CCHIT Has Company

It appears CCHIT, an offspring of the large HIT trade association HIMSS, won't get its wish for Health IT Certification hegemony. I think the outcome of a multidisciplinary HIT policy workgroup's deliberations on this issue reasonable:<br /><h2 face="Georgia,'Times New Roman',Times,serif" size="1.333em" style="border-width: 0px; margin: 0em 0.5em; padding: 0.05em 0em; outline-width: 0px; font-weight: bold; font-style: inherit; vertical-align: baseline; line-height: 1.15em;"></h2> <blockquote>Aug. 17, 2009<br /><br />iHealthBeat.org<br /><br /><a style="font-weight: bold;" href="http://www.ihealthbeat.org/Articles/2009/8/17/Policy-Committee-OKs-Plan-To-Establish-Multiple-EHR-Certifiers.aspx">Policy Committee OKs Plan To Establish Multiple EHR Certifiers</a><br /><br />On Friday, the [HHS] Health IT Policy Committee adopted recommendations that called for multiple entities to certify electronic health record systems, Health Data Management reports.<br /><br />The committee's certification and adoption work group issued the recommendations (Goedert [1], Health Data Management , 8/14).<br /><br />To receive official certification, EHR systems must meet a minimum set of criteria and achieve the "meaningful use" objectives of the federal economic stimulus package. Under the stimulus law, health care providers who demonstrate meaningful use of EHRs will receive Medicare and Medicaid incentive payments (O'Harrow, Washington Post , 8/15).<br /><br />Recommendations<br /><br />The work group recommended that:<br /><br />* Certification criteria allow for open-source software;<br />* Certification processes should let health care organizations qualify for EHR subsidies under Stark Law exceptions that allow organizations to subsidize the cost of EHRs for physicians;<br />* Certification should last for four years;<br /><span style="font-weight: bold;"> * Multiple groups perform HHS certification under a single set of criteria;</span><br />* The National Institute for Standards and Technology should participate in accreditation and certification decisions;<br />* The Office of the National Coordinator for Health IT should define certification criteria;<br />* ONC should create an accreditation process for certification groups;<br />* Officials develop alternative certification processes for self-developed software; and<br />* Vendors are required to receive certification from only one group ( Health Data Management , 8/14).<br /><br /><span style="font-weight: bold;">The work group said it envisions the establishment of 10 to 12 different EHR certification groups</span>, in addition to the Certification Commission for Health IT (Manos, Healthcare IT News , 8/14).<br /><br />The recommendations now go to HHS for consideration ( Health Data Management, 8/14).</blockquote><br />The workgroup said CCHIT is too closely aligned with the health IT industry, noted that the industry trade group HIMSS helped found CCHIT, and noted that CCHIT's members includes several people with ties to HIMSS and health IT companies. They were clearly uncomfortable with the potential conflicts of interest, especially if CCHIT gained sole responsibility for HIT "certification." <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[A term I put in quotes since it really is "features qualification" at this point, not certification such as a physician receives after passing Specialty Boards - ed.]</span><br /><br />Having been on the receiving end of CCHIT bullying myself ("<a href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html">Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-Certified HIT</a>"), it's clear most Americans don't like bullies, especially bullying from powerful lobbying organizations such as HIMSS and its progeny. (It's also become clear they don't like 1000+ page healthcare reform plans shoved, unread, down their throats by political bullies.)<br /><br />By the way, since the July 21, 2009 publication of my JAMA letter "<a href="http://hcrenewal.blogspot.com/2009/07/health-care-information-technology.html">Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>" and Koppel and Kreda's reply, pointing out the terrible situation that HIT "defects nondisclosure" and "hold harmless" clauses create for hospital executives, physicians and patients, I have heard from the Joint Commission, but not from HIMSS.<br /><br />Perhaps HIMSS leadership believes I have nothing worthy to add to the discussion. (Perhaps another 'Open Letter' is called for.)<br /><br />-- SS

CCHIT Has Company

It appears CCHIT, an offspring of the large HIT trade association HIMSS, won't get its wish for Health IT Certification hegemony. I thi...

