healthy4u

Making Hospitals Safer by Making Healthcare IT Safer

At my July 24, 2009 HC Renewal post "<a href="http://hcrenewal.blogspot.com/2009/07/inquiry-to-joint-commission-on-points-i.html">Inquiry to Joint Commission on points raised in my July 22, 2009 JAMA letter on HIT</a>", I reproduced a letter I sent to the Joint Commission seeking their opinions on the issue of Health IT "hold harmless" and "defects nondisclosure" contractual terms. (See "<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>", JAMA 2009;301(12):1276-1278 and my HIT difficulties website essay <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">here</a>.) Those contractual terms cause hospital executives to violate Joint Commission safety standards and their own fiduciary responsibilities to people both providing and seeking care in hospitals. My inquiry was acknowledged, and I await a reply. In <a href="http://www.nytimes.com/2009/08/03/opinion/l03medical.html?_r=2&ref=todayspaper">Making Hospitals Safer for Patients</a>, New York Times, Aug. 2, 2009 , Mark R. Chassin, president of The Joint Commission, wrote: <div style="margin-left: 40px; font-family: arial;">To the Editor:Jim Hall makes an important point about the costs and preventability of harm caused by medical errors, but his suggestion for a National Medical Safety Board is not the answer. It is not sufficient to investigate health care “crashes” one at a time and hope to transform the health care system into one that performs more reliably.Too often, the lessons learned are not easily transferable to other hospitals or even to other problems within the same organization. The key to transforming our health care system into a safer one is to use proven quality improvement methods — already in use in high-risk fields like aviation and nuclear power — as part of everyday work ... </div> In a followup email to the Joint Commission, I pointed out to Dr. Chassin that this is the same key to improving the quality and safety of EHR, CPOE and other information technology-based medical devices. I also pointed out that "Hold harmless" and "Defects nondisclosure" -- a.k.a. "gag clause" -- contractual methods (unless I'm mistaken, in which case we're all in jeopardy) are not used in building and deploying safety-critical devices found in the aviation and nuclear energy industries. -- SS

Making Hospitals Safer by Making Healthcare IT Safer

At my July 24, 2009 HC Renewal post " Inquiry to Joint Commission on points raised in my July 22, 2009 JAMA letter on HIT ", I re...

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An Outsider’s Take on American Medicine

Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine, but one part concerns his coming from Britain to America in the late 1980s. Born in South Africa, he attended medical school there, then went to Britain rather than be drafted into the military. With research budgets cut under Thatcher, he came to America to be able to pursue his medical career. After his dreary British experience during a period of budget cutbacks, he greatly enjoyed the cheerful commercialism and general prosperity of American medicine. He promptly found a research project to work on that would enable him to write a Master’s thesis, and the work was fun and went swimmingly. Nonetheless, Dr. Kaplan was quite disconcerted by some of the differences between British and American medicine. Working on another study, he reviewed hemorrhoid surgery results. He was startled to realize how much more surgery was done for minor piles in the U.S. than in Britain, though results were unimpressive – then “I found the payment invoices in each patient’s folder. These were met by the health insurers, who paid out a lot more for an operation than injections. . . . The logic of a for-profit system appeared to lead to expensive solutions and spiraling costs.”He was also startled by anecdotal reports of how the stock market crash of 1987 led one surgeon to actually shed tears mid-surgery when he heard the news. As well, the serious, money-oriented medical students surprised him, as he was used to quite a number of more arty, intellectual types among medical students in other countries.Still, he was thrilled about his promising research results on a heated balloon angioplasty device. Later, he was disillusioned to hear that after the device received FDA approval, the main competitor, a laser manufacturer, bought out the idea and shelved it to keep it off the market. I thought his observations fit well with Dr. Poses’ concern about insidious corruption in medicine and too many physicians who don’t feel the expected fiduciary responsibility to patient welfare. As well, it makes Maggie Mahar’s term of “money-driven medicine” seem – well – on the money.

