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Another Major HIT Project Setback at UCSF: Vendor, Client or Both at Fault?

In yet another example of a major health IT project setback, in August I wrote about UCSF's apparent problems with health IT implementation that I learned about through anonymous comments at the <a href="http://www.histalk.com/">HisTALK</a> blog. At "<a href="http://hcrenewal.blogspot.com/2009/08/lessons-unlearned-health-it-failure-act.html">Lessons Unlearned: Health IT Failure, Act 2</a>" I wrote: <blockquote>I find it remarkable that this resource-wasting scenario (with possible adverse patient care repercussions) can occur: <ul><li>In a state that's in a severe economic crisis, </li><li>At an organization that failed severely in a HIT and administrative IT merger ten years ago (in the failed, late 1990's attempted merger between UCSF and Stanford's medical centers, see the 2000 stories "UCSF/Stanford: Marriage was rough; divorce is expensive" <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2000/04/24/focus4.html">here</a> and "A thousand MIS personnel cannot merge two healthcare systems"<a name="thousand"> </a><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=A%20thousand%20MIS%20personnel%20cannot%20merge%20two%20healthcare%20systems">here</a>),</li><li>With an EHR product, Centricity, that is the descendant of Logician that others have implemented successfully (including myself, speaking from experience), </li><li>With GE, a major global high technology vendor, presiding over this new failure at a major academic medical center,</li><li>With ample preventive material available in books, journals on the web about such failures (e.g., at the many pages and links <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/">here</a> and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">here</a>, as just a few examples). </li></ul></blockquote> I asked if vendor and hospital executives bother to read such materials. Here is an update in this poorly-covered mystery: <blockquote>Friday, October 9, 2009 <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html">UCSF halts clinical IT installation</a> San Francisco Business Times - by <a href="http://www.bizjournals.com/search/results.html?Ntt=%22Chris%20Rauber%22&Ntk=All&Ntx=mode%20matchallpartial" id="byline">Chris Rauber</a> <div id="storycontent"> Dr. Sam Hawgood, newly appointed dean of the University of California, San Francisco's<a class="story_clink" href="http://www.bizjournals.com/sanfrancisco/gen/University_of_California,_San_Francisco_10AE04B6F6FD4994A2DE25245732FFE4.html"></a> School of Medicine, confirmed that UCSF has put the brakes on installation of a $50 million clinical IT system from General Electric [which had acquired Medicalogic's "Logician" EHR some years ago - ed.] In late August/early September, the Business Times was unable to reach high-ranking UCSF officials to comment on anonymous reports on the respected HISTalk blog and by sources that UCSF was unhappy with early results of the electronic medical records system installation. An informed insider says GE was “way behind schedule” in writing code, and “UCSF got fed up with the endless GE delays,” and is looking to identify other vendors for a drug order entry system. “We are taking a pause to evaluate our best options moving forward, and we will be making a decision in the next two to three months, and then moving forward aggressively,” Hawgood said. The delay will not put the IT project behind schedule, he said, because “once we make a decision regarding the vendor, we’ll be back on track for an aggressive installation.” [Unfortunately, that sounds like wishful thinking or spin to me - ed.] UCSF has brought in consultant Kurt Salmon Associates to help it evaluate the IT project’s woes, which were said to be creating considerable frustration within <a class="story_clink" href="http://www.bizjournals.com/sanfrancisco/related_content.html?topic=UCSF%20Medical%20Center">UCSF Medical Center</a>, and obviously the School of Medicine as well. </div>  </blockquote> This setback is of great concern to me. I believe such scenarios could become commonplace in coming years as healthcare organizations bow to the ARRA-created pressure to computerize "or else" by 2014 - that is, suffer reimbursement penalties for not being "meaningful users" of HIT. (Whatever that somewhat presumptuous term describing a largely experimental technology will ultimately come to mean.) I have frequently written about the HIT vendors being dominated by those with an MIS (management information systems or "business computing") background, and unshakably