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Philips Medical: A Followup

In a Nov. 2008 post entitled "<a href="http://hcrenewal.blogspot.com/2008/11/who-leads-in-intellectually-challenged.html">Who Leads in Intellectually Challenged Responses to Medical Informatics Backgrounds, The U.S. or Europe?</a>", I chastised Philips Medical for their ossified and uninspired approach to biomedical informatics talent management (by nonmedical "experts", in fact), and that ossification's deleterious effect on innovation.<br /><br />I forwarded the post to Philips management. Needless to say, I never received a response.<br /><br />This appeared on Aug. 5, 2009 at layofftracker.blogspot.com:<br /><br /><h2 class="date-header"><span style="font-size:100%;"></span></h2><blockquote><h2 class="date-header"><span style="font-size:100%;">Wednesday, August 5, 2009</span></h2> <a name="3426548320135672823"></a> <h3 class="post-title entry-title"> <a href="http://layofftracker.blogspot.com/2009/08/philips-healthcare-announces-layoffs.html">Philips Healthcare announces layoffs</a> </h3> <div>Got via a <a href="http://visakhcr.googlepages.com/layofftracker-tipme">Tip</a>. </div><div><br /></div><div><b>Philips Healthcare announces layoffs. Memo below.</b></div><div><br /></div><div>Message from Steve Rusckowski</div><div><br /></div><div>Dear Colleague,</div><div><br /></div><div>In our Q2 and Semi-Annual 2009 Report released on July 13, Philips reported a year-on-year decline in Healthcare sales. While we are substantially lower in our profitability as compared to Q2 2008, material improvements were made in our profitability from Q1 2009 to now, due to our sustained efforts on cost-containment. However, we still fell short of our targets and there is risk for further deterioration in several of our markets.</div><div><br /></div><div>To build a stronger organization for our future, we need to be a simpler, leaner, more flexible organization, while continuing to bring costs and capacity in line with current demand levels. Our long-term success will be measured by our ability to pro-actively and purposefully navigate through the lingering economic slowdown.</div><div><br /></div><div>The Healthcare Executive Team, in collaboration with our extended management across the sector, will adapt our organization to the needs of the markets. Where we see opportunities we will seize them, where markets change we will take the necessary steps to enable profitable growth.</div><div><br /></div><div>To safeguard and strengthen our business, our sector will expand, and where possible, accelerate our efforts to cut further operating costs, <span style="font-weight: bold;">including an additional reduction in our workforce. After careful analysis and consideration, this action will impact nearly all of our businesses and functions within North America beginning this month.</span></div><div><br /></div><div>The necessity of this workforce reduction is driven by <span style="font-weight: bold;">increasing double-digit declines in equipment orders across all of our businesses in North America.</span> The combination of tightening credit markets, persistent delays in capital equipment purchases, reimbursement pressures and the uncertainty of health care reform, are contributing to a weak overall U.S. health care market. <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[He forgot to mention innovation failure - ed.]</span> Responding to these dynamics is crucial to secure our immediate business performance and preparation for our future.</div><div><br /></div><div>In North America, the vast majority of employees affected by the workforce reduction will be notified next week. Some employees will be notified as early as this week, with others notified later, as business needs dictate. Impacted employees will be notified by management and/or representatives from Human Resources.</div><div><br /></div><div>As always, Philips is fully committed to supporting all employees through this process and will treat everyone fairly, professionally and with respect. In accordance with local legislation and procedures, affected employees will be offered severance packages and other appropriate assistance and support.<span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"> [Being treated with "respect" at a time of massive unemployment, of course, means being handed a few months' salary -- unless you are an executive -- and then being booted out the door - ed.].</span></div><div><br /></div><div>I recognize the impact of these decisions is difficult and distracting on a personal and business level.<span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"> [Getting laid off is indeed somewhat "personally distracting" - ed.]</span> On behalf of the Executive Team, I want to thank you for pulling together and giving your best effort to stay focused during these challenging times.</div><div><br /></div><div>It is important to recognize, we are battling a global recession, with impact extending across all sectors and geographies. While we are taking these measures within the North American region, we will continue to assess economic conditions and business challenges across our sector and will implement further cost measures whenever needed.</div><div><br /></div><div>I will continue to keep our lines of communication open <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[to survivors - ed.]</span>, as we proceed ahead. As we do, let’s continue to focus on our customers, as we commit to supporting one another.</div><div><br /></div><div>I remain confident in our business strategy and our collective passion to make a positive difference in health care.</div><div><br /></div><div>Best regards,</div><div><br /></div><div>Steve Rusckowski</div><div>CEO</div><div>Philips Healthcare</div></blockquote><div></div><br />I suggest that to "build a stronger organization for our future" ("our" referring to those who actually retain their positions for now), Philips management start reforms at the top. One reform would be to re-evaluate just how "expert" their experts are.<br /><br />Philips shareholders, take note.<br /><br />-- SS

