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A tale of 10,000,000 books

<blockquote>The fundamental reasons why the electric car has not attained the popularity it deserves are (1) The failure of the manufacturers to properly educate the general public regarding the wonderful utility of the electric; (2) The failure of [power companies] to make it easy to own and operate the electric by an adequate distribution of charging and boosting stations. The early electrics of limited speed, range and utility produced popular impressions which still exist.</blockquote>This quotation would hardly surprise anyone who follows electric vehicles. But it may be surprising to hear that in the year when it was written thousands of electric cars were produced, and that year was nearly a century ago. This appeared in a <a href="http://books.google.com/books?id=SKkvAAAAYAAJ&pg=RA1-PA1236&dq=electric+vehicle&as_brr=4&ei=aDmvSpelIo3YkQTdsJz1Ag#v=onepage&q=electric%20vehicle&f=false">1916 issue of the journal Electrical World</a>, which I found in <a href="http://books.google.com/">Google Books</a>, our searchable repository of millions of books. It may seem strange to look back a hundred years on a topic that is so contemporary, yet I often find that the past has valuable lessons for the future. In this case, I was lucky — electric vehicles were studied and written about extensively early in the 20th century, and there are many books on the subject from which to choose. Because books published before 1923 are in the public domain, I am able to view them easily.<div> But the vast majority of books ever written are not accessible to anyone except the most tenacious researchers at premier academic libraries. Books written after 1923 quickly disappear into a literary black hole. With rare exceptions, one can buy them only for the small number of years they are in print. After that, they are found only in a vanishing number of libraries and used book stores. As the years pass, contracts get lost and forgotten, authors and publishers disappear, the rights holders become impossible to track down.<div> Inevitably, the few remaining copies of the books are left to deteriorate slowly or are lost to fires, floods and other disasters. While I was at Stanford in 1998, <a href="http://news.stanford.edu/news/1998/april1/flood41.html">floods damaged or destroyed tens of thousands of books</a>. Unfortunately, such events are not uncommon — a similar flood happened at Stanford just 20 years prior. You could read about it in <a href="http://books.google.com/books?id=D_v-HAAACAAJ">The Stanford-Lockheed Meyer Library Flood Report</a>, published in 1980, but this book itself is no longer available.</div><div> Because books are such an important part of the world’s collective knowledge and cultural heritage, Larry Page, the co-founder of Google, first proposed that we digitize all books a decade ago, when we were a fledgling startup. At the time, it was viewed as so ambitious and challenging a project that we were unable to attract anyone to work on it. But five years later, in 2004, Google Books (then called Google Print) was born, allowing users to search hundreds of thousands of books. Today, they number over 10 million and counting.</div><div> The next year we were sued by the Authors Guild and the Association of American Publishers over the project. While we have had disagreements, we have a common goal — to unlock the wisdom held in the enormous number of out-of-print books, while fairly compensating the rights holders. As a result, we were able to work together to devise a <a href="http://books.google.com/googlebooks/agreement/">settlement</a> that accomplishes our shared vision. While this settlement is a win-win for authors, publishers and Google, the real winners are the readers who will now have access to a greatly expanded world of books.</div><div> There has been some debate about the settlement, and many groups have offered their opinions, both for and against. I would like to take this opportunity to dispel some myths about the agreement and to share why I am proud of this undertaking. This agreement aims to make millions of out-of-print but in-copyright books available either for a fee or for free with ad support, with the majority of the revenue flowing back to the rights holders, be they authors or publishers.</div><div> Some have claimed that this agreement is a form of compulsory license because, as in most class action settlements, it applies to all members of the class who do not opt out by a certain date. The reality is that rights holders can at any time set pricing and access rights for their works or withdraw them from Google Books altogether. For those books whose rights holders have not yet come forward, reasonable default pricing and access policies are assumed. This allows access to the many orphan works whose owners have not yet been found and accumulates revenue for the rights holders, giving them an incentive to step forward.</div><div> Others have questioned the impact of the agreement on competition, or asserted that it would limit consumer choice with respect to out-of-print books. In reality, nothing in this agreement precludes any other company or organization from pursuing their own similar effort. The agreement limits consumer choice in out-of-print books about as much as it limits consumer choice in unicorns. Today, if you want to access a typical out-of-print book, you have only one choice — fly to one of a handful of leading libraries in the country and hope to find it in the stacks.</div><div> I wish there were a hundred services with which I could easily look at such a book; it would have saved me a lot of time, and it would have spared Google a tremendous amount of effort. But despite a number of important digitization efforts to date (Google has even helped fund others, including some by the Library of Congress), none have been at a comparable scale, simply because no one else has chosen to invest the requisite resources. At least one such service will have to exist if there are ever to be one hundred.</div><div> If Google Books is successful, others will follow. And they will have an easier path: this agreement creates a books rights registry that will encourage rights holders to come forward and will provide a convenient way for other projects to obtain permissions. While new projects will not immediately have the same rights to orphan works, the agreement will be a beacon of compromise in case of a similar lawsuit, and it will serve as a precedent for orphan works legislation, which Google has always supported and will continue to support.</div><div> Last, there have been objections to specific aspects of the Google Books product and the future service as planned under the settlement, including questions about the quality of bibliographic information, our choice of classification system and the details of our privacy policy. These are all valid questions, and being a company that obsesses over the quality of our products, we are working hard to address them — improving bibliographic information and categorization, and further detailing our privacy policy. And if we don’t get our product right, then others will. But one thing that is sure to halt any such progress is to have no settlement at all.</div><div> In the <a href="http://books.google.com/books?id=SJbPAAAAMAAJ&pg=RA1-PA232&dq=alexandria+library+fire&as_brr=4&ei=bxW3Su2hLIHUlATWxsHrDw#v=onepage&q=alexandria%20library%20fire&f=false">Insurance Year Book 1880-1881</a>, which I found on Google Books, Cornelius Walford chronicles the destruction of dozens of libraries and millions of books, in the hope that such a record will “impress the necessity of something being done” to preserve them. The famous library at Alexandria burned three times, in 48 B.C., A.D. 273 and A.D. 640, as did the Library of Congress, where a fire in 1851 destroyed two-thirds of the collection.</div><div> I hope such destruction never happens again, but history would suggest otherwise. More important, even if our cultural heritage stays intact in the world’s foremost libraries, it is effectively lost if no one can access it easily. Many companies, libraries and organizations will play a role in saving and making available the works of the 20th century. Together, authors, publishers and Google are taking just one step toward this goal, but it’s an important step. Let’s not miss this opportunity. Posted by Sergey Brin, Co-Founder & President, Technology</div> (This first appeared in the New York Times, available <a href="http://www.nytimes.com/2009/10/09/opinion/09brin.html">here</a>.) </div>