and arrogantly deficient in talent management where Medical Informatics expertise is concerned. GE may also suffer from domination by engineers whose primary experience is at the level of capital equipment, PACS etc., much as I wrote about competitor Philips Medical <a href="http://hcrenewal.blogspot.com/2009/08/in-nov.html">here</a> and <a href="http://hcrenewal.blogspot.com/2008/11/who-leads-in-intellectually-challenged.html">here</a>. Having once worked for a GE competitor myself, Comdisco Healthcare Group, and having asked GE representatives about what a phrase on a banner at an RSNA show stating "GE: Leader in Radiology Informatics" meant -- and getting blank stares and comments that "it has something to do with the computers connected to our xray devices" back in return-- my concern was that the problems are not just UCSF centric but vendor centric as well. UCSF is a big, complex organization, with a lot of very smart clinicians and lots of politics, and I conjecture that GE bit off more than it could chew regarding development, customization and deployment of major health IT at such an organization. It requires far more than technical excellence. My concern is that GE, along with many if not most of the other major health IT vendors, lack the Medical Informatics and <a href="http://rkcsi.indiana.edu/archive/SI/Arts/SI_report_Aug_14.doc">Social Informatics</a> talent and depth to make our ambitious national EHR plans a reality. The overselling of vaporware and "yes, we can do that, no problem" promises by sales and marketing are also a concern, as I find common in HIT where salespeople promise the world to close a deal. Then, the technical people need to play catch up to the grandiose promises made by their creative sales colleagues. I fear in a few years we will be in the situation that the UK's National Programme for IT (NPfIT) in the NHS <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">is in now</a>. If we want to avoid that fate, we as a country must: <ul><li>Increase transparency and information diffusion about HIT difficulties and failures greatly. That my <a href="http://www.tinyurl.com/hit-misadventure">website on HIT failures</a> is still nearly unique on the Web after ten years is symptomatic of a true lack of information sharing on real world HIT problems. My monitoring of access patterns to the site as reported in <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">this 2006 AMIA poste</a>r (PDF) strongly suggests the demand for such material far exceeds the supply. The AMIA/AHIMA book of which I am an associate editor entitled "<a href="https://imis.ahima.org/orders/productDetail.cfm?pc=AB102209&bURL=%2Forders%2Findex.cfm%3F">H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations</a>" and the new journal "<a href="http://www.schattauer.de/index.php?id=558&L=1">Applied Clinical Informatics</a>" whose Editor-in-Chief is Dr. Chris Lehmann, informaticist at Johns Hopkins, are a start -- but just a start on candid information diffusion about applied HIT realities.</li></ul><ul><li>Health IT vendors need to understand that those in MIS and engineering are, in the context of complex clinical settings where clinician-supportive HIT is to be developed and deployed, often dyscompetent (they fail to maintain acceptable standards in one or more areas of professional practice) or even incompetent (lacking the requisite cognitive and non-cognitive abilities and qualities to perform effectively in the scope of professional practice). Lacking an understanding of medical culture and the <a href="http://www.ctlab.org/documents/Hiding%20in%20plain%20sight.pdf">nature of medical settings</a> is a highly compromising deficit. It leads to mission hostile HIT devices such as shown <a href="http://tinyurl.com/hostileuserexper">here</a>. There needs to be much better talent management in that regard.</li></ul><ul><li>Suboptimal HIT vendor performance, and defective HIT devices, should not be tolerated. Repeat purveyors of such technology should be materially sanctioned for wasting precious healthcare resources. Whether this happens primarily in the courtroom, or in the court of "consumer opinion" by HIT buyers -- based on transparent consumer reports on HIT - remains to be seen.</li></ul> -- SS Addendum: a reader familiar with the UCSF situation largely confirms my suspicions as above regarding vendor capabilities and the vendor's biting off more than it could chew, greatly delaying deliverables. They did say, however, that I was not correct (in this case) about the issue of salesperson "promise the moon" behavior, and that this was not a factor in the project stoppage.