Philips Medical: A Followup

In a Nov. 2008 post entitled " Who Leads in Intellectually Challenged Responses to Medical Informatics Backgrounds, The U.S. or Europe?...

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Lessons Unlearned: Health IT Failure, Act 2

The following appeared on the <a href="http://histalk2.com/2009/08/13/news-81309/">HISTalk site on 8/14/2009</a> from a writer with the screen name UCSFWatch:<br /><br /><blockquote>From <strong>UCSFWatch</strong>:<span style="color: rgb(0, 0, 255);"> “Re: UCSF CIO’s e-mail. The GE Centricity Enterprise project is in full stop mode.”</span> The attached and unverified e-mail from CIO Larry Lotenero says this: “The medical center’s Senior Management Group has engaged Kurt Salmon Associates (KSA) to assist us with a review of our IT clinical strategy. We are doing the review because we are dissatisfied with our progress to implement clinical applications to support the care of our patients. KSA will arrange interviews with many of you to capture your insights for the strategy planning. They will be on-site to begin their interviews on August 18. If KSA contacts you, I ask that you be as flexible as possible with your schedule to accommodate this process. We expect to receive a final report before November. For now, all activities associated with developing the GE clinical system should immediately be put on hold. Despite this action, we remain fully focused on our goal to complement our excellent clinical care providers with equally excellent clinical applications as soon as possible.”</blockquote><br />If true (as it likely is), I find this remarkable.<br /><br />I would have to refer to it as "UCSF Healthcare IT Failure, Act 2" for reasons just below.<br /><br />I find it remarkable that this resource- and money-wasting scenario (with possible adverse patient care repercussions) can occur:<br /><br /><ul><li>In a state that's in a severe economic crisis, </li></ul><ul><li>At an organization that failed severely in a HIT and administrative IT merger just ten years ago (in the failed, late 1990's attempted merger between UCSF and Stanford's medical centers, see the 2000 stories "<span style="font-style: italic; font-weight: bold;">UCSF/Stanford: Marriage was rough; divorce is expensive</span>" <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2000/04/24/focus4.html">here</a> and <a name="thousand"><span style=";font-family:Arial;color:brown;">"<span style="font-style: italic; font-weight: bold;font-family:georgia;">A thousand MIS personnel cannot merge two healthcare systems</span>" </span></a><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=A%20thousand%20MIS%20personnel%20cannot%20merge%20two%20healthcare%20systems">here</a>),</li></ul><ul><li>With an EHR product, Centricity, that is the descendant of Logician that others have implemented successfully (including myself, speaking from experience), </li></ul><ul><li>With GE, a major global high technology vendor, presiding over this new failure at a major academic medical center,<br /></li></ul><ul><li>With ample preventive material available in books, journals on the web about such failures (e.g., at the many pages and links <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/">here</a> and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">here</a>, as just a few examples).