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Health IT Vendors Trafficking in Patient Data?

Of all of the risks regarding electronic health records, the largest is perhaps to privacy and confidentiality, and other civil liberties through the ability of information technology to rapidly duplicate and disseminate massive amounts of data. This duplication and dissemination can be performed in a controlled manner for the betterment of patient and public health, but it can also occur in a harmful manner that serves the interests of others, often without meaningful informed consent by the patients (legal jargon on typical disclosure forms that almost nobody reads or understands does not fall into what I consider "meaningful"). This can occur in, for example, the stealing of computers and computer backup disks, tape etc., which seems to be a common occurrence in the news in recent years, or through corporate processes that carry inherent risk of abuse. Here is just one recent example of both data mismanagement and theft involving not patients (by chance) but physicians themselves: <div class="story_headline"></div><blockquote style="font-family:arial;"><div class="story_headline"><a href="http://www.post-gazette.com/pg/09280/1003481-28.stm">Blue Cross: Thousands of doctors' computer data stolen</a></div> <div class="story_lastupdate">Wednesday, October 07, 2009</div> <div class="story_byline">By Bill Toland, Pittsburgh Post-Gazette</div> Tens of thousands of doctors under contract with Pittsburgh's Highmark Inc. are being notified that their personal information, including Social Security numbers or tax ID numbers, may have been compromised when a laptop containing sensitive data was stolen from a Blue Cross-Blue Shield Association employee. Physicians and specialists in western and central Pennsylvania are being notified of the breach this week, according to a Highmark spokesman. Across the country, the number of affected doctors is expected to reach the hundreds of thousands once a review of the theft is complete, said national Blue Cross-Blue Shield Association spokesman Jeff Smokler. The stolen computer did not contain patient information. [Simply due to luck -ed.] The letter sent to Highmark providers said "a BCBSA employee [transferred] provider data information onto a personal laptop, in violation of BCBSA's established data security policies.</blockquote> I have recently become aware of an example of purposeful corporate healthcare data trafficking that gives me pause. Cerner’s LifeSciences <a href="http://www.cerner.com/public/filedownload.asp?LibraryID=36854">traffics in patient data</a> taken from the EMRs its company sells to healthcare organizations. See the document below. They advertise: <blockquote>Cerner LifeSciences’ data warehouses and consulting services help you manage your R&D opportunity through Cerner’s analytical solutions. Through our data mining of our vast warehouse of electronic health records (EHRs), you can accelerate development processes and reduce business risks. Each year, new compounds debut new abilities or first-in-class molecules. Far more common are new compounds that target the same receptors as compounds already in the market ... This is when Cerner LifeSciences makes it possible to analyze anonymous, HIPAA-compliant, EHR-derived data for efficacy and safety. </blockquote> Cerner apparently includes contract language with their HIT customers that allows them to traffic in "de-identified" patient data for sale to drug companies and others, getting the data essentially as a "value add" (to the HIT vendor, that is) from its healthcare IT customers. (The flyer below does not indicate pricing of healthcare data, but it's likely substantial.) <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBCPzr_1pknEEBMjkdunC3RxoXOGScAax4EYuyE_3OCXCsxtI_7AvblP_ztLpi7hEJ_tiXI62uWpw6KcbB-W4hcWZYytdLoDq8VSXrr64fu9y1_w5WUU8hIeLNES6BJdkJQWb7AdpPABbm/s1600-h/cerner_data.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389847579833593810" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBCPzr_1pknEEBMjkdunC3RxoXOGScAax4EYuyE_3OCXCsxtI_7AvblP_ztLpi7hEJ_tiXI62uWpw6KcbB-W4hcWZYytdLoDq8VSXrr64fu9y1_w5WUU8hIeLNES6BJdkJQWb7AdpPABbm/s320/cerner_data.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 228px; height: 288px;" /></a>A major HIT vendor selling patient data to anyone who wants it. Click to enlarge. (Full copy is at <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=feb600bc1eca4fb3b1b18b15975909cb&URL=http%3a%2f%2fwww.cerner.com%2fpublic%2ffiledownload.asp%3fLibraryID%3d36854">this link</a> in PDF format). </div> This practice raises numerous questions: <ul><li>Meaningful informed consent issues: as an example, of 1000 patients at one of the facilities using this vendor's HIT products, what percentage would be able to tell me they know their data is being trafficked to pharmaceutical companies and other organizations for profit?</li></ul><ul><li>Healthcare data ownership and stewardship issues: who, exactly, extracts the data for aggregation and sale? Hospital employees properly trained and bonded (i.e., Healthcare Information Management professionals) regarding privacy of patient data? IT personnel lacking such credentials and experience? HIT vendor employees?</li></ul><ul><li>De-identification issues: what processes are being used to de-identify data? Who is performing it? At some point before the data is de-identified, it is protected information in identifiable form. Is access to the data during de-identification audited in any way, and if so, by whom? If not, why not? (Also see article on re-identification below.) </li></ul><ul><li>Legal issues: who is, by contract, liable for data breaches that occur in the transfer process?</li></ul><ul><li>Fiduciary issues: as I expressed in my July 22, 2009 JAMA letter to the editor regarding "vendor hold harmless" and IT defects gag clauses, are hospital executives further violating their fiduciary responsibilities by signing HIT contracts that surrender ownership of patient data to third parties? (see my posts "<a style="font-style: italic;" href="http://hcrenewal.blogspot.com/2009/07/health-care-information-technology.html">JAMA letter: Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>" and "<a style="font-style: italic;" href="http://hcrenewal.blogspot.com/2009/07/inquiry-to-joint-commission-on-points-i.html">Inquiry to Joint Commission on points I raised in my JAMA letter on HIT</a>" for more on those issues.</li></ul><ul><li>Pharma integrity issues: with the many stories on this blog and others about ethically questionable pharma practices such as <a href="http://hcrenewal.blogspot.com/search/label/ghost%20writing">ghostwriting</a>, <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">manipulation of clinical research</a>, <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">suppression of research</a>, pushing drugs on physicians and patients for unapproved <a href="http://hcrenewal.blogspot.com/search?q=unapproved">off-label </a>uses, etc., what are these organizations going to do with the data? Who will have access to it, and will their access be audited? Are they going to resell it? Might they try to re-identify data to locate individuals of interest? And so forth. </li></ul> Serious consideration of these issues in vendor-led healthcare data trafficking becomes more imperative in the face of just how easy it is to "re-identify" data: <blockquote>Ohm, Paul: "Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization" (August 13, 2009). University of Colorado Law Legal Studies Research Paper No. 09-12. Available at SSRN: <a href="http://ssrn.com/abstract=1450006">http://ssrn.com/abstract=1450006</a> Abstract: Computer scientists have recently undermined our faith in the privacy-protecting power of anonymization, the name for techniques for protecting the privacy of individuals in large databases by deleting