Another Major HIT Project Setback at UCSF: Vendor, Client or Both at Fault?

In yet another example of a major health IT project setback, in August I wrote about UCSF's apparent problems with health IT implementat...

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Sham Peer Review: Could This Bad Faith Practice Contribute to the Silence About Healthcare IT Problems?

Health IT problems and failures seem to be rarely heard about in the public media, yet almost every physician and student I know, including those actively involved in HIT projects, privately tell me of many mishaps, traps and difficulties they encounter frequently. Some of these problems impact patient care, up to and including some only-by-the-grace-of-god "near misses" - and worse. They also state they do not want to be quoted publicly for fear of reprisals. While I'd thought that part of this issue was fear of retaliation from vendors and hospital executives for contractual "defects gag clause" violations, another practice that may be uncomfortably common might also be a significant contributor to the general lack of information about bad HIT: bad faith ("sham") peer review. Sham peer review or malicious peer review is a name given to the alleged abuse of a <a href="http://en.wikipedia.org/wiki/Medical_peer_review" title="Medical peer review">medical peer review</a> process to punish a physician for personal or other non-medical reasons (Wikipedia). This practice is really a show trial for physicians deemed by hospital management to be whistleblowers (e.g., on quality issues) or troublemakers. Sometimes it is used as a tool by competing physicians as well. The article "<a href="http://www.jpands.org/vol14no3/huntoon.pdf">Tactics Characteristic of Sham Peer Review</a>" (PDF) by Lawrence R. Huntoon, MD PhD of the American Association of Physicians & Surgeons spells out some of the characteristics of this process: <blockquote>The tactics used by hospitals and others in conducting a sham peer review are remarkably similar throughout the country. The common feature of these tactics is that they violate due process and/or fundamental fairness, and they often represent an attempt to make the incident or event "fit the crime."   Although our legal system is not perfect, it does incorporate sound principles and procedures designed to protect an accused individual's right to due process and fundamental fairness (e.g. an accused person is considered innocent until proven guilty). In evaluating the fairness of peer review, one can often find corresponding principles of due process and fundamental fairness in our legal system.</blockquote> This article is worth reading in its entirety. It details tactics such as: <ul><li>Ambush Tactic and Secret Investigations - unprepared physician is surprised by what amounts to a well-organized interrogation panel</li></ul><ul><li>Depriving Targeted Physician of Records Needed to Defend Himself - bureaucracy and red tape prevent a physician from mounting a timely defense.</li></ul><ul><li>Considering a physician "Guilty Until Proven Innocent" - burden of proving innocence shifted to the accused physician.</li></ul><ul><li>Numerator-Without-Denominator Tactic - cherry picking of cases to unfairly highlight (unavoidable) adverse outcomes.</li></ul><ul><li>Misrepresenting the Standard of Care - hospital administration hires an outside expert who opines that because the targeted physician did not use the same surgical technique or medical treatment that the expert prefers, the targeted physician must be practicing beneath the standard of care.</li></ul><ul><li>Trumped-Up and/or False Charges - "spin" and outright fabrications are deployed.</li></ul><ul><li>The "Disruptive Physician" Label - this deserves full explanation here:</li></ul> <blockquote>The definition of "disruptive physician" is highly subjective and subject to manipulation and abuse. Recently, the general and vague definition of "disruptive physician" has been fortified with the more specifically vague and subjective descriptions in the "Code of Conduct" as promulgated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Nonverbal conduct, such as facial expression and body language, can be used to label a physician "disruptive," and no evidence is required beyond how the accuser feels. [Unbelievable - Ed.] Increasingly, the term "disruptive physician" has become synonymous with "mentally impaired" physician. A physician who is wrongfully labeled "disruptive" because he does not agree with the hospital administration's views, or complains about substandard care in the hospital, can be subjected to inpatient treatment at a facility that specializes in treating "disruptive physicians." "Treatment" at one of these facilities may include treatment with medications, which if the "dissident physician" refuses to take "voluntarily," may result in automatic termination of privileges for failure to comply with the recommended "treatment." Physicians typically emerge from one of these "treatment" facilities with psychiatric diagnoses of narcissistic personality disorder, obsessive-compulsive disorder, or both.</blockquote><ul><li>Dredging Up Old Cases from the distant past to Justify Summary Suspension</li></ul><ul><li>Ex-Parte Communications - although such communications taint the entire hearing process and clearly violate fundamental fairness and due process, hearing officers, hired by the hospital, often allow ex-parte communications.</li></ul> <ul><li> Hospital Attorney or Conflicted Attorney Used to Influence the Peer Review Process - Hospitals that employ sham peer review often will use an attorney who represents the hospital or who represents both the hospital and medical staff simultaneously (i.e. a conflicted attorney) to influence the peer review process.</li></ul><ul><li>Bias - e.g., stacking the investigative committee or hearing panel with physicians who have personal animus or bias against the accused physician; allowing the prosecution much more time to review records or present the case than the targeted physician; etc.</li></ul> Also see the article "Twelve Signs of Sham Peer Review" <a href="http://hollandhart.typepad.com/healthcare/2006/05/twelve_signs_of.html">here</a> by a healthcare law firm. Also of interest is "Readers' Responses to the Letter by Chalifoux and the Editorial by Bond in Regard to Sham Peer Review" at <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681969/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681969</a> in response to an article by Roland Chalifoux, Jr, D.O. entitled "So what is a sham peer review?", MedGenMed. 2005;7:47 available at Medscape <a href="http://www.medscape.com/viewarticle/515862">here</a>.If the threat of sham peer review is being leveraged against physicians who are deemed "complainers" or "troublemakers", to the point of prosecution for facial expressions deemed "disruptive" by others, than it is understandable how physicians might be reluctant to complain about multimillion dollar HIT projects (the outcomes of which hospital executives' reputations and career advancement may depend upon) that have gone awry.Finally, I should probably ask: does sham peer review contribute to silence about healthcare C-suite mismanagement and malfeasance in general? -- SS

Sham Peer Review: Could This Bad Faith Practice Contribute to the Silence About Healthcare IT Problems?