<br /></li></ul><br />This last point raises additional questions:<br /><br /><ul><li>Do IT managers at UCSF and GE actually read the HIT literature and the web, I wonder? Have they ever done a Google search on "<a href="http://www.google.com/search?q=healthcare+IT+difficulties">healthcare IT difficulties</a>" or "<a href="http://www.google.com/search?q=healthcare+IT+failure">healthcare IT failure</a>", or related concepts?<br /></li></ul><ul><li>Do they think the materials found via such searches frivolous, useless, or not credible?<br /></li></ul><br />Finally, it is quite remarkable that the best UCSF can do is hire yet another expensive management consulting firm to try to remediate this failure. What are UCSF IT personnel paid to do, exactly?<br /><br />Perhaps AMIA, AHRQ, HHS and others in the administration need to focus less on <span style="font-weight: bold;">new</span> research on figuring why these situations occur, and devote resources to ensuring modern knowledge of HIT failure scenarios <span style="font-weight: bold;">already extant</span> is leveraged.<br /><br />If not, we're likely (as I fear) to have a lot of UCSF Act 2's in the next few years, as organizations attempt to implement HIT by 2014 so as to not be penalized by HIT provisions in the ARRA act.<br /><br />Perhaps (again, if the HISTalk note is true), we need to bring back the likes of "Neutron Jack" (Jack Welch, well known for laying off less than stellar divisions at GE), and perhaps the Governator needs to "terminate" the roles of the leadership of this project.<br /><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPKkFydtEwFSr1xBQrpGpQ_rZYsdiD6F7MGLodU3tmu7YRQHKigYF5fE_f-l8aVkiaW81KYuuZbwQSi6qo71toXjZCFGzMVjC5QxlTQ2rfEu1HvcW-x5YwgBtcIjACGBue6sIbAOKycrC1/s1600-h/the-terminator.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371329041525853522" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPKkFydtEwFSr1xBQrpGpQ_rZYsdiD6F7MGLodU3tmu7YRQHKigYF5fE_f-l8aVkiaW81KYuuZbwQSi6qo71toXjZCFGzMVjC5QxlTQ2rfEu1HvcW-x5YwgBtcIjACGBue6sIbAOKycrC1/s320/the-terminator.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 157px; height: 200px;" /></a><span style="font-size:85%;">Gov. Schwarzenegger had a way with those<br />who fiddled around destructively with computers...</span><br /></div><br /><br /><div>See other disappointing stories about events at UCSF on this blog at <a href="http://hcrenewal.blogspot.com/search?q=ucsf">this link</a>.<br /><div><br /></div><div>-- SS</div></div>

Lessons Unlearned: Health IT Failure, Act 2

The following appeared on the HISTalk site on 8/14/2009 from a writer with the screen name UCSFWatch: From UCSFWatch : “Re: UCSF CIO’s e-m...