information like names and social security numbers. These scientists have demonstrated they can often 'reidentify' or 'deanonymize' individuals hidden in anonymized data with astonishing ease. By understanding this research, we will realize we have made a mistake, labored beneath a fundamental misunderstanding, which has assured us much less privacy than we have assumed. This mistake pervades nearly every information privacy law, regulation, and debate, yet regulators and legal scholars have paid it scant attention. We must respond to the surprising failure of anonymization, and this Article provides the tools to do so. </blockquote> Further, Cerner is digging deeper into the life sciences, licensing its "Discovere" system to clinical trials vendor such as <a href="http://www.quintiles.com/">Quintiles Transnational</a> (<a href="http://kansascity.bizjournals.com/kansascity/stories/2009/09/28/daily41.html">link</a> to story in Bizjournals.com): <blockquote>Quintiles will use Cerner’s Web-based Discovere product, whose features include the ability to integrate data from study participants and site researchers and increase data quality by reducing transcription errors, the companies said in a release. A Cerner spokeswoman said the company isn’t disclosing financial terms of the deal.</blockquote> According to <a href="http://histalk2.com/2009/10/04/monday-morning-update-10509/">an entry</a> at HISTalk, part of "Discovere" is the former First Genetic Trust technology that Cerner bought some time ago. Quintiles signed an agreement with Cerner back in 2001 and took an equity position in it. The Discovere modules include biobanking, research registries, public health investigator workflow, clinical trials management, and adverse event reporting. Is Cerner also selling HIT-gleaned patient data to Quintiles and other CRO's (clinical research organizations)? Other HIT vendors are sure to follow in Cerner's footsteps for competitive reasons, if not already doing so. Another major issue: HIT vendors like this are devoting resources to profit from medical data, diverting resources from their core business. Might health IT vendors make better use of their resources, such as improving the core products they sell to hospitals and clinicians, avoiding the "mission hostile user experience" I wrote about in <a href="http://tinyurl.com/hostileuserexper">this eight part series</a>? Might they devote resources to solving problems that are affecting entire national health IT programs, instead of peddling data from the systems they have managed to implement to third parties? From the UK's experiences as recorded in 2007 by the former head of their National Program for HIT in the NHS (NPfIT): <blockquote>Richard Granger has said he was “ashamed of the quality of some of the systems put into the NHS by Connecting for Health suppliers”, singling Cerner out for criticism (<a href="http://www.e-health-insider.com/news/item.cfm?ID=2854">link</a>). Going further than he before in acknowledging the extent of failings of systems provided to some parts of the NHS - such as Milton Keynes – the Connecting for Health boss, said "Sometimes we put in stuff that I'm just ashamed of. Some of the stuff that Cerner has put in recently is appalling."</blockquote> As recorded in Jan. 2009 by the <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">UK House of Commons - Public Accounts Committee</a> : <blockquote> ... Termination of Fujitsu's contract has caused uncertainty among Trusts in the South and new deployments have stopped. One option: have a choice of either Lorenzo or [Cerner] Millennium. There are, however, considerable problems with existing deployments of [Cerner] Millennium and serious concerns about the prospects for future deployments of Lorenzo. ... Programme not providing value for money at present because there have been few successful deployments of the [Cerner] Millennium system and none of Lorenzo in any Acute Trust. Trusts cannot be expected to take on the burden of deploying care records systems that do not work effectively … the Department should assess the financial case for allowing Trusts to put forward applications for central funding for alternative systems compatible with the objectives of the Programme.</blockquote><p:colorscheme colors="#ffffff,#000000,#808080,#000000,#bbe0e3,#333399,#009999,#99cc00"><div shape="_x0000_s1026"><div class="O1" style=""> </div></div></p:colorscheme>Most recently, in the UK Cerner's Millennium product is blamed for the jump from 1,700 to 23,000 patients <a href="http://www.e-health-insider.com/news/5260/barts_18_week_backlog_in_thousands">whose referrals don’t meet the 18-week target from referral to treatment</a> at Barts and the London NHS trust. Should HIT vendors be devoting resources to data peddling, instead of focusing on their core mission to produce usable HIT that can facilitate healthcare professionals in providing care? Finally, as an added item of interest, our current healthcare "czar", <a href="http://en.wikipedia.org/wiki/Nancy-Ann_DeParle">Nancy-Ann DeParle</a> was on the board of Cerner just prior to appointment in the current administration. All of these issues considered, while I am not implying improprieties current or future, the possible permutations of problems in the resale of clinical data by HIT vendors potentially created by careless data stewardship, profit motive, conflict of interest, malevolent motives, etc. is endless. If there ever were a scenario for civil liberties groups to explore, it's this one. -- SS addendum on HIT quality and COI issues: found this at <a href="http://histalk2.com/2009/10/06/news-10709/">HISTalk</a> as well: <blockquote> IT outsourcing puts MU Health at risk An associate professor of pathology at University of Missouri <a href="http://www.columbiatribune.com/news/2009/oct/06/it-outsourcing-puts-mu-health-at-risk/">criticizes</a> his employer’s decision to outsource to Cerner … A simple Internet search turns up a plethora of complaints and reports of lawsuits regarding the effectiveness of Cerner’s software and, more important, its failure to provide requested support. The pattern of receiving untested software has been a recurring problem at this institution ... ... University <st1:placetype st="on">Hospital</st1:placetype>’s success depends largely on the effectiveness of the people in information technology. In the past on two occasions, the billing was so flawed the hospital faced serious fiscal problems. The most recent one was in 2002, when the hospital’s viability was threatened. The major issue was the inability to produce accurate and timely billings, which cost the system millions of dollars. <st1:place st="on"><st1:placetype st="on"></st1:placetype></st1:place> [where have I seen that before? How about: <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Insufficient%20IT%20management">here</a> (Yale) and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=miami">here</a> - ed.] ... The medical school’s administrative residency program is on probation and is undergoing critical review; a major factor is that the Cerner system is so cumbersome that resident training is compromised … Three years ago, the radiology department dropped a Cerner software program because it was seriously flawed.” ... [UM President] Forsee has several business and personal ties to the company (Cerner). Forsee and Cerner CEO Neal Patterson serve together on at least two boards of trustees, and online records indicate Forsee’s son-in-law, Brandon Bell, works for Cerner.” </blockquote> If this all is true, I believe the problems with HIT in general are no better now, and probably worse, than when I started <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">writing about such issues</a> a decade ago. I rest my case on whether the HIT vendors should focus on solving basic quality, usability and efficacy issues before peddling data ... -- SS

