blogspot.com/2009/07/turning-patients-into-dialysis-dollars.html">here</a>); </li><li>An award-winning show on public television featured remarks favoring drug treatment of psychiatric illness by an academic "key opinion leader" without disclosing his multiple financial ties to the pharmaceutical industry (link <a href="http://hcrenewal.blogspot.com/2009/07/peabody-award-for-show-featuring.html">here</a>); </li><li>A state legislator pleaded guilty to selling his services to an academic medical center (link <a href="http://hcrenewal.blogspot.com/2009/07/ny-state-legislator-pleads-guilty-to.html">here</a>);<br /></li></ul><p><em>Health Care Leaders Do Not Share Physicians' Traditional Values</em><br /></p><ul><li>Leaders of the university that employs the academic "key opinion leader" mentioned above intimidated another of its professors because he wrote a blog critical of the pharmaceutical industry (link <a href="http://hcrenewal.blogspot.com/2009/07/blogger-that-dares-not-speak-his.html">here</a>); </li><li>A study showed that primary care doctors burn out not just because they think their pay is low, but because they work in "chaotic" environments, lead by people who do not inspire trust and whose values are not aligned with those of the physicians (link <a href="http://hcrenewal.blogspot.com/2009/07/window-on-unworkable-settings-in-which.html">here</a>); </li></ul><p>And our archives, going back now to the end of 2004, include much more.</p><p>For the most part, however, these are not the issues discussed in the great health care reform debate. </p><p>There does seem to be, at the margins, some discussion of a few productive approaches, which deserve credit. These include the Sunshine bill, which would improve disclosure of conflicts of interest generated by health care corporations' payments to health care professionals and academics; the push to support some comparative effectiveness research; and some attempts to address the perverse incentives built into the system used by Medicare to pay physicians. It is not clear, however, whether these efforts are going to get very far, and in any case, they remain peripheral to  fervent discussions of health care financing, which seems to be the only topic of interest to most would-be health care reformers. </p><p>I believe that the US health care reform will not produce good results if it fails to address the issues we discuss on Health Care Renewal.    </p><p>But discussion of them, of course, may threaten many with vested interests, and lots of people who have been made rich and powerful by the current system.</p><p>So look forward to endless debates about whether the "public option" for health insurance is a good or bad idea, but nothing about how the insurance industry is lead, much less how pharmaceutical, biotechnology, device companies, hospitals and academic medical centers, medical not-for-profit organizations, health care information technology companies, and government agencies are lead, and how bad leadership facilitated by bad governance will continue to make things worse.  </p>

What Health Care Reformers Don't Discuss

Health care reform is now the big health care story in the US. Discussion of various health care reform proposals regularly lead in print an...

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JAMA letter: "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards"