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Sharing with Google Groups

As more and more businesses and organizations "<a href="http://googleblog.blogspot.com/2009/08/going-google-with-google-apps.html">go Google</a>," we find that many of the features we develop based on feedback from large enterprises end up benefiting all of our users. We recently <a href="http://googleenterprise.blogspot.com/2009/08/sharing-with-groups.html">rolled out improvements</a> to the way <a href="http://groups.google.com/">Google Groups</a> interacts with several of our applications. Now, sharing <a href="http://calendar.google.com/">calendars</a>, <a href="http://sites.google.com/">sites</a> and <a href="http://docs.google.com/">documents</a> with multiple people is easy — instead of adding people one at a time, you can simply share with an entire Google Group.<br /><br />As an example, imagine you're organizing a local intramural softball team tournament. You use Google Docs to keep track of the rosters for each team as well as each team's performance.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbakI1Me2G_drSp9BSWu7u8GOiivtNEGEbOS1_TgpAN9OxHB-zFoSxzwTs1L08VV-3KDAa48TzTk5pomxJsCqODfMtWmClAGwRSStbSYU2MIWibFPzuBbC2zP0P5C8DjxKs9Ow9ComgGc9/s1600-h/1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055130392786930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbakI1Me2G_drSp9BSWu7u8GOiivtNEGEbOS1_TgpAN9OxHB-zFoSxzwTs1L08VV-3KDAa48TzTk5pomxJsCqODfMtWmClAGwRSStbSYU2MIWibFPzuBbC2zP0P5C8DjxKs9Ow9ComgGc9/s400/1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 345px;" /></a><br />You want all the players, but only the players, to have editing access. You already have a Google Group set up with the tournament participants, so you simply share the spreadsheet with the group itself, granting the group members permission to edit.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHJuGFxJv_l3vkDlwx5Lz27K154bxvH8V6kx3GuyGEsUUsjtok6EYWZVAnW2GT-PWhHxiOj3miC6hiABykkf7e38TvO2tSMTkV-Si7X9A99oxri9Xl1smqot0SPME4nmQBN7DMFulvfi8u/s1600-h/2.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055141565926946" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHJuGFxJv_l3vkDlwx5Lz27K154bxvH8V6kx3GuyGEsUUsjtok6EYWZVAnW2GT-PWhHxiOj3miC6hiABykkf7e38TvO2tSMTkV-Si7X9A99oxri9Xl1smqot0SPME4nmQBN7DMFulvfi8u/s400/2.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 280px; height: 218px;" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIP3Ars5gkI-tqkhWjbpy1rG4dBtA6UrSzy1lL9TLPp5xP3qwFjP7aryVdsxjEqTE0bKYWLcVYH65XrlbV_moQu2xp7WVI_xakazcbzXp07-gCBZ9PF0hy4ye9gdYXVqc3bCNkV3gJCH7/s1600-h/3.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055143333679058" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIP3Ars5gkI-tqkhWjbpy1rG4dBtA6UrSzy1lL9TLPp5xP3qwFjP7aryVdsxjEqTE0bKYWLcVYH65XrlbV_moQu2xp7WVI_xakazcbzXp07-gCBZ9PF0hy4ye9gdYXVqc3bCNkV3gJCH7/s400/3.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 274px;" /></a><br />Now, when people join or leave the Google Group, they will automatically gain or lose editing access to the spreadsheet. It's that easy.<br /><br />This was a feature that people wanted to "just work" — and now it does. Go ahead and try it out with your sites, calendars and documents!<br /><br /><span class="byline-author">Posted by Jeffrey Chang, Associate Product Manager, Google Groups</span>

Sharing with Google Groups

As more and more businesses and organizations " go Google ," we find that many of the features we develop based on feedback from l...

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New features and languages for Google Insights for Search