Health IT Vendors Trafficking in Patient Data?

Of all of the risks regarding electronic health records, the largest is perhaps to privacy and confidentiality, and other civil liberties th...

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Making intranets more like the Internet with enterprise search

Employees at big companies often have mountains of information available to do their jobs — information that lives (and hides!) in various areas within the organization. The information can lie buried deep within an enterprise content management system or a company intranet. Unlike the Internet, however, this info isn't necessarily well organized — there isn't always a searchable index to sift through and get good results. Lots of companies want to make searching their intranet more like searching the Internet — bringing Google.com-type search to their internal information stores. <a href="http://www.mercer.com/homepage.htm?siteLanguage=100">Mercer</a>, the global professional services company, has been dealing with this issue for a while. Their intranet, Mercer Link, has more than 350,000 webpages, and over 1.5 million docs in a content management system— lots of information for employees to search through as they work on projects for clients. They're now using the <a href="http://google.com/gsa">Google Search Appliance</a> to give employees a more searchable intranet experience, so the docs and pages that were hidden or hard to find are now easier to track down fast. Mercer's enterprise search architect Haroon Suleman, along with AMR Research's Jim Murphy, will be sharing the company's search story in a <a href="https://googleonline.webex.com/mw0305l/mywebex/default.do?nomenu=true&siteurl=googleonline&service=6&main_url=https%3A%2F%2Fgoogleonline.webex.com%2Fec0600l%2Feventcenter%2Fevent%2FeventAction.do%3FtheAction%3Ddetail%26confViewID%3D531993315%26siteurl%3Dgoogleonline%26%26%26">special webinar</a> aimed at enterprises, "Search: A Vital Element to a Content Strategy," this Thursday, October 8 at 11 a.m. PDT. You can register and learn more about the conversation here — hope you can join.<div> Posted by Vijay Koduri, Google Enterprise Search team</div>

Making intranets more like the Internet with enterprise search

Employees at big companies often have mountains of information available to do their jobs — information that lives (and hides!) in various a...

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What is a browser?

I've been trying to explain to my mom for months what a web browser is, with little luck. After a few rounds of failed attempts, I grew curious about people's general understanding of web browsers. So I decided to conduct a highly-scientific (read: not scientific at all) survey of my friends and got the following results: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh788wGCnw0HNOsQwcGeBMDp4YSRrAd8CATCuRDNqYtXWHUZ9fGY9TV_hElLpMHdwa5onoOU6j34K1ydWVlrq4C-nyOFoDs4H6uxN21TcqiF3UkXec2axsyDYBhS1k8bNJsdbXPWWD5rueG/s1600-h/graphs3.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389526490029738098" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh788wGCnw0HNOsQwcGeBMDp4YSRrAd8CATCuRDNqYtXWHUZ9fGY9TV_hElLpMHdwa5onoOU6j34K1ydWVlrq4C-nyOFoDs4H6uxN21TcqiF3UkXec2axsyDYBhS1k8bNJsdbXPWWD5rueG/" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 550px; height: 168px;" /></a> As it turns out, <a href="http://www.youtube.com/watch?v=o4MwTvtyrUQ">my mom's not the only one</a> who is confused about web browsers — even though the browser is one of the most-used programs on computers. For my mom, my friends and everyone else who may be wondering about web browsers, I created a one minute video to help explain what they're all about about: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/BrXPcaRlBqo&hl=en&fs=1&rel=0&cc_load_policy=0&showinfo=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/BrXPcaRlBqo&hl=en&fs=1&rel=0&cc_load_policy=0&showinfo=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> I've also created a simple site, <a href="http://www.whatbrowser.org/">WhatBrowser.org</a>, that gives even more information about browsers. On this site, you can see which web browser you're using, explore links to browser diagnostic tests and read some useful tips for getting the most out of your browser. Lots of our time each day is spent online, and every page on the web is experienced through the browser. Unfortunately, most people don't realize that there are many browsers out there, which differ on features like speed, security and extensibility. So, the next time you find yourself as the informal tech support for your family and friends, make sure to explain why their browser matters — and of course, what it is! Posted by Jason Toff, Associate Product Marketing Manager and son of Alla Toff

What is a browser?

I've been trying to explain to my mom for months what a web browser is, with little luck. After a few rounds of failed attempts, I grew ...