Health IT problems and failures seem to be rarely heard about in the public media, yet almost every physician and student I know, including ...

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Invite a friend to Google Voice

(Cross-posted from the <a href="http://googlevoiceblog.blogspot.com/2009/10/invite-friend-to-google-voice.html">Google Voice Blog</a>) Since the <a href="http://googleblog.blogspot.com/2009/03/here-comes-google-voice.html">debut</a> of Google Voice, our <a href="http://googleblog.blogspot.com/2009/06/google-voice-invites-on-their-way.html">early users</a> have shared lots of feedback that has led to some exciting new features, like the ability to <a href="http://googlevoiceblog.blogspot.com/2009/09/receive-and-reply-to-sms-messages-by.html">receive SMS messages via email</a> and the option to <a href="http://googlevoiceblog.blogspot.com/2009/07/need-new-number.html">change your Google Voice number</a>. But one of the most frequent requests we've received is for the ability to share Google Voice with friends and family. Starting today, we're beginning to give out invitations to Google Voice users. If you currently use Google Voice, over the next few weeks, you'll see an "Invite a friend" link appear on the left-hand side of your inbox. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG80uL9Rgpiq1sAr8BC1P7dRID9Xg68dUj8S8gY65oQf-UeKqi3qy8IvP9okWzS9kfa_KlrBEvNHgibYb3B36DrpYMy4ecxwO9vhH5YjBScqj-Est4O10Nuti0TKz4KDXMsi3Yaqh869yr/s1600-h/voice1.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5392137089526378770" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG80uL9Rgpiq1sAr8BC1P7dRID9Xg68dUj8S8gY65oQf-UeKqi3qy8IvP9okWzS9kfa_KlrBEvNHgibYb3B36DrpYMy4ecxwO9vhH5YjBScqj-Est4O10Nuti0TKz4KDXMsi3Yaqh869yr/s400/voice1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 332px;" /></a> We'll be rolling out these invitations gradually, so don't worry if you don't see your invitations immediately. We're initially giving out three invites to each account, but we're planning to provide more invitations in the future. If you don't have an account yet, you can request a Google Voice invitation at <a href="http://www.google.com/voiceinvite">google.com/voiceinvite</a>. Posted by Craig Walker and Vincent Paquet, Product Managers, Google Voice

Invite a friend to Google Voice

(Cross-posted from the Google Voice Blog ) Since the debut of Google Voice, our early users have shared lots of feedback that has led to s...

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Introducing Google Building Maker

<div>(Cross-posted on the <a href="http://google-latlong.blogspot.com/2009/10/introducing-google-building-maker.html">Google Lat Long Blog</a>) </div><div> </div>Some of us here at Google spend almost all of our time thinking about one thing: How do we create a three-dimensional model of every built structure on Earth? How do we make sure it's accurate, that it stays current and that it's useful to everyone who might want to use it? One of the best ways to get a big project done — and done well — is to open it up to the world. As such, today we're announcing the launch of <a href="http://www.google.com/buildingmaker">Google Building Maker</a>, a fun and simple (and crazy addictive, it turns out) tool for creating buildings for <a href="http://earth.google.com/">Google Earth</a>. We like to think of Building Maker as a cross between <a href="http://maps.google.com/">Google Maps</a> and a gigantic bin of building blocks. Basically, you pick a building and construct a model of it using aerial photos and simple 3D shapes – both of which we provide. When you're done, we take a look at your model. If it looks right, and if a better model doesn't already exist, we add it to the 3D Buildings layer in Google Earth. You can make a whole building in a few minutes. Our early beta testers insist that Building Maker is more like a game than a tool. Check out this video to see Building Maker in action: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/JI6wVtCY99E&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/JI6wVtCY99E&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> For now, you can choose to make buildings in any of about 50 cities. We'll keep adding more cities, but don't feel left out if we don't have your hometown yet — modeling in a place you've never been is a fantastic way to discover more about it. Teachers might find that Building Maker is a great way to get students interested in geography. Armchair tourists can not only visit an unfamiliar city; they can engage with it. It's amazing what you learn when you look at something really closely. Here are some more things you should know about Building Maker: <ul><li>Building Maker is an online tool, and it runs entirely in your web browser (Google Chrome, Firefox, Safari, Internet Explorer, etc.)</li><li>Before you can add a building to Google Earth, you need to sign in to your <a href="http://www.google.com/accounts">Google Account</a> (so you get credit for what you contribute).</li><li>Models you create with Building Maker "live" in the <a href="http://sketchup.google.com/3dwarehouse">Google 3D Warehouse</a> (a giant, online repository of 3D models).</li><li>You can use <a href="http://sketchup.google.com/">Google SketchUp</a> (our free, general-purpose 3D modeling tool) to edit or otherwise <a href="http://sketchup.google.com/support/bin/answer.py?answer=161753">modify</a> anything you make with Building Maker.</li><li>Make sure you have the latest version of <a href="http://earth.google.com/">Google Earth</a> installed on your computer.</li><li>If you're on a Mac, you need to download the <a href="http://code.google.com/apis/earth">Google Earth plug-in</a> directly.</li></ul>Building Maker is free and available in 14 languages. Go to <a href="http://www.google.com/buildingmaker">www.google.com/buildingmaker</a> to join the worldwide mapping community. Have fun! Posted by Mark Limber, Product Manager and Matt Simpson, User Experience Designer