A tale of 10,000,000 books

The fundamental reasons why the electric car has not attained the popularity it deserves are (1) The failure of the manufacturers to properl...

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Healthcare Renewal Named a Forbes "Must Read" Health Blog

Healthcare Renewal Named a Forbes "Must Read" Health Blog

Healthcare Renewal has been named a Forbes "must read" health blog, one of three under the category "physician blogs." ...

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Google Flu Trends expands to 16 additional countries

If you're like us, you're probably thinking a lot about how this year's flu season might affect you and your community. To help you out, we at <a href="http://www.google.org/">Google.org</a> are excited to announce the expansion of <a href="http://www.google.org/flutrends/">Google Flu Trends</a> to 16 additional countries, including much of Europe. We've also made the site available in 37 languages. Flu is a global threat, affecting millions worldwide each year, so we're pleased to make this tool available in more regions and languages. <a href="http://googleblog.blogspot.com/2008/11/tracking-flu-trends.html">Last November</a>, we launched Google Flu Trends in the United States after finding a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. By tracking the popularity of certain Google search queries, we are able to estimate the level of flu, in near real-time. While some traditional flu surveillance systems may take days or weeks to collect and release data, Google search queries can be counted immediately. Google Flu Trends provides an additional surveillance tool that may help public health officials and the public make more informed decisions about preparing for the flu season. In the past year, we've expanded our coverage to include Mexico, New Zealand and Australia and have continued to see a good correspondence between our estimates and official flu activity data. In fact, our analysis of last season shows that Google Flu Trends had a close 0.92 correlation with official U.S. flu data. An important aspect of Google Flu Trends is that we filter out terms that may be popular because people hear about them in the news. What we do not use in the models is a term like [swine flu] since people are more likely to type that into Google because they want to know more information about it, given the news headlines, and not because they actually have H1N1 or swine flu. For more information about how we built this model, take a peek at this video: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/6111nS66Dpk&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/6111nS66Dpk&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> If you visit Google Flu Trends for the U.S., you'll notice that the flu season is starting early this year. For tips on how to stay healthy this season, please visit our friends at the <a href="http://www.cdc.gov/flu/protect/preventing.htm">U.S. CDC</a> and <a href="http://www.ecdc.europa.eu/en/healthtopics/Pages/Influenza_A%28H1N1%29_Outbreak.aspx">the ECDC</a>. Posted by Matt Mohebbi and Dan Vanderkam, Software Engineers

Google Flu Trends expands to 16 additional countries

If you're like us, you're probably thinking a lot about how this year's flu season might affect you and your community. To help ...