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Fall update on Google Health

We're still hard at work improving <a href="https://www.google.com/health">Google Health</a>, our online Personal Health Record (PHR). We've gotten valuable feedback from many of you who are importing data into Google Health from connected providers. We often hear that you want to import data from your health insurance plans, so we're working on just that. Today, at the <a href="http://www.health2con.com/sf2009/">Health 2.0 conference</a> in San Francisco, we're announcing the addition of two new health insurance companies to the Google Health platform: <a href="https://www.harvardpilgrim.org/portal/page?_pageid=213,277133&_dad=portal&_schema=PORTAL">Harvard Pilgrim Health Care</a> and the <a href="https://googlehealth.apwuhp.com/landing.aspx">American Postal Workers Union Health Plan (APWU Health Plan)</a>. The <a href="http://www.apwuhp.com/">APWU Health Plan</a>, the not-for-profit department of the American Postal Workers Union, now offers Google Health through their High Option PPO plan. Members get 18 months of data copied into their Google Health Account upon linking their member portal with Google Health and then automatic updates from that point on. <a href="https://www.harvardpilgrim.org/portal/page?_pageid=213,49561&_dad=portal&_schema=PORTAL">Harvard Pilgrim Health Care</a> serves more than one million members across Massachusetts, Maine, New Hampshire and beyond and roughly 777,000 of their members who use the HMO, POS and PPO products can securely import their Harvard Pilgrim health history into Google Health. This includes prescription data used in the last year and any records on illnesses, conditions, procedures and immunizations dating back to 2006. Once a member links his health plan portal account with Google Health, his data will be automatically updated when a new claim is generated by a physician. With these new additions and <a href="https://www.bluecrossma.com/GoogleHealth/?activity=enroll&source=google">Blue Cross Blue Shield of MA</a>, which joined in December of 2008, we now have three health insurance plans that are connected to Google Health and actively promoting it as a PHR option to their members. We'll be studying how useful this data is to our users, as we've learned that <a href="http://googleblog.blogspot.com/2009/04/listening-to-google-health-users.html">some data is not as useful as others</a>. We're also working with companies that offer unique "convenience" services, such as secure email and video consultations with doctors. One example is a company called <a href="https://www.mdlivecare.com/">MDLiveCare</a>, a telehealth provider now available in the Google Health online services directory. MDLiveCare is helping to empower patients by sending the complete doctor's clinical note to Google Health from any consultation a patient has with their network of oncall board certified doctors and licensed mental health therapists. <a href="http://hellohealth.com/">Hello Health</a> is another example of a company that facilitates connecting with a doctor online and is launching with Google Health today. Also, in case you missed our updates, here are some <a href="http://www.google.com/intl/en-US/health/whatsnew.html">improvements</a> we worked on over the summer: <ul><li>File Upload: Still dealing with paper files at home? You can now upload files you have scanned or have on your computer, such as test results you previously received in the mail. Each file you upload can be anywhere from 4MB to 100MB. Start by completing and uploading an <a href="http://googleblog.blogspot.com/2009/07/plan-ahead-document-and-share-your.html">advance directive</a>. </li><li>Insurance Information: You can now store all of your health insurance information in your Google Health profile, including your plan name, plan ID, group number, subscriber and policy ID and member phone number. </li><li>Graphing: Keep track of your test results visually to see how key numbers progress over time. If you have more than one cholesterol lab result saved in your profile, you can view these results over time in a graph and track your progress. </li></ul>Keep tuning in to find out what's in store for Google Health in 2010. And keep the <a href="http://productideas.appspot.com/#16/e=2684d">feedback</a> coming. We're still learning a lot from all of you. Posted by Roni Zeiger, M.D., Product Manager

Fall update on Google Health

We're still hard at work improving Google Health , our online Personal Health Record (PHR). We've gotten valuable feedback from many...

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Google PowerMeter's first device partner

Today, we're very excited to announce we have secured our first official device partner. (That means having a smart meter installed by your utility is no longer a prerequisite for using Google PowerMeter!) For the last several months, a few hundred Google employees have been testing a number of in-home electricity monitoring devices. Those of us lucky enough to have one of these devices installed in our homes experienced first-hand how access to high-resolution <a href="http://www.eci.ox.ac.uk/research/energy/downloads/smart-metering-report.pdf">energy use information drives meaningful behavior change</a> (PDF). So we set out to make that data easier for everyone to access and understand by sending the collected data to our <a href="http://www.google.org/powermeter">Google PowerMeter</a> software. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeR6niGdSyrRLq7RYuGVBmUNQadqKK9nvROUWEwc4XKQhV5bilL-6KlGC4vseYeN7HTzTRzGOiJS1UqxAONN0X-pNZ0heZ9XZ967V9dl2wozxuJehjQ5ekXKC-ICdh-GzNZIrKv8J5u9rV/s1600-h/green1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389252974829879858" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeR6niGdSyrRLq7RYuGVBmUNQadqKK9nvROUWEwc4XKQhV5bilL-6KlGC4vseYeN7HTzTRzGOiJS1UqxAONN0X-pNZ0heZ9XZ967V9dl2wozxuJehjQ5ekXKC-ICdh-GzNZIrKv8J5u9rV/s200/green1.png" style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 97px; height: 200px;" /></a> The TED 5000 from Energy Inc. is an energy monitor that measures electricity usage in real-time (TED stands for "<a href="http://www.theenergydetective.com/index.html">The Energy Detective</a>"). As of today, we're pleased to announce that anyone in North America can <a href="http://www.theenergydetective.com/ted-5000-overview.html">purchase and install the TED 5000</a> and see personal home energy data using our free software tool, Google PowerMeter, from anywhere you can access the web including through <a href="http://googlemobile.blogspot.com/2009/06/snack-time-with-new-igoogle-for-android.html">iGoogle for mobile phones</a>. (If you already have a TED 5000, you can download a free <a href="http://www.theenergydetective.com/ted-5000-firmware-upgrade.html">firmware upgrade</a> to enable this functionality.) Combined with Google PowerMeter, the TED 5000 device can help you understand your electricity usage to save energy and money. Energy Inc. is just our first device partner and if you are working for a company that manufactures energy monitors, we'd like to <a href="https://services.google.com/fb/forms/powerreaderdevice/">hear from you</a>. Stay tuned for more! Posted by Tom Sly, New Business Development & Charles Spirakis, Software Engineer

Google PowerMeter's first device partner

Today, we're very excited to announce we have secured our first official device partner. (That means having a smart meter installed by y...