An Outsider’s Take on American Medicine

Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine...

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Should you spring clean your solar panels?

Ever since we <a href="http://www.google.com/intl/en/press/pressrel/rechargeit_20070618.html">assembled a 1.6 MW solar panel installation</a> at our <a href="http://maps.google.com/?q=Google%20Inc.@37.423156,-122.084917&hl=en">headquarters</a> in Mountain View in 2007, we've been wondering, "Does cleaning the solar panels make them more effective?" We thought it might, but we needed to be sure. So we analyzed the mountains of data that we collect about the energy that these panels produce — after rain, after cleaning and at different times of the year. We have two different sets of solar panels on our campus — completely flat ones installed on carports, and <a href="http://www.google.com/corporate/green/footprint.html">rooftop ones</a> that are tilted. Since the carport solar panels have no tilt, rain doesn't do a good job of rinsing off the dirt they collect. (Also, our carports are situated across from a sand field, which doesn't help the situation.) We cleaned these panels for the first time after they had been in operation for 15 months, and their energy output doubled overnight. When we cleaned them again eight months later, their output instantly increased by 36 percent. In fact, we found that cleaning these panels is the #1 way to maximize the energy they produce. As a result, we've added the carport solar panels to our spring cleaning checklist. The rooftop solar panels are a different story. Our data indicates that rain does a sufficient job of cleaning the tilted solar panels. Some dirt does accumulate in the corners, but the resulting reduction in energy output is fairly small — and cleaning tilted panels does not significantly increase their energy production. So for now, we'll let Mother Nature take care of cleaning our rooftop panels. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0lx40pCSuxxwsXj3WgaWURsWSnzV0jBr7I07IK1dVjYHgMM3cnbSyVD6by6DO5PVJI5ysZVCwYSNOr7xKD2ziHC6FNMzbh58k36nl0QmjEINA-XLmBVeH3_zyjCmp8x-4febMvC0RdX1t/s1600-h/solar+panels+photo.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364735671269906418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0lx40pCSuxxwsXj3WgaWURsWSnzV0jBr7I07IK1dVjYHgMM3cnbSyVD6by6DO5PVJI5ysZVCwYSNOr7xKD2ziHC6FNMzbh58k36nl0QmjEINA-XLmBVeH3_zyjCmp8x-4febMvC0RdX1t/s400/solar+panels+photo.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 248px;" /></a><div style="text-align: center;">Accumulated dirt in the corners of a rooftop solar panel</div> We've also been crunching numbers on dollars-and-cents; the more energy our panels produce, the sooner we'll be paid back by our solar investment. Our analysis now predicts that Google's system will pay for itself in about six and a half years, which is even better than we initially expected. If you want to learn more about our solar study, check out these <a href="http://docs.google.com/present/view?id=dfhw7d9z_0gtk9bsgc">slides</a> showing the effects that seasonality, tilt, dirt, particulate matter, rain and cleaning have on Google's solar energy output. We hope you solar panel owners out there can tailor our analysis to the specifics of your own installation to produce some extra energy of your own! Posted by Winnie Lam, Senior Product Manager

Should you spring clean your solar panels?

Ever since we assembled a 1.6 MW solar panel installation at our headquarters in Mountain View in 2007, we've been wondering, "Do...

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Search Options now on Google Images

