healthy4u

Managing your reputation through search results

<div>(Cross-posted on the <a href="http://googlewebmastercentral.blogspot.com/2009/10/managing-your-reputation-through-search.html">Webmaster Central Blog</a>)</div><div> </div>A few years ago I couldn't wait to get married. Because I was in love, yeah, but more importantly, so that I could take my husband's name and people would stop getting that ridiculous picture from college as a top result when they searched for me on Google. After a few years of working here, though, I've learned that you don't have to change your name just because it brings up some embarrassing search results. Below are some tips for "reputation management": influencing how you're perceived online, and what information is available relating to you. Think twice The first step in reputation management is preemptive: Think twice before putting your personal information online. Remember that although something might be appropriate for the context in which you're publishing it, search engines can make it very easy to find that information later, out of context, including by people who don't normally visit the site where you originally posted it. Translation: don't assume that just because your mom doesn't read your blog, she'll never see that post about the new tattoo you're hiding from her. Tackle it at the source If something you dislike has already been published, the next step is to try to remove it from the site where it's appearing. Rather than immediately contacting Google, it's important to first remove it from the site where it's being published. Google doesn't own the Internet; our search results simply reflect what's already out there on the web. Whether or not the content appears in Google's search results, people are still going to be able to access it — on the original site, through other search engines, through social networking sites, etc. — if you don't remove it from the original site. You need to tackle this at the source. <ul><li>If the content in question is on a site you own, easy — just remove it. It will naturally drop out of search results after we recrawl the page and discover the change. </li><li>It's also often easy to remove content from sites you don't own if you put it there, such as photos you've uploaded, or content on your profile page.</li><li>If you can't remove something yourself, you can <a href="http://www.google.com/support/websearch/bin/answer.py?answer=9109">contact the site's webmaster</a> and ask them to remove the content or the page in question.</li></ul>After you or the site's webmaster has removed or edited the page, you can expedite the removal of that content from Google using <a href="http://www.google.com/support/webmasters/bin/answer.py?answer=92865">our URL removal tool</a>. Proactively publish information Sometimes, however, you may not be able to get in touch with a site's webmaster, or they may refuse to take down the content in question. For example, if someone posts a negative review of your business on a restaurant review or consumer complaint site, that site might not be willing to remove the review. If you can't get the content removed from the original site, you probably won't be able to completely remove it from Google's search results, either. Instead, you can try to reduce its visibility in the search results by proactively publishing useful, positive information about yourself or your business. If you can get stuff that you want people to see to outperform the stuff you don't want them to see, you'll be able to reduce the amount of harm that that negative or embarrassing content can do to your reputation. You can publish or encourage positive content in a variety of ways: <ul><li>Create a <a href="http://www.google.com/profiles">Google profile</a>. When people search for your name, Google can display a link to <a href="http://googleblog.blogspot.com/2009/04/search-for-me-on-google.html">your Google profile in our search results</a> and people can click through to see whatever information you choose to publish in your profile.</li><li>If a customer writes a negative review of your business, you could ask some of your other customers who are happy with your company to give a fuller picture of your business.</li><li>If a blogger is publishing unflattering photos of you, take some pictures you prefer and publish them in a blog post or two.</li><li>If a newspaper wrote an article about a court case that put you in a negative light, but which was subsequently ruled in your favor, you can ask them to update the article or publish a follow-up article about your exoneration. (This last one may seem far-fetched, but believe it or not, we've gotten multiple requests from people in this situation.)</li></ul>Hope these tips have been helpful! Feel free to stop by our Web Search Forum and <a href="http://www.google.com/support/forum/p/Web+Search/thread?tid=31539c32bdd9eebf&hl=en">share your own advice or stories</a> about how you manage your reputation online. Posted by Susan Moskwa, Webmaster Trends Analyst

Managing your reputation through search results

(Cross-posted on the Webmaster Central Blog ) A few years ago I couldn't wait to get married. Because I was in love, yeah, but more impo...