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A Board of Trustees, or a Social Club for the Superclass?

We just <a href="http://hcrenewal.blogspot.com/2009/10/trustee-of-what-caliber-for-hospital.html">posted</a> about the unlikely appointment of one Mr Robert K Steel as a trustee of the Hospital for Special Surgery in New York. Mr Steel appears to have no particular expertise or experience in health care, and no special affinity for its values. On the other hand, Mr Steel was briefly the CEO of Wachovia who presided over that company's demise, despite his avowed goal of keeping it independent. Previously, he served as an Under Secretary of the Treasury during Secretary Henry Paulson's controversial bail-out of financial institutions. He also was Chairman of the Board of Trustees of Duke University during the time of the lacrosse scandal, and pledged his full support to the actions of its President (whom he had a personal role in hiring), including those that seemingly put preserving the Duke brand ahead of protecting the rights of its students. Why would such a person be appointed to the board of a prestigious teaching hospital? Maybe he was seen as a good fit. The hospital board has 42 members in addition to its CEO ex-officio. Of these, 13 are physicians, and 29 are "civilians." Of the latter 29, 23 by my count have major relationships, and frequently have current or past leadership roles in financial companies, some of which were recipients of recent Treasury Department bail-outs. Thus, a majority of all board members come from finance. In addition, 7 of the 13 physician board members have financial relationships with health care corporations that might be construed as conflicts of interest. The details are below: Non-Physician Board Members Atiim "Tiki" Barber (sports broadcaster) James M Benson - retired chairman of John Hancock Life Insurance; retired Chairman, President and CEO of New England Financial and of GenAmerica Financial Corporation Peter L Briger Jr - Principal and Co-Chairman, Fortress Investment Group Michael C Brooks - Partner, Venrock Charles P Coleman III - Tiger Global Management Leslie Cornfeld (deputy US Attorney) Cynthia Foster Curry (spouse of owner of Toyota dealer) Barrie M Damson - President and Chair, Damson Financial Resources Inc James G Dinan - Chairman and CEO, York Capital Management Winfield P Jones (attorney) Monica Keany - managing director, Morgan Stanely David H Koch - executive vice president and member, board of directors, Koch Industries (a conglomerate that provides "commodity and financial trading services" among other products and services) Lara R Lerner - spouse of Randolph Lerner, former CEO of MBNA, which he sold to Bank of America, now has family holdings (>$1 billion in 2008) of Bank of America stock Marylin B Levitt - spouse of Arthur Levitt Jr, former chair of the SEC, now advisor to AIG and the Carlyle Group Alan S MacDonald - chief client officer, Citigroup David M Madden - founder and principal of Narrow River Management (investment management company that focuses on pharmaceutical companies) Richard L Menschel - senior director, Goldman Sachs (in 2002) Dean R O'Hare - retired CEO of Chubb Corporation, director of DFA Capital Management Aldo Papone - retired chairman of American Express Travel Related Services Gordon Pattee - President, MAP Capital Corp Charlton Reynders Jr - Chairman and CEO, Reynders Gray Co Susan W Rose (philanthropist) William R Salomon - honorary chairman, Citigroup Jonathan Sobel - Global Head of Risk Management, Investment Management Division, Goldman Sachs Robert K Steel - retired CEO, Wachovia (see above) Daniel G Tully - founding partner and managing director, Altaris (investment company focused on "healthcare industry") Mrs Douglas A Warner III - spouse of former chairman of JP Morgan Chase, current director of General Electric (which has both health care and finance divisions) Kendrick R Wilson III - former executive, Goldman Sachs Ellen M Wright (occupation not clear) Physician Board Members Mathias P Bostrom MD - consultant for Smith & Nephew Richard A Brand MD - Charles N Cornell MD - royalties from Exactech Melvin J Glimcher MD - Steven R Goldring MD - member, board of directors, Telik David L Helfet MD - member of advisory boards, OHK Medical Devices Inc, Healthpoint Capital, Orthobond Corp Carl F Nathan MD - Stephen A Paget MD - consultant to Medarex, Crescendo Bioscience Scott Rodeo MD Thomas P Sculco MD - royalties from Exactech Russell F Warren MD - chairman of the board, Highlands Acquisition Corp, chairman of the scientific advisory board, chief scientific officer, principal member of the investment committee, Ivy Capital Partners, board of directors, Orthonet, royalties from Biomet, member of scientific advisory board, Cayenne Medical, member of scientific board of advisors, HealthPoint Capital, royalties from Smith & Nephew Torsten N Wiesel MD - Philip D Wilson Jr MD - Summary As we have written previously, boards of trustees of not-for-profit health care organizations are supposed to supervise the management of these organizations, making sure it is prudent, and upholds the organizations' missions. Boards have duties to exercise reasonable care, avoid conflicts of interest, and again, uphold their organizations' missions. Thus, ideally, boards should be composed of people most likely to fulfill these duties. In the real world, current board members usually have sole authority to appoint new board members. Thus it may be all too tempting to make fit with the current board members the main criterion for appointment of new board members. We have posted about university and hospital boards which have pluralities or majorities of members from the finance sector. Such remarkable homogeneity suggests that they picked new board members because of their similarity to current board members. (For example, see posts about the boards of <a href="http://hcrenewal.blogspot.com/2009/09/why-have-governing-boards-forsaken.html">Dartmouth</a>, <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">Harvard</a>, and <a href="http://hcrenewal.blogspot.com/2009/04/hedge-fund-u.html">Yeshiva</a> Universities, and of <a href="http://hcrenewal.blogspot.com/2009/01/to-whom-did-scorpions-in-bottle-owe.html">Partners Healthcare</a>.) Thus, the boards of prestigious not-for-profit health care organizations may come to resemble social clubs for the superclass more than collections of passionate defenders of the progress of health care. It is hard to imagine how boards packed with finance industry executives would be the best upholders of academic and health care values, especially after the shortcomings of many finance industry leaders became so obvious in the global financial meltdown/ great recession. If health care is to become more affordable, more accessible, of greater quality, and less demoralizing for health care professionals, health care organizations need leaders known for their devotion to putting patients first rather than their devotion to socializing with their cronies.