Since <a href="http://adwords.blogspot.com/2008/08/announcing-google-insights-for-search.html">launching</a> Google Insights for Search a year ago, we've been providing daily insight into what the world is searching for. Whether you're an advertiser looking to <a href="http://analytics.blogspot.com/2009/02/tips-and-tools-for-expanding-keywords.html">expand keyword lists</a>, an economist <a href="http://googleresearch.blogspot.com/2009/04/predicting-present-with-google-trends.html">analyzing economic trends</a> or just looking to settle a <a href="http://www.google.com/insights/search/#q=batman%2Csuperman%2Cspiderman&cmpt=q">popularity contest</a>, Google Insights for Search can help provide the answers.<br /><br />Looking at search trends helps you understand when, where and how the world's interests have changed. Simply type in search terms to see how search query volume has evolved over time, in which geographic regions search interest is greatest and other related searches.<br /><br />Today, we are proud to announce that Insights for Search is now available in 39 languages around the world. We're also introducing a <a href="http://googleresearch.blogspot.com/2009/08/on-predictability-of-search-trends.html">forecasting feature</a> for <a href="http://www.google.com/support/insights/bin/topic.py?hl=en&topic=13975">some queries</a> based on an extrapolation of the historical trends and search patterns. And to help you visualize these changes and trends, we've also added an <a href="http://www.google.com/insights/search/#q=Twitter&date=today%2012-m&cmpt=q">animated map</a> so you can watch how search interest changes over time in different locations.<br /><br />You can check out some of these cool features in our video below.<br /><br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/4lq98ulKNgg&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/4lq98ulKNgg&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br />Visit <a href="http://www.google.com/insights/search">Google Insights for Search</a> and see what the world is searching for. You can also keep on top of the latest trends by adding a customizable <a href="http://www.google.com/ig/adde?moduleurl=google_insightsforsearch_relatedsearches.xml&source=imag&up__results_type=RISING&up__property=empty&up__search_term=hybrid&up__location=empty&up__category=0&up__time_range=3-m&up__max_results=10">gadget</a> to your <a href="http://www.google.com/ig">iGoogle</a> page or embedding a gadget directly on your website.<br /><br /><span class="byline-author">Posted by Hal Varian, Chief Economist and Yossi Matias, Head of Israel R&D Center</span>

New features and languages for Google Insights for Search

Since launching Google Insights for Search a year ago, we've been providing daily insight into what the world is searching for. Whether...

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A University Leader's Goal: "Taking New Biotechnology ... to Market?"