Introducing Google Building Maker

(Cross-posted on the Google Lat Long Blog ) Some of us here at Google spend almost all of our time thinking about one thing: How do we crea...

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Save the date: Google I/O 2010

<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2SXiliSHOJYo8z30ip8dEnL_IrR2AxtOywjrob9S48_qykaI9v79K-ZrPJNX0fvqjPYbSdMJDvNm3bjqT50D9PJ8CrmlExmAN_Fy3TNYczis10woLajOQ4Ia3QojY47co1zUBS9Dgyhl5/s1600-h/adn2f3b3c7_305hspknzfr_b.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5391835677996707970" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2SXiliSHOJYo8z30ip8dEnL_IrR2AxtOywjrob9S48_qykaI9v79K-ZrPJNX0fvqjPYbSdMJDvNm3bjqT50D9PJ8CrmlExmAN_Fy3TNYczis10woLajOQ4Ia3QojY47co1zUBS9Dgyhl5/s320/adn2f3b3c7_305hspknzfr_b.jpg" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 70px;" /></a><div> </div><div> </div><div> </div><div> </div><div> </div><div> </div><div>We thought we'd let you know that our largest developer conference will be returning to Moscone Center, San Francisco on May 19-20, 2010. Find out more details on the <a href="http://googlecode.blogspot.com/2009/10/mark-your-calendars-for-google-io-2010.html">Google Code Blog</a>! Posted by Joyce Sohn, Google Developer Team</div>

Save the date: Google I/O 2010

We thought we'd let you know that our largest developer conference will be returning to Moscone Center, San Francisco on May 19-20, 2010...

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Shared folders and multiple file upload in Google Docs

Today, we are happy to launch one of the <a href="http://productideas.appspot.com/#25/e=220cb">most requested Google Docs features</a> — the ability to share folders. Shared folders make it easy for a team of people to collaborate on projects that require multiple documents, spreadsheets or presentations. If you have a group of items you want to share, all that you have to do is put them into one folder and share it. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKGJQ8hG3Y4qa7XJY54CG99Zka2MSh5ubtCRlBZXtMj8OH01qm3NSeT3Jp-UcvNp3tHnbbwHk0piWzvjQhZayXgCgm5FkrOAoaVNGM7WOph9Jl0sP9mRsgOZZKanbNqjxhHguAcKefPe3s/s1600-h/d1.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5391768341405716082" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKGJQ8hG3Y4qa7XJY54CG99Zka2MSh5ubtCRlBZXtMj8OH01qm3NSeT3Jp-UcvNp3tHnbbwHk0piWzvjQhZayXgCgm5FkrOAoaVNGM7WOph9Jl0sP9mRsgOZZKanbNqjxhHguAcKefPe3s/s400/d1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 103px;" /></a> Once you've shared a folder, all of the items in the folder will be accessible to the group. You can also add someone to an existing shared folder to give them access to all of the folder's content. Likewise, each item you add to the folder will be automatically shared. Just like with sharing documents, you can <a href="http://docs.google.com/support/bin/answer.py?hl=en&answer=50085">specify edit and view-only access</a> for a folder. In addition to sharing folders, you can now upload multiple files to Google Docs at the same time, simplifying the process of transferring documents from your desktop to the cloud. Once your documents are in the cloud, you can access them from any device connected to the Internet or share them with people you choose. These features are currently rolling out and will be available to everyone by the end of the day. If you're interested in learning more, check out our post on the <a href="http://googledocs.blogspot.com/2009/10/shared-folders-and-more-in-google-docs.html">Google Docs blog</a>. Posted by Vijay Bangaru, Product Manager, Google Docs