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Pfizer (in the Guise of Pharmacia) Pfound to Violate Pfraud Law, While Pfizer CEO Made Pfederal Reserve Advisor

It was only a month ago that Pfizer Inc, the world's largest pharmaceutical company, submitted to a gargantuan $2.3 billion settlement and yet another corporate integrity agreement. As we posted <a href="http://hcrenewal.blogspot.com/2009/09/pfour-legal-settlements-for-pfizer-why.html">here</a>, this was the company's fourth major settlement of charges of unethical marketing behavior since 2002. Now Pfizer is in trouble again. As reported <a href="http://www.google.com/hostednews/ap/article/ALeqM5gKN6h5RGezwol5GiqLvvTxaVAYUQD9B1VSL00">by the AP</a>, <blockquote> A judge on Tuesday imposed $4.5 million in forfeitures on prescription drug company Pharmacia Inc.[a Pfizer Inc subsidiary] for misrepresenting prices and defrauding Wisconsin's Medicaid system. A jury in February found that Pharmacia violated the state's Medicaid fraud law 1.44 million times over a decade. State Justice Department attorneys had demanded about $212 million in forfeitures, but Dane County Circuit Judge Richard Niess said jurors grossly overcalculated the number of violations. After reviewing the evidence, the judge found the actual tally was 4,578. He elected to set the forfeiture level at $1,000 per violation. The judge said he was concerned that if he ordered the maximum $68.6 million Pharmacia would pass the expense to consumers and nothing showed any of the fraudulent $7 million went directly to Pharmacia's profits. On the other hand, the judge said, a $100 per violation forfeiture totaling $457,800 would 'not register so much as blip on Pharmacia's multibillion-dollar annual fiscal radar screen' and a higher amount would draw attention to the need to reform pharmaceutical reimbursement scales. </blockquote> I must say that I do not understand the reasoning the judge used to set the penalties. If he thought that Pfizer would merely pass along a large penalty to patients, why would the company not pass along a smaller penalty to them. In any case, this is just the latest in a long string of cases in which a health care corporation was found to have committed unethical or illegal acts, but the only the corporation itself, but not the people who actually performed, directed or authorized the acts, paid a penalty. And when the penalty is paid by the corporation, its impact can be spread over all stock-holders, all employees, and all patients, clients, or customers, thus diluting its effect, and protecting those who authorized, directed, or performed the acts in question. I submit again that only when the people in health care leadership who perform, direct or authorize bad behavior pay penalties will bad behavior be deterred. Note that while Pfizer may be the world's largest pharmaceutical corporation, it seems to be the corporation most often cited for, convicted of, or having to make settlements for bad behavior (see some recent examples <a href="http://hcrenewal.blogspot.com/search/label/Pfizer">here</a>). (Although in the current case, you would have to read the news report very carefully to realize that Pfizer was involved. The fact that Pharmacia is a Pfizer subsidiary was only mentioned in passing.) Nonetheless, one would think Pfizer's leadership would be ashamed, and their reputation would suffer. But no. At about the same time this latest settlement was announced, this <a href="http://www.reuters.com/article/companyNews/idUSN0160921020091001">report from Reuters </a>appeared: <blockquote> The Federal Reserve Bank of New York said on Thursday that Pfizer (PFE.N) chief executive Jeffrey Kindler and Loews Corp (L.N) chief executive James Tisch will fill the two vacancies on its board of directors. Kindler was elected to finish a three-year term ending Dec. 31, taking the seat PepsiCo (PEP.N) chief executive Indra Nooyi resigned from in February. Regional Federal Reserve banks' boards of directors offer recommendations on Fed policy, but have no policy-making powers. They also provide anecdotal information about the business conditions that help inform the central bank. Regional Fed banks have three classes of directors: Class A, elected by member banks to represent banks; Class B, elected by member banks but representing the public; and Class C, which represent the public but are chosen by the Board of Governors in Washington. Kindler and Tisch join Jeffrey Immelt, chairman and chief executive of General Electric (GE.N) as Class B directors. </blockquote> I suppose Kindler could offer quite a bit of "anecdotal information" about bad behavior in the pharmaceutical industry. But it seems rather comic to think about the CEO of the world's biggest, and lately baddest pharmaceutical company as "representing the public." Rather, and more seriously, this is just the latest example of how leaders of health care organizations have joined the superclass, and how the superclass protects its own.