A Board of Trustees, or a Social Club for the Superclass?

We just posted about the unlikely appointment of one Mr Robert K Steel as a trustee of the Hospital for Special Surgery in New York. Mr Ste...

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A Trustee of What "Caliber" for the Hospital for Special Surgery

The <a href="http://www.hss.edu/about.asp">Hospital for Special Surgery </a>in New York, a prestigious institution focused on orthopedics and rheumatology, closely affiliated with Weill Cornell Medical College, just announced its newest trustee, whose qualifications for the position turn out to be just a wee bit curious. Here they are as described by <a href="http://au.sys-con.com/node/1121412">the press release</a>: He is a former CEO of Wachovia <blockquote> Hospital for Special Surgery announced today that Robert K. Steel, former President and Chief Executive Officer of Wachovia Corporation, has been named a member of the hospital's Board of Trustees. Steel facilitated Wachovia's merger with Wells Fargo to create the second-largest retail brokerage in the country. </blockquote> Before then, he served in the Treasury Department <blockquote> Prior to running Wachovia, Steel served in the U.S. Treasury Department as Under Secretary for Domestic Finance, a Senate-confirmed position. In that role, he was the principal adviser to Secretary Henry Paulson on matters of domestic finance and led the department's activities regarding the domestic financial system, fiscal policy and operations, and governmental assets and liabilities. Steel brings a wealth of experience to the Hospital for Special Surgery Board. He regularly testified before House and Senate Committees on matters such as reform at Fannie Mae and Freddie Mac, foreclosure prevention, and the rescue of Bear Stearns. </blockquote> Before then, he was a leader at Goldman Sachs <blockquote> Steel spent almost 30 years at Goldman Sachs, rising to vice chair of the firm. </blockquote> He was also chairman of the board of Duke University <blockquote> In 2009, Steel completed his term as chair of the board of Duke University. </blockquote> The other members of the Hospital for Special Surgery board were delighted by Steel's qualifications: <blockquote> 'All on the Board of Trustees are delighted to have someone of the caliber of Robert Steel join us to help guide the future of our institution as a leader in orthopedics, rheumatology and their related disciplines,' said Aldo Papone, Co-Chair of the Board of Trustees at the Hospital for Special Surgery. Hospital Board Co-Chair Dean R. O'Hare added, 'As patients continue to seek the Hospital for Special Surgery's world class services in record numbers, we are very pleased Robert Steel is here to support this institution and the superb team of people who work here.' </blockquote> Setting aside the obvious issues that Mr Steel seems to have no particular knowledge of or training in medicine or health, and nothing in the press release suggests he has particular devotion to the values of health care, what do his cited qualifications really mean? Let's go through them in the order they were mentioned above. Former CEO of Wachovia In fact, Steel became CEO of Wachovia in July, 2008, only to soon preside over the company's failure and its hurried merger with Wells Fargo. As <a href="http://www.nytimes.com/2008/09/27/business/27bank.html">reported by the New York Times</a>, by September, 2008, Steel had to give up any hopes of keeping Wachovia independent, <blockquote> As concern spread Friday that more banks might run into trouble even with a $700 billion rescue for the financial system, Wachovia, one of those hardest hit by the housing crisis, became the latest to reach for a lifeline. Weighed down by a huge portfolio of troubled mortgage loans, the nation’s fourth-largest bank by assets entered into preliminary deal talks with Citigroup, and extended feelers to Wells Fargo and Banco Santander of Spain.... In July, the bank hired Robert K. Steel, 56, a former vice chairman at Goldman Sachs, from the Treasury Department, where he worked with Treasury Secretary Henry M. Paulson Jr., trying to resolve the mortgage market crisis. Mr. Steel vowed to keep Wachovia independent and sought to raise $5 billion in capital over the next year by selling noncore assets. </blockquote> The deal with Citigroup fell through, and Wachovia was <a href="https://www.wellsfargo.com/press/2009/20090101_Wachovia_Merger">taken over by Wells Fargo </a>on January 1, 2009. So although Wachovia's portfolio of doubtful mortgages was not the fault of Robert K Steel, he did not succeed in his vow of independence proved to be hollow. Furthermore, questions were raised about Mr Steel's overly optimistic predictions about Wachovia's financial conditions just before the company had to enter into merger talks. As <a href="http://query.nytimes.com/gst/fullpage.html?res=9F04E7D91730F933A0575AC0A96E9C8B63">reported by the New York Times </a>on September 30, 2008: <blockquote> 'Jim, we have a great future as an independent company,' Robert K. Steel, Wachovia's chief executive, told James Cramer on CNBC's 'Mad Money.' 'We're also focused on very exciting prospects when we get things right going forward. I didn't have time today to talk about the good things going on at Wachovia.' That interview wasn't last month or last year -- it took place, amazingly, two weeks ago. Wachovia's shares closed at $10.71 that day. On Monday, Citigroup bought the company for $1 a share. What was Mr. Steel thinking? Did he think he could 'spin' his way to survival? On Mr. Cramer's show Monday night, he spent an entire segment apologizing to his viewers about having Mr. Steel on the program and for his own bullish call on Wachovia's stock. 'I screwed up,' he said, referring at one point to Mr. Steel as a friend for 25 years. 