An <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/17/BA3R197K8C.DTL">article</a> from the San Francisco Chronicle noted how the new Chancellor of the <a href="http://www.ucdavis.edu/index.html">University of California - Davis (UC-Davis)</a>, Linda Katehi, is already contending with controversy. One brief section about her goals for the campus caught my eye. The article noted that Dr Katehi (who has a doctorate in engineering) holds 16 patents, then:<br /><br /><br /><blockquote><br />Now Katehi wants to <em><strong>transfer that entrepreneurship</strong></em> to the campus she'll lead.<br /><br />'The campus is in a wonderful position to become <em>a major force in <strong>improving and strengthening the economy of the state</strong></em>,' Katehi told The Chronicle, adding that she'll help UC Davis to become more aggressive in <em><strong>taking new biotechnology</strong> and agriculture products <strong>to market</strong>.<br /></em></blockquote><br /><br />So it would seem that Dr Katehi's goals are making UC-Davis more entrepreneurial, strengthening the California economy, and marketing selling biotechnology products. All of that would make some sense if UC-Davis were a biotechnology company.<br /><br />However, it is not. UC-Davis, of course, is a major academic campus of the University of California system, with multiple graduate and professional schools, including a medical school. Its <a href="http://strategicplan.ucdavis.edu/mission_vision_distinction.html#mission">mission</a> is:<br /><br /><br /><blockquote><br />Through a distinctive tradition of core-discipline excellence, interdisciplinary collaborations and productive partnerships, <em>UC Davis teaches students to think critically, objectively and creatively and to be lifelong learners, engaged leaders and productive citizens</em>;<em> pursues research to advance knowledge and to address state, national and global challenges</em>; and serves the public through the <em>generation, broad dissemination and application of knowledge.</em><br /></blockquote><br /><br />The statement does mention "application" as well as dissemination of knowledge. It seems quite a stretch, though, for that one word to justify putting a priority on entrepreneurship, economic development, and marketing biotechnology products. In fact, Dr Katehi's goals seem to be far removed from, if not in conflict with the university's mission. This is just a recent example of how the leaders of academic institutions seem to be forgetting or radically deconstructing their academic missions, and in particular, how leaders of academic medicine seem to think that their job is to sell drugs and devices.<br /><br />Consider how Dr David Korn, then Senior Vice President, Division of Biomedical and Health Sciences Research of the of the Association of American Medical Colleges (AAMC), wrote that medical schools and their parent universities must confront "societal demands that they become engines of economic development," so that they must "create a precarious equipoise between the world and values of commerce and those of traditional public service." Furthermore, the government and the public, " impatient for new medicinal products, disease preventions, and cures," "fail to understand or too easily forget that in our capitalistic economy the pathway by which research invention becomes beneficial application is often totally dependent on venture capital, the availability of which commonly demands the active participation of the academic inventors in the commercial venture; put simply, no participation, no money. It is this demand, more than any other cause, that has driven the dramatic increase in medical faculty entrepreneurship." [Korn D. Conflicts of interest in biomedical research. JAMA 2000; 284: 2234-7. Link <a href="http://jama.ama-assn.org/cgi/content/full/284/17/2234">here</a>.] Thus, nine years ago, Dr Korn, and the AAMC seemed to have acquiesced to a radical restructuring of the academic medical mission to put entrepreneurship, and the development and marketing of commercial products ahead of teaching, research and patient care.<br /><br />This fundamental change of the focus on academic medicine seems to have been accepted, if not embraced by other academic leaders, like Dr Katehi. It does seem to correlate with some notable changes in how academic medical leaders think and act: devaluing the education mission and demanding that faculty put a priority on bringing in money (see post <a href="http://hcrenewal.blogspot.com/2007/04/medical-schools-to-faculty-show-me.html">here</a>); , forming their own, often highly lucrative financial relationships with health care corporations (see post <a href="http://hcrenewal.blogspot.com/2007/10/medical-school-leaders-conflicts-of.html">here</a>); acquiescing to faculty becoming "key opinion leaders" and thus supporting marketing of drugs and devices (see post <a href="http://hcrenewal.blogspot.com/2008/06/key-opinion-leaders-were-sales-people.html">here</a> and <a href="http://hcrenewal.blogspot.com/search/label/key%20opinion%20leaders">this link</a>); allowing continuing medical education to serve marketing purposes (see link <a href="http://hcrenewal.blogspot.com/search/label/continuing%20medical%20education">here</a>); allowing drug and device company sponsors of clinical research to suppress and manipulate the research (see link <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">here</a> and <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">here</a>); etc, etc. Thus it seems to underlie many of the most dysfunctional aspects of our current health care system.<br /><br />I find it hard to believe that the public really would want existing respected academic institutions to be turned into biotechnology companies, without any plans to replace their academic roles, and that it wanted faculty members to turn into product developers and salespeople. (Yes, there may be good reason for faculty who do basic science, but not clinical research to consult for health care corporations, in certain instances. But that is a relatively minor, and somewhat separate point.)<br /><br />In my humble opinion, one goal of meaningful health care reform would be to refocus academic medicine on its academic mission, and let drug and device companies alone develop and market their products.

A University Leader's Goal: "Taking New Biotechnology ... to Market?"

An article from the San Francisco Chronicle noted how the new Chancellor of the University of California - Davis (UC-Davis) , Linda Katehi,...

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Senate Investigates Hospital Group Purchasing Organizations