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Google Translator Toolkit and minority languages

Today, we've added 285 new languages to <a href="http://translate.google.com/toolkit">Google Translator Toolkit</a>, bringing the total number of languages supported by this product to <a href="http://translate.google.com/support/toolkit/bin/answer.py?hl=en&answer=147837">345</a> — and making it possible to translate between 10,664 language pairs. Google Translator Toolkit is a language translation service for professional and amateur translators that builds on <a href="http://translate.google.com/">Google Translate</a> and makes translation <a href="http://googleblog.blogspot.com/2009/06/translating-worlds-information-with.html">faster and easier</a>. In addition, we've made the Translator Toolkit interface available in <a href="http://translate.google.com/support/toolkit/bin/answer.py?hl=en&answer=147837">35 languages</a>, so that more people can access the service in their own language. At Google, we're focusing on how Translator Toolkit can help preserve and revitalize small and minority languages. Minority languages, also called regional, indigenous, heritage or threatened languages, are languages spoken by the minority people in one locale in a sovereign state or country. Were these endangered languages to become extinct, it would mean an immeasurable loss of knowledge, culture and way of life to minority people worldwide. For this project we worked with Dr. Te Taka Keegan, a Māori language activist and senior lecturer in computer science at the University of Waikato who spent much of his career on how technology can assist in minority language revitalization. At Google, Dr. Keegan researched how computer-aided translation tools can help preserve minority languages. To support his research, we released an alpha version of the Translator Toolkit to various members of Māori translation community in Aotearoa (New Zealand). <a href="http://en.wikipedia.org/wiki/M%C4%81ori">Māori</a>, an Eastern Polynesian language spoken predominately in Aotearoa (New Zealand), is a good starting point because it is one world's 7,000 languages under threat of extinction. According to the <a href="http://www.stats.govt.nz/%7E/media/Statistics/Publications/Census/2006-Census-reports/QuickStats-About-A-Subject/Maori/qstats-about-maori-2006-census.ashx">2006 census</a>, 132,000 people can hold a conversation in Māori. That's roughly 24% of Māori or 4% of New Zealanders. Dr. Keegan found that tools such as Translator Toolkit can help minority languages in several ways: <ul><li>Translation memories and glossaries, when shared across members of a language community, can help unify the language’s written form, increasing translation speed and quality of documents published in that language and preserving the language in the long run.</li><li>Because computer-aided translation can improve translation speed and quality, translators become more productive. When automatic translation is available, as it is for 87 of Google Translator Toolkit's 345 languages, it increases speed further by producing instant translations that people can use as a starting point for their work. And at Google, we use these human translations to improve the translation algorithm of Google Translate over time, creating a virtuous cycle that benefits both human translators and machine translation.</li><li>Online presence of small languages keeps languages relevant in the age of the Internet and globalization, encouraging minority language use by children, who are ultimately responsible for bringing the language to future generations.</li></ul>Languages provide identity, pride, a sense of belonging and spiritual guidance to minority language communities. We hope that by giving both majority and minority language speakers around the world the tools to make online content accessible in their language, we will enable more people to share their culture and knowledge with others worldwide. Ko te reo te hā te mauri o te Māoritanga Language is the very life-breath of being Māori. <div>(Māori) Mak-muwekma mak-noono ya roote 'innutka, mak-'uyyaki_, Nuhu, mak pekre ne tuuxi, 'At mak roote 'innutka hu_i_tak. Our culture and our language are the way to our past, From it we embrace the present, And follow the road to the future. (Muwekma Ohlone Indian tribe, original residents of San Francisco and Santa Clara Counties, California, the home of Google) Posted by Michael Galvez, Product Manager, and Sanjay Bhansali, Engineering Manager</div>

Google Translator Toolkit and minority languages

Today, we've added 285 new languages to Google Translator Toolkit , bringing the total number of languages supported by this product to ...

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Introducing this year's CFDA/Vogue Fashion Fund Finalists as iGoogle artists!