A few months ago when we announced the <a href="http://googleblog.blogspot.com/2009/05/more-search-options-and-other-updates.html">Search Options</a> panel, we promised that you would soon see similar functionality across our other search properties. Today we are rolling out Search Options for <a href="http://images.google.com/">Google Images</a>. This new feature offers quick access to existing tools, including search by <a href="http://googleblog.blogspot.com/2009/04/search-rainbow.html">color</a> and <a href="http://googleblog.blogspot.com/2008/12/new-search-by-style-options-for-google.html">image type</a>. Color search will find images that are only in color or only in black and white, or even images that contain a specific color, such as red, pink, or green. Type search is a great way to narrow down your results if you are looking for a specific kind of image, such as a <a href="http://images.google.com/images?q=tiger&imgtype=photo">photo</a>, <a href="http://images.google.com/images?q=tiger&imgtype=clipart">clip art</a>, <a href="http://images.google.com/images?q=tiger&imgtype=lineart">line drawing</a> or <a href="http://images.google.com/images?q=tiger&imgtype=face">face</a>. We've also revamped our size search. In addition to choosing from commonly searched-for sizes, now you can search for an exact image size or any image larger than a certain size. You can find images of practically any size, including <a href="http://images.google.com/images?q=nebula&imgsz=70mp">70 megapixels or more</a>. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheZ67y2bc7uOqLE-nfsFKf7G7i7hah2VJkvms9hGF9kv0tB1rY8YisR8NX_NYWC_MW_-IMZJg1tpPvcJxKJ_VcdxqF_seGLZyzXiTXSLrv8Z-i5Ga4IfIC14M_X9PMXs8LAOMg3Q-Fo9E7/s1600-h/images_toolbelt.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364743947710302882" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheZ67y2bc7uOqLE-nfsFKf7G7i7hah2VJkvms9hGF9kv0tB1rY8YisR8NX_NYWC_MW_-IMZJg1tpPvcJxKJ_VcdxqF_seGLZyzXiTXSLrv8Z-i5Ga4IfIC14M_X9PMXs8LAOMg3Q-Fo9E7/s320/images_toolbelt.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 309px;" /></a> The new layout makes it faster and easier to combine and toggle between options. It also makes it easier for us to add additional image search options in the future, so keep your eyes peeled. Just click "Show options..." in the blue bar on the search results page to try out any of these tools. Posted by Ken Dauber, Software Engineer, and Nate Smith, Associate Product Manager

Search Options now on Google Images

A few months ago when we announced the Search Options panel, we promised that you would soon see similar functionality across our other sea...

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BLOGSCAN - More on Senate Hearings on Industry Funded CME

There has been considerable coverage of the remarkable hearings by the US Senate Special Committee on Aging on industry funded continuing medical education (CME). See <a href="http://carlatpsychiatry.blogspot.com/2009/07/senate-cme-hearing-impressions-more.html">reporting</a> by Dr Daniel Carlat on the Carlat Psychiatry Blog, and <a href="http://blog.prescriptionproject.org/?p=745">by the Prescription Project </a>on their Postscript Blog. See also the <a href="http://brodyhooked.blogspot.com/2009/07/ban-industry-funded-cme-and-accme-while.html">comments </a>by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog. Some key points were that the Senators failed to see why physicians cannot afford to pay for their own CME, and therefore must depend on corporate funding to support; and the Senators failed to buy the argument that medical progress vitally depends on health care corporations paying for and influencing the education physicians get.

BLOGSCAN - More on Senate Hearings on Industry Funded CME

There has been considerable coverage of the remarkable hearings by the US Senate Special Committee on Aging on industry funded continuing me...

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Bloggers Can Spread the Word, Just Not About the Sponsors' Competitors