Almost four years ago, we <a href="http://hcrenewal.blogspot.com/2005/11/investigation-of-novation.html">posted</a> about the strange world of hospital group purchasing organizations (GPOs). These organization purchase large volumes of medical products for member hospitals, but a "safe harbor provision" in federal law allows them to charge the vendors, not the hospitals for their services. In fact, it is legal for hospitals to share in fees the vendors give these organizations, and to award contracts to vendors who pay the largest fees.<br /><br />Our 2005 post focused on allegations about the operations of a single GPO, <a href="http://www.novationco.com/">Novation.</a> We noted "several cases in which Novation's actions seemed to have denied hospitals access to the best products, or have increased, rather than ratcheted down the cost s of supplies and equipment."<br /><br />Now, the US Senate is investigating a group of the largest GPOs. <a href="http://www.nytimes.com/2009/08/14/health/policy/14purchasing.html">According to the New York Times</a>,<br /><blockquote><br />Lawmakers eager to broaden health care coverage while holding down costs are examining the institutional market for medical supplies, a largely unseen $60 billion-a-year realm where things like bedpans and heart implants change hands.<br /><br />Senators from committees like finance, judiciary and aging are investigating the practices of companies that represent big networks of hospitals, nursing homes and other institutions. <em>These group purchasing organizations select 'preferred' manufacturers and negotiate the prices of medical products, which are a closely held secret.</em> They then use a variety of carrots and sticks to make sure their hospitals buy those brands at the contracted price.<br /><br />The senators are concerned that these groups’ practices <em>may be inflating health costs at taxpayer expense. Much of the cost is borne by the government, as it reimburses hospital expenses through the Medicare program.<br /></em><br />On Wednesday, the senators sent letters to the seven biggest group purchasing organizations, known as G.P.O.’s, demanding detailed information about their business practices, including how they are paid, what services they perform besides picking brands and negotiating prices, and how their revenues are affected when an affiliated hospital buys supplies on its own instead of using the group contract.<br /><br />The senators also asked for copies of contracts, something not normally made public.<br /><br />For years, there have been <em>complaints that the buying process is opaque and unfair. The purchasing companies’ operating expenses are usually paid by the manufacturers sitting across the bargaining table, leaving them open to accusations of steering huge blocks of institutional business to the vendors willing to pay the most.<br /></em><br />The group purchasing organizations deny this, saying they award contracts on the merits and help hospitals get good deals, saving the government money.<br /><br /><em>The savings are hard to verify, because the market’s opacity makes price comparisons nearly impossible.</em><br /><br /><em>Normally, Medicare’s law against kickbacks would bar vendors from paying the companies that award them contracts, but Congress granted the industry a special 'safe harbor' many years ago, in the belief that volume purchasing saved money.</em> The senators seem to want to test that belief and perhaps change or abolish the safe harbor, something that would turn the industry on its head.<br /><br />Some of the group purchasing organizations have been in the spotlight before. Premier and <em>Novation</em> were the subject of articles in The New York Times in 2002, which prompted Congressional hearings and the issuance of an industry code of conduct. But Senate aides said they were still hearing reports of possible abuse.... </blockquote>What I wrote about group purchasing organizations four years ago still seems apt.<br /><blockquote><br />In summary, although GPOs were ostensibly set up simply to save hospitals money when purchasing supplies and equipment, these organizations have turned into huge, complicated and opaque entities whose actions are hidden, but which seem to be conveying large amounts of money back and forth among suppliers, hospitals, and the GPOs themselves. It is not at all clear that the GPOs save the hospitals money, nor get them the best possible supplies for the money they spend.<br /><br />The leaders of the hospitals, including some of the countries most prestigious teaching hospitals, that own Novation and other GPOs ought to explain what these organizations really are doing, and particularly how they are supporting the hospitals' missions.<br /><br />Again, this is another example of how opaque and unaccountable hospital leadership may be. But, the less transparent and accountable are health care leaders, the more the health care mission is at risk.<br /></blockquote><br /><br />Finally, I applaud the Senators for taking this up at this time. To have meaningful health care reform, we need to address issues such as the opacity and unaccountability of the leadership of health care organizations, particularly not-for-profit hospitals that are supposed to put their patient care (and academic, if applicable) missions ahead of enhancing their financial surpluses and their executives' compensation.<br /><br />ADDENDUM (19 August, 2009) - See interesting comments on this post, including some important information from the trade organization for group purchasing organizations.

Senate Investigates Hospital Group Purchasing Organizations

Almost four years ago, we posted about the strange world of hospital group purchasing organizations (GPOs). These organization purchase lar...

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