'I believed in the guy. Did he take advantage of me? Perhaps yes.' </blockquote> Early this year, the <a href="http://online.wsj.com/article/SB123275454114111651.html">Wall Street Journal reported </a>that these remarks lead to an investigation by the US Securities and Exchange Commission (SEC): <blockquote> The Securities and Exchange Commission is investigating remarks that former Wachovia Corp. Chief Executive Robert K. Steel made about the future of the bank the day before it started talks about a potential merger.... Among the issues under scrutiny is whether Mr. Steel, 57 years old, misled investors when he appeared on CNBC's 'Mad Money' program on Monday, Sept. 15. The next day, Sept. 16, Wachovia's board met by telephone to discuss strategic options for the company, including raising money, selling core businesses and merging with another company, according to an SEC filing. On Sept. 17, Mr. Steel called Morgan Stanley CEO John Mack to discuss a potential merger, according to people familiar with the matter. By the week of Sept. 22, under pressure from regulators and with customers starting to withdraw deposits, Mr. Steel was immersed in merger negotiations with Citigroup Inc. and Wells Fargo & Co. executives, according to regulatory filings and people familiar with the matter. After initially agreeing to sell its banking operations to Citigroup, Wachovia on Oct. 3 agreed to sell the full company to Wells Fargo. </blockquote> So although Mr Steel could not be blamed for the unfortunate financial position of Wachovia on the day he took over as CEO, he failed in his goal of keeping the company independent, and questions have been raised as to whether his overly optimistic comments just before merger negotiations began misled investors. Thus, his brief performance as leader of Wachovia does not seem something to boast about as a qualification to be a trustee of the Hospital for Special Surgery. Under Secretary of the Treasury For Finance Mr Steel was appointed to his post at the Treasury Department by Henry Paulson. Mr Steel seemed to have a major role in the Paulson Treasury Department's response to the global financial meltdown of 2008. Criticism of Paulson and his department's response to the crisis is so well-known that we need not repeat it here. In response to the discussion in the news release above about Steel's testimony before congress, it is worth quoting a <a href="http://www.nytimes.com/2008/04/04/business/04scene.html">New York Times article </a>about a hearing that took place after the bail out of Bear Stearns, but before the crisis became full-blown. <blockquote> 'How do we guard against a future Bear Stearns,' asked Senator Charles E. Schumer. 'Was someone asleep at the switch?' </blockquote> Later, <blockquote> Did Henry M. Paulson Jr., the Treasury secretary, mandate a rock-bottom price for Bear? 'What did you know and when did you know it,' [Senator Christopher] ... Dodd asked, his voice loud as he pressed Mr. Bernanke, Mr. Steel and Mr. Geithner for an answer. Mr. Steel and Mr. Geithner were artful and vague in their responses.... </blockquote> And just a few days ago, a story emerged that Paulson's plans to force a merger of Wachovia and Goldman Sachs failed because of the multiple conflicts of interest involved, including those affecting Mr Steel (as <a href="http://www.bloomberg.com/apps/news?pid=20601087&sid=aDuX0FiPrFA4">per Bloomberg News</a>): <blockquote> Paulson, the CEO at Goldman Sachs until mid-2006, contacted current CEO Lloyd Blankfein and an unidentified Wachovia director, urging them to consider a combination, Sorkin reported. Goldman Sachs co-President Gary Cohn and Wachovia CEO Robert Steel -- a former vice chairman at the New York investment bank and an undersecretary to Paulson at Treasury -- thought they were near completion of a transaction after Fed Governor Kevin Warsh said the central bank would consider a merger, according to the excerpt. Billionaire investor Warren Buffett, chairman of Omaha, Nebraska-based Berkshire Hathaway Inc., was contacted about investing in the combined companies, Sorkin reported. Buffett told a Goldman Sachs banker the merger would never happen because of the investment bank’s ties to officials at the Treasury and Wachovia, Sorkin reported. </blockquote> So it is not obvious that Mr Steel's work at the Treasury Department covered him in glory, or constituted a particular qualification to lead the Hospital for Special Surgery. Chairman of the Board of Duke University Mr Steel's time in the leadership of Duke coincided with one of the major scandals to afflict higher education in the 21st century, usually called the Duke Lacrosse Scandal. Very briefly, several Duke University students who were also on the university's lacrosse team were charged with raping an exotic dancer. After they were charged, the university leadership seemed to judge that the players were guilty before the trial, and that the whole lacrosse team had to bear some sort of collective guilt. Eventually, the charges were dismissed for lack of evidence, and the prosecutor who pursued them so avidly was disgraced. It turns out that Mr Steel had a role in this scandal too. According to <a href="http://www.newyorker.com/archive/2006/09/04/060904fa_fact">a New Yorker article</a>, Mr Steel took a leadership role in the hiring of Due President Richard H Brodhead: <blockquote> The man charged with bringing Brodhead to Duke was Robert K. Steel, a trustee and chairman of the search committee.... </blockquote> After the lacrosse players were accused of rape, a bizarre email led Brodhead to abandon a measured approach: <blockquote> Brodhead, who had been trying to maintain a balance between avoiding prejudgment and satisfying the mounting pressure for action, was outraged. He said he found the message 'sickening and repulsive,' and he acted immediately. He suspended McFadyen [the student who wrote the email]. Coach Pressler was informed that he had until the end of the day to leave the campus, where he had coached for sixteen years. Brodhead also announced a series of committees that would investigate the team, the administration’s handling of the matter, and the Duke culture itself. In a letter to the Duke community, he wrote that the lacrosse episode 'has brought to glaring visibility underlying issues that have been of concern on this campus and in this town for some time.' The letter went on: They include concerns of women about sexual coercion and assault. They include concerns about the culture of certain student groups that regularly abuse alcohol and the attitudes these groups promote. They include concerns about the survival of the legacy of racism, the most hateful feature American history has produced. Compounding and intensifying these issues of race and gender, they include concerns about the deep structures of inequality in our society—inequalities of wealth, privilege, and opportunity (including educational opportunity), and the attitudes of superiority those inequalities breed. And they include concerns that, whether they intend to or not, universities like Duke participate in this inequality and supply a home for a culture of privilege. </blockquote> This quote in retropsect is beyond ironic given that there was never good evidence to support the charges against the lacrosse players. Brodhead cancelled the lacrosse team's season, but it turned out his reasoning, and that of Mr Steel who seemed to have a major role in the decision, was based mainly on the perceived need to preserve the "Duke brand": <blockquote> When Brodhead cancelled the season, he had said that the moment was too serious to be playing games. What he meant, in part, was that Duke could not be seen to be playing games. From the start, Brodhead had been forced to navigate among several potentially hazardous interests—lacrosse parents who felt angry and abandoned by the school, dismayed alumni and donors, the agitated citizens of Durham, the clamoring press—while protecting what is known in the Allen Building as 'the Duke brand.' On that fitful weekend in late March when the TV satellite trucks hit campus, the lacrosse team could be seen practicing for the Georgetown game, a scene that became an endless video loop suggesting institutional indifference. 