We're always delighted to introduce new design flair to our user experience, especially through the personal expression of iGoogle themes. As a canvas for artists to express themselves and reach Google users around the world, we've shared more than 125 iGoogle Artist themes since May 2008. Today, I'm excited to announce ten new artist themes, all from talented up-and-coming fashion designers you may not have already heard of. Each year, <a href="http://www.style.com/vogue/">Vogue</a> and <a href="http://www.cfda.com/">CFDA</a> sponsor a fashion fund, created to support emerging designers. Through inspiration drawn from Google, our colors and our products, this year's ten finalists have created both incredible fashions and corresponding iGoogle themes. From the high-tech and contemporary designs of <a href="http://www.waynenyc.com/">Wayne</a> to the Google Maps-inspired work of <a href="http://www.sophietheallet.com/">Sophie Theallet</a>, each of these ten new themes is a unique way to refresh your homepage's fall wardrobe. Artist themes are one of many ways we invite talented artists and innovators to share their designs, whether world-renowned or emerging. So check out the <a href="http://www.google.com/help/ig/art/gallery.html">latest Artist themes</a> and pick one that appeals to you. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsfLSWfx7ySH2-fjcCWNqwTYr6432ZWJhBEXCJCI4IFAkOPy_QZnzAw30iHi7qDTd-tPDGf8a48L_AFYetXeGpy5ld2YvlCZM_xminTPpJTcs712d503TY6xkEcb11Vavbok9hyX0V2z_w/s1600-h/vogue.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5392881709487962466" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsfLSWfx7ySH2-fjcCWNqwTYr6432ZWJhBEXCJCI4IFAkOPy_QZnzAw30iHi7qDTd-tPDGf8a48L_AFYetXeGpy5ld2YvlCZM_xminTPpJTcs712d503TY6xkEcb11Vavbok9hyX0V2z_w/s400/vogue.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 291px;" /></a> Finally, we'd like to offer our congratulations to this year's Fashion Fund finalists. We're proud to be showcasing them in our iGoogle artist themes. Based on their iGoogle themes and design entries, their talents are obvious and we're happy to see them recognized! Posted by Marissa Mayer, VP, Search Products & User Experience, and Michaela Prescott, Senior Product Marketing Manager

Introducing this year's CFDA/Vogue Fashion Fund Finalists as iGoogle artists!

We're always delighted to introduce new design flair to our user experience, especially through the personal expression of iGoogle theme...

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A green tour of the Google campus