Pfizer (in the Guise of Pharmacia) Pfound to Violate Pfraud Law, While Pfizer CEO Made Pfederal Reserve Advisor

It was only a month ago that Pfizer Inc, the world's largest pharmaceutical company, submitted to a gargantuan $2.3 billion settlement a...

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Quickly view formatted PDFs in your search results

Google search results sometimes include documents that were not originally formatted to be viewed in a web browser, such as PDFs. In the past, the only way to view these documents was to download them and open them in a separate viewer application. To provide an alternative, we made it possible to quickly and easily <a href="http://www.google.com/help/faq_filetypes.html#application">view these files</a> as HTML right in a web browser by clicking "View as HTML." This was an improvement, but unfortunately the "View as HTML" option loses some of the formatting from the original PDF, such as graphics, tables, fonts and other elements. Today, we've added new links to "Quick View" PDFs in your browser with the formatting intact. The new links are based on the same technology that's available <a href="http://gmailblog.blogspot.com/2008/12/fast-pdf-viewing-right-in-your-browser.html">in Google Docs and Gmail</a>, as well as to <a href="http://googledocs.blogspot.com/2009/09/view-online-files-using-google-docs.html">webmasters</a> through the Google Docs viewer. We've been rolling this technology out to the search results page since July, and as of today we've added "Quick View" links to more than 50% of the PDFs in our index. The new links appear at the end of the second line of the result, right underneath the title. For example, here is a search result for the IRS 1099 form: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9NzrJjCLno5SAtBtYXYLiDXN-i4_zb1EDnt4pBI1ZmWL0yd2jnKwegBMVVt4ymG7TAiiRaFfRlErpmfD9lF5QcRuYL0KNzt3Oy09imZiCzUcBxGuwxDimnrQiI0F2B3zIO36y15QbCg-k/s1600-h/cgqmq8g4_53cc65rwgd_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389906586994960562" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9NzrJjCLno5SAtBtYXYLiDXN-i4_zb1EDnt4pBI1ZmWL0yd2jnKwegBMVVt4ymG7TAiiRaFfRlErpmfD9lF5QcRuYL0KNzt3Oy09imZiCzUcBxGuwxDimnrQiI0F2B3zIO36y15QbCg-k/s400/cgqmq8g4_53cc65rwgd_b.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 249px;" /></a> Clicking "Quick View" will open up the PDF right in your browser with graphics, formatting and tables preserved. This is what it looks like after opening:<div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6qAXokwtt6oBVUy5Kx7v1ZZFz4U72zrvriQzU_pnE_koAASBanE8p7oATM3yZMe95Wo2qzwFBdSjsKMZJtpIhdq-q1FAeNUuRMU11kHpp8FzS9t_CuyvzjdikQxv6ZnkDR972-Y2Jj4pO/s1600-h/cgqmq8g4_22qzzc26f9_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5389906594005416786" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6qAXokwtt6oBVUy5Kx7v1ZZFz4U72zrvriQzU_pnE_koAASBanE8p7oATM3yZMe95Wo2qzwFBdSjsKMZJtpIhdq-q1FAeNUuRMU11kHpp8FzS9t_CuyvzjdikQxv6ZnkDR972-Y2Jj4pO/s400/cgqmq8g4_22qzzc26f9_b.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 265px;" /></a> Over time we'll be rolling out the viewer for more documents and file types. In the meantime, in some cases you'll see the "View as HTML" link, which allows you to see a basic HTML-only version. Viewing PDF documents in your browser might not make paying taxes any more fun — but hopefully this feature will make it a little bit faster!<div> Posted by Krista Davis, Software Engineer, and Raj Krishnan, Product Manager</div></div>

Quickly view formatted PDFs in your search results

Google search results sometimes include documents that were not originally formatted to be viewed in a web browser, such as PDFs. In the pas...

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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 href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBCPzr_1pknEEBMjkdunC3RxoXOGScAax4EYuyE_3OCXCsxtI_7AvblP_ztLpi7hEJ_tiXI62uWpw6KcbB-W4hcWZYytdLoDq8VSXrr64fu9y1_w5WUU8hIeLNES6BJdkJQWb7AdpPABbm/s1600-h/cerner_data.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><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 href="http://hcrenewal.blogspot.com/2009/07/health-care-information-technology.html" style="font-style: italic;">JAMA letter: Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>" and "<a href="http://hcrenewal.blogspot.com/2009/07/inquiry-to-joint-commission-on-points-i.html" style="font-style: italic;">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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