My letter "<i>Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</i>" was published in JAMA yesterday.    A preview of the letter can be seen <a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382">here</a>, or a full version <a href="http://jama.ama-assn.org/cgi/content/full/302/4/382">here</a> if you subscribe to JAMA.  <div><br /></div><div>The letter was in response to Koppel and Kreda's groundbreaking March 2009 JAMA article "<i><a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians</a>.</i><i>"   </i></div><div><div><br /></div><div>The JAMA letter covered some of the same points I addressed extensively at my Drexel HIT website essay "<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=koppel_kreda"><i>Hold Harmless and Keep Defects Secret Clauses</i></a>", including the major point that <span>hospital executives signing such contracts </span><span style="font-weight: bold;">are in violation of Joint Commission standards for conduct related to safety, and in violation of their fiduciary responsibilities </span><span>towards patient and employee safety and freedom from undue liability</span>.  In the Drexel website essay I also noted that:</div><div><br /></div><div><blockquote>... these stipulations [hold harmless and gag clauses in contracts] further instantiate my observation that <b>health IT lacks the rigor of medical science itself</b>, its major Achilles heel.</blockquote></div><div><br /></div><div>Koppel and Kreda note <a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382-a">in their JAMA reply</a> to my JAMA letter that:</div><br /><blockquote>Dr Silverstein's letter adds context to our Commentary on HIT vendors' self-protective "hold harmless" clauses while introducing an important discussion about hospitals' and vendors' possible violations of Joint Commission standards. We agree with Silverstein about the misapplication of the standard business software contracting model.</blockquote><div><br /><div>Of interest, the American Medical Informatics Association (AMIA) had authored a reply to Koppel and Kreda quite different than mine, which for a time appeared on their national website (www.jamia.org) but was later withdrawn apparently due to concerns that such a letter might be viewed as an official organizational position.  It was entitled "<i>Response to Commentary in JAMA -- Ross Koppel, David Kreda</i>" and can be read in its entirety <a href="http://evernote.com/pub/poikonen/PublicPharmacoinformatics#Note/582cbf46-d342-46bc-a39e-3d57e3a31388">here</a>. </div><br />The AMIA response piece concluded:</div><div><br /></div><div><blockquote>"While we support increased transparency around error disclosure, <b>the belief that the best approach to increase the safety and effectiveness of EHR systems is by legal regulation of system vendors is misplaced.</b> Such an approach would stifle innovation and not achieve the desired goals. At a minimum equal attention needs to be given to the role that provider organizations bring to configuration, management and oversight of the software and related processes."</blockquote><blockquote><br /></blockquote></div></div><div>In fact, Koppel and Kreda addressed the provider side issues extensively in their article.</div><div><br /></div>Of interest, JAMA did not publish the AMIA response but instead published mine.  Perhaps it's because JAMA felt I had something important to say, as opposed to simply making excuses for HIT vendors and valuing prevention of "stifling of innovation" over hospital leadership's safety and fiduciary obligations to patients and staff.<div><br /></div><div>"The belief that the best approach to improving HIT safety is via regulation is <b>misplaced</b>?" (Misplaced how, exactly?)  Tell that to the airline or public transit or pharma or the medical device industries.  Or to the public whose care is increasingly dependent upon these HIT systems.</div><div><br /></div><div>It is my firm opinion that "innovation" done recklessly, in secrecy,  without accountability, and via exploitation  is not innovation at all.<br /><div><br /></div><div>-- SS<br /><br /><span style="font-weight: bold;">July 23 addendum:</span><br /><br />Dr. Koppel has forwarded to me a letter he and Mr. Kreda submitted to AMIA in response to AMIA's aforementioned critique of his March 2009 JAMA "Hold Harmless Clause" article.  Koppel and Kreda's  letter, "<span style="font-style: italic;">On the AMIA Response to Commentary in JAMA by Ross Koppel and David Kreda</span>" can be read <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/koppel_holdharmless_amia_reply.doc">here</a> (MS Word .doc format).<br /><br />Highlights:<br /><blockquote><br />... Where the AMIA authors disagree with us is the emphasis placed on errors produced in the coupling.  <span style="font-weight: bold; font-style: italic;">[The coupling of healthcare organization and software, i.e., alterations and customizations beyond the control of the software vendor - ed.]</span>  We say a vast number or errors are generated in the marriage. But they say we have essentially ignored how many errors are created by doctors and hospitals seeking to consummate their relationship with HIT systems in situ ...<br /><br />... A brief recap of our JAMA commentary seems in order. We wrote about: (1) the HIT vendor “non-disclosure” clauses that prevent clinicians from sharing information about errors generated from faulty software; (2) the clauses that remove all vendor responsibility for errors in their systems – and place all responsibility on clinicians and hospitals (the “hold harmless/learned intermediary” clauses); (3) the need to protect vendors from responsibilities for errors introduced when hospitals implement HIT or when untrained or incompetent clinicians use the HIT; and (4) the need for more balanced contracts that are fair to clinicians and hospitals ...<br /><br />... Given that we addressed the non-software issues we are said to have ignored, we are not sure why our JAMA commentary earned the response it received on official AMIA letterhead. We hope, therefore that this letter can further a longer conversation about the many ways to make clinical IT software and its implementation better. Nonetheless, we stand by our statement that the imbalance in incentives we described in our JAMA Commentary is a structural obstacle that on balance hurts improving the clinical part of clinical IT.<br /><br /></blockquote>Read the whole thing at the link above.  (I placed Koppel and Kreda's response to AMIA on my faculty server.   The response, to the best of my knowledge, was not published by AMIA itself.)<br /><br />-- SS<br /></div></div>

JAMA letter: "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards"

My letter " Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards " was published in JAMA ...

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