The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big health care organizations are trying to use these new media to promote their messages. New media, however, are no more immune from the effects of conflicts of interest than are old media. An <a href="http://www.ragan.com/ME2/Audiences/dirmod.asp?sid=&nm=&type=MultiPublishing&mod=PublishingTitles&mid=5AA50C55146B4C8C98F903986BC02C56&tier=4&id=49D51282F593432BB0D53C8D849E2193&AudID=3FF14703FD8C4AE98B9B4365B978201A">article</a> from corporate communications company Ragan.com about how the American Heart Association (AHA) is using bloggers to get people interested in a heart-healthy diet and exercise program illustrates how even "civilian" bloggers can get caught up in the web of conflicts of interest that pervades health care. The background is: <blockquote>Keeping track of the conversations on the array of social media networks can gobble up your workday. So why not find someone else to do it for you? The American Heart Association did just that, approaching four established bloggers with a proposal: Write about our new campaign, Go Red For Women: BetterU, and we’ll link to your blog from our site. BetterU is a 12-week online nutrition and fitness program to improve heart health among women. The blogs appear to be working. They’ve helped drive traffic to Go Red/BetterU since the program’s June 1 launch. </blockquote> It did seem that the AHA went to considerable effort to make sure they had recruited just the right bloggers. <blockquote>The AHA researched potential candidates with the help of agencies Edelman PR and Edelman Digital. After a month-and-a-half, they settled on four bloggers: Joshilyn, Nyasha, Stacey, and Nadia. The criteria: The bloggers had to be female, have an enthusiastic following, be diverse in age and ethnicity, and have a high Technorati rating. Most important, their content and advertising had to align with the association’s values, says Director of Marketing Anu Gandhi. 'You’re really ultimately picking a spokesperson for Go Red for Women and the larger American Heart Association,' [senior manager for cause communications Megan] Lozito says. 'That’s a really important process for us — that it be correct and that it be the right people. So we spent a lot of time getting to know those ladies and making sure our mission would be aligned.' </blockquote>More interesting was the values with which the bloggers were supposed to align, particularly those relating to the program's corporate sponsors (see the logos at the bottom right of the <a href="http://www.goredforwomen.org/BetterU/index.aspx">BetterU web-site</a>). <blockquote>From there, the association brought the bloggers to the Dallas headquarters for a full health screening at The Cooper Institute, a photo session, a preview of the BetterU program, and some message training. Although the BetterU bloggers got some message training in Dallas, Gandhi says AHA has been hands off when it comes to what they can and can’t say about the program. The bloggers are asked to post once a week about BetterU and follow basic guidelines—no profanity, no defamation, no writing about nor condoning any medications or treatments. She says they also ask bloggers not to talk about competitors of AHA’s two national sponsors: Macy’s and Merck Pharmaceuticals. </blockquote> I would suspect that the explicit instruction not to favor Merck's competitors would also remind the bloggers not not do say anything that might make the giant pharmaceutical company unhappy. <blockquote>Eight weeks into the program, they haven’t had any problems. 'There are things we don’t want them to write, like profanity, but that’s also part of the vetting in the beginning,' Lozito says. 'We wanted to find people who believe in our mission, who speak to the same type of audience, but at the same time we want them to have their own flavor and own tone, because it’s a blog.' </blockquote>So the bloggers recruited by the AHA may be happy, since they now have a big organization's web-site driving traffic to their blogs. The AHA may be happy, since the bloggers can spread the word about their BetterU program. I imagine the marketers at Merck may be happy too, since the bloggers have been warned about the need to keep the corporate sponsors happy. However, what may be good for all the parties in this transaction may not be so good for the general public, as another opportunity for uninhibited, honest discussion of health care issues has been lost. This is an explicit example of the adverse effects of commercial funding of not-for-profit disease advocacy groups. Corporate sponsors may not expect anything as gross as advertising in return for their money. However, they may expect something more subtle, a generally favorable attitude toward the sponsor, at least the disinclination to say anything that might put the sponsor in a negative light. After all, politeness requires that we be nice to the people who are nice to us. But being nice to sponsors may not be so nice for the people that a health care not-for-profit organization is supposed to serve. PS - for those who like science fiction, see the <a href="http://abc.go.com/fallpreview/index?pn=v">preview</a> of the new version of "V," in which Anna, the leader of the Visitors, an invasion force disguised as human-appearing, benign aliens, warns her television interviewer, <blockquote>Just be sure not to ask anything that would put us in a negative light. </blockquote>

Bloggers Can Spread the Word, Just Not About the Sponsors' Competitors

The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big healt...