We care about a clean energy future and that's a commitment that starts at home. In honor of <a href="http://www.blogactionday.org/">Blog Action Day 2009</a> and this year's climate change theme, we wanted to walk you through some of the green features of <a href="http://maps.google.com/maps?hl=en&safe=off&client=firefox-a&ie=UTF8&q=google+mountain+view&fb=1&gl=us&hq=google&hnear=mountain+view&cid=0,0,11972054812773967638&ei=YVzWSsfpEoOysgOq0JXZAg&ved=0CAoQnwIwAA&ll=37.423293,-122.084305&spn=0.008691,0.022724&z=16&iwloc=A">our global headquarters</a> here in sunny Mountain View, California. <ul><li>Getting to work: We've got a shuttle service that brings employees from around the Bay Area to the Googleplex every day. These shuttles are outfitted with wi-fi and fueled by B20 biodiesel. And employees who <a href="http://googleblog.blogspot.com/2009/05/bike-to-work-day-2009.html">bike</a>, walk, skip, hop or otherwise self-power to work can earn points that translate into a donation from Google to their charity of choice.</li></ul><ul><li>Turning on the lights: The rooftops at our headquarters are covered in 9,212 photovoltaic <a href="http://www.google.com/corporate/solarpanels/home">solar panels</a> that produce 1.6 MW of electricity — enough energy to power about 1,000 California homes.</li></ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBX3pwJNa0O4RMeS4A75P8WGV_ARPSiawMDPqyUJd3UCZcZqgtRt08s1OzqCYJyz0eCrRHOMXAB4mkRgBFe41OPDeAR9sVQeQ0BpUEn_Wg2_hi5cpENJOhxPScfe3D1y1Peoy_Qydu_PZN/s1600-h/green1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5392610287411292450" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBX3pwJNa0O4RMeS4A75P8WGV_ARPSiawMDPqyUJd3UCZcZqgtRt08s1OzqCYJyz0eCrRHOMXAB4mkRgBFe41OPDeAR9sVQeQ0BpUEn_Wg2_hi5cpENJOhxPScfe3D1y1Peoy_Qydu_PZN/s400/green1.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a><ul><li>Healthy buildings: The facilities at our main campus use sustainable building materials that are environmentally friendly and healthier, such as "cradle-to-cradle" certified products designed to never end up in landfills, fresh air ventilation, daylighting, and whenever possible, PVC- and formaldehyde-free materials.</li></ul><ul><li>No, we're not kidding: We've been known to <a href="http://googleblog.blogspot.com/2009/05/mowing-with-goats.html">use goats</a> instead of lawn mowers to graze the fields surrounding our campus.</li></ul><ul><li>Getting around town: We have a fleet of 8 plug-in vehicles that Google employees can use free of charge to run errands during the day. (In the summer of 2008 our Google.org <a href="http://www.rechargeit.org/">RechargeIT initiative</a> launched a controlled driving experiment, and our plug-in hybrids achieved more than 90 MPG!) Shared bicycles are also scattered among our buildings for Googlers to use for short trips around campus, reducing the need for cars during the work day.</li></ul><ul><li>Waste not, want not: Waste from our Mountain View cafes is separated and the organic component is composted. As a result, we've reduced waste sent to landfills, reduced greenhouse gases and recycled nutrients leading to improved soil quality without chemicals. And any disposable plateware and cutlery we continue to use in the cafés is now compostable.</li></ul>Check out <a href="http://www.google.com/green">this website</a> to learn more about Google's green initiatives, and thank you to Blog Action Day for orchestrating the " largest-ever social change event on the web" yet again. Posted by Anthony Ravitz, Real Estate & Workplace Services

A green tour of the Google campus

We care about a clean energy future and that's a commitment that starts at home. In honor of Blog Action Day 2009 and this year's c...

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One-stop shop: Buy Promoted Videos in AdWords

We first launched Promoted Videos as a search advertising program on YouTube, allowing content creators to drive viewership of their videos by targeting the hundreds of millions of searches that happen on YouTube every day. But in the past year Promoted Videos has evolved into a much broader discovery vehicle, appearing on search, the YouTube homepage, video <a href="http://ytbizblog.blogspot.com/2009/08/promoted-videos-now-appearing-on.html">watch pages</a> and recently <a href="http://adsense.blogspot.com/2009/10/youtube-promoted-videos-to-appear-on.html">across the AdSense network</a>. We've also built better conversion opportunities via <a href="http://ytbizblog.blogspot.com/2009/06/use-call-to-action-overlays-to-drive.html">Call-to-Action overlays</a>. As a result, Promoted Videos is now driving millions of video views per week, with clicks having increased 500% since January. In a world where 20 hours of video are uploaded to YouTube every minute, Promoted Videos has become a critical way for creators to get their content in front of viewers across the web. Now that it's easier than ever to drive views of your video, we also wanted to make it easier to run these campaigns in the first place. Starting today you can buy Promoted Videos directly in AdWords. Any AdWords advertiser with video content — from a small business looking to promote a product, to a movie studio premiering a new trailer — can use Promoted Videos to make sure their videos find a larger audience. This integration will provide a single destination for your overall Google ad buy, and will give YouTube advertisers access to campaign tools in AdWords. AdWords is a global platform, so we're excited to use this integration as a way to start rolling out Promoted Videos internationally. With this launch, Promoted Videos are now available in Canada, the U.K., France, Italy, Germany, Spain and the Netherlands. We hope our international users, partners and advertisers will take full advantage of this new opportunity to ensure their videos are more easily discovered around the world, and we look forward to expanding to other countries in the coming weeks. Posted by Jonathan Goldman, YouTube Software Engineer

One-stop shop: Buy Promoted Videos in AdWords

We first launched Promoted Videos as a search advertising program on YouTube, allowing content creators to drive viewership of their videos ...

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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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