'We had to stop those pictures,' Bob Steel says. 'It doesn’t mean that it’s fair, but we had to stop it. It doesn’t necessarily mean I think it was right—it just had to be done.' </blockquote> Clearly, according to Mr Steel and his protege, President Brodhead, preserving the Duke brand was more important than the fair treatment of its students. In 2007, as per <a href="http://www.foxnews.com/story/0,2933,265481,00.html">this Fox News report</a>, the North Carolina Attorney General dispelled the accusations against the lacrosse players. <blockquote> [Attorney General Roy] Cooper said Wednesday that not only was there insufficient evidence proving the three assaulted an exotic dancer at an off-campus lacrosse player in March 2006, but there was 'no credible evidence that an attack occurred at that house on that night.' He even proclaimed the players 'innocent.' 'The result of our review and investigation shows clearly that there is insufficient evidence to proceed on any of the charges,' Cooper said. 'Today we are filing notices of dismissal for all charges.' He added: 'We believe these cases were a result of a tragic rush to accuse and failure to verify serious allegations. Based on these significant inconsistencies of evidence and the various accounts given by the accusing witness, we believe these three individuals are innocent of these charges.' </blockquote> After their exoneration, Mr Steel sent out a message affirming his support of President Brodhead's decisions (presumably including suspending the lacrosse season to preserve the Duke brand, firing the lacrosse coach for no obvious reason, and launching an unwarranted witch-hunt against erroneous attitudes toward sexual assault, and race and gender.) Per <a href="http://durhamwonderland.blogspot.com/2007/04/steel-e-mail.html">the Durham-in-Wonderland blog </a>(written by Prof KC Johnson, who also wrote <a href="http://www.amazon.com/Until-Proven-Innocent-Correctness-Injustices/dp/0312369123">the book </a>about the Duke lacrosse scandal), here is what Steel wrote: <blockquote> Throughout the past year President Richard Brodhead consulted regularly with the trustees and has had our continuing support. He made considered and thoughtful decisions in a volatile and uncertain situation. Each step of the way, the board agreed with the principles that he established and the actions he took. </blockquote> Finally, Steel is now a defendent in a law-suit in the aftermath of of this case, <a href="http://abclocal.go.com/wtvd/story?section=news/local&id=6099859">per the AP</a>: <blockquote> Three unindicted Duke University lacrosse players have amended their civil lawsuit against the school and the city of Durham stemming from false rape accusations two years ago. The Herald-Sun of Durham reported Wednesday the players allege that Duke trustees chairman Robert Steel controlled the school's response and that the school was most interested in protecting its image. </blockquote> So Mr Steel's handling of the Duke lacrosse scandal during his time as chairman of the board of that university also did not exactly cover him in glory, or provide an obvious qualification for him to be a trustee of the Hospital for Special Surgery. Summary So Mr Steel -as CEO of Wachovia failed to keep the company independent, and is under investigation of charges that he misled stock-holders; - as Under Secretary of the Treasury was involved in what many believe was a bungled strategy to combat the global financial meltdown mainly by handing billions of dollars to the misguided Masters of the Universe who brought the meltdown upon us; and - as Chairman of the Board of Duke University seemed to put an ultimately unsuccesful attempt to defend the Duke brand ahead of the rights of its students, and is now the defendent of at least one related lawsuit. It is too soon to tell whether the SEC investigation of the lawsuit will be decided for or against Mr Steel. However, it seems utterly bizarre that the board of the Hospital for Special Surgery would regard Mr Steel's track record as indicative of the "caliber" needed to lead one of the country's premier hospitals. How Mr Steel inspires such praise brings to mind some findings of pollster Frank Luntz that <a href="http://www.latimes.com/news/opinion/la-oe-luntz27-2009sep27,0,4242608.story">appeared in the Los Angeles Times</a>: <blockquote>Today, Americans are boiling mad, and the elites from Washington to Wall Street to West Hollywood don't get it. It can best be summarized by 12 short words bellowed by Howard Beale, the deranged TV anchor in the movie 'Network': 'I'm as mad as hell, and I'm not going to take this anymore.' Americans in the unhappy majority are struggling to keep their jobs as million-dollar bonuses are being awarded at companies their tax dollars bailed out. The core American complaint about politics is that wrongdoing isn't punished, other than at the next election. From scandalous personal behavior to bailouts of everyone and everything except the hardworking middle class, Washington is seen as the source for America's mistakes. Enforcing rules and letting failures fail would stop the excesses today and prevent the mistakes of tomorrow. Such accountability in business would likewise prevent executives at imploding companies from walking away with millions while their employees get skunked. For business and political elites, the message should be clear: Restore trust. </blockquote>Mr Steel's unlikely career trajectory shows how once someone becomes a member of the superclass, the new power elite that spans business, government, and academics, that person is likely to continue to wield power no matter how poor his or her track-record, to the detriment of nearly everyone else.

A Trustee of What "Caliber" for the Hospital for Special Surgery

The Hospital for Special Surgery in New York, a prestigious institution focused on orthopedics and rheumatology, closely affiliated with Wei...

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