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I now pronounce you monetized: a YouTube video case study

(Cross-posted from the <a href="http://ytbizblog.blogspot.com/2009/07/i-now-pronounce-you-monetized-youtube_30.html">YouTube Biz Blog</a>) Last week the world watched in wonder as <a href="http://www.youtube.com/watch?v=4-94JhLEiN0">Jill Peterson and Kevin Heinz's wedding party</a> transformed a familiar and predictable tradition into something spontaneous and just flat-out fun. The video, set to R&B star Chris Brown's hypnotic dance jam "Forever," became an overnight sensation, accumulating more than 10 million views on YouTube in less than one week. But as with all great YouTube videos, there's more to this story than simple view counts. At YouTube, we have sophisticated <a href="http://www.youtube.com/t/contentid">content management tools</a> in place to help rights holders control their content on our site. The rights holders for "Forever" used these tools to claim and monetize the song, as well as to start running <a href="http://googleblog.blogspot.com/2008/10/i-clicked-to-buy-and-i-liked-it.html">Click-to-Buy</a> links over the video, giving viewers the opportunity to purchase the music track on Amazon and iTunes. As a result, the rights holders were able to capitalize on the massive wave of popularity generated by "JK Wedding Entrance Dance" — in the last week, searches for "Chris Brown Forever" on YouTube have skyrocketed, making it one of the most popular queries on the site: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYnjNQAEcwibWDqUDzVZSF0XyH_ANWS_YUbsQbXrLnaiNvhUmP_9ABcORtDEBPk8i8Ufty_uKCFwE7hnckYihiTdddYzi0fO_zQ9tPN8fMRgPPP8uzkk2jA69-eQIRJHuwR4G6_jsF7aEo/s1600-h/chris+brown+forever.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364282734135124178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYnjNQAEcwibWDqUDzVZSF0XyH_ANWS_YUbsQbXrLnaiNvhUmP_9ABcORtDEBPk8i8Ufty_uKCFwE7hnckYihiTdddYzi0fO_zQ9tPN8fMRgPPP8uzkk2jA69-eQIRJHuwR4G6_jsF7aEo/s400/chris+brown+forever.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 153px;" /></a> This traffic is also very engaged — the click-through rate (CTR) on the "JK Wedding Entrance" video is 2x the average of other Click-to-Buy overlays on the site. And this newfound interest in downloading "Forever" goes beyond the viral video itself: "JK Wedding Entrance" also appears to have influenced the official <a href="http://www.youtube.com/watch?v=X2IExa2A198">"Forever" music video</a>, which saw its Click-to-Buy CTR increase by 2.5x in the last week. So, what does all of this mean? Despite compelling data and <a href="http://news.bbc.co.uk/2/hi/technology/7967908.stm">studies</a> around consumer purchasing habits, many still question the promotional and bottom-line business value sites like YouTube provide artists. But in the last week, over a year after its release, Chris Brown's "Forever" has again rocketed up the charts, reaching as high as #4 on the <a href="http://www.apple.com/itunes/top-100/songs/">iTunes singles chart</a> and #3 on <a href="http://www.amazon.com/gp/bestsellers/dmusic/digital-music-track/ref=pd_ts_dmusic_nav">Amazon's best selling MP3 list</a>. We've seen <a href="http://www.fastcompany.com/blog/kit-eaton/technomix/monty-python-youtube-move-boosts-dvd-sales-23000">similar successes</a> in the past with partners like Monty Python. One of our main goals at YouTube is to help content creators effectively make money from the distribution of their content online. That they can do so in a way that brings artists and our community together to create fun, spontaneous and inspiring works, is one of the best and most exciting things about YouTube. Posted by Chris LaRosa, Technical Account Manager, and Ali Sandler, Music Partner Manager

I now pronounce you monetized: a YouTube video case study

(Cross-posted from the YouTube Biz Blog ) Last week the world watched in wonder as Jill Peterson and Kevin Heinz's wedding party transf...

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