healthy4u

HHS to promote low-cost electronic health record software packages including the VA's VistA

If I were a proprietary health IT vendor, the following bolded passage in the new Healthcare Bill (PDF <a href="http://finance.senate.gov/press/Bpress/2009press/prb101909.pdf">here</a>) would make me a bit nervous: SEC. 1102. ENCOURAGING MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS. (a) STUDY.—The Secretary of Health and Human Services shall conduct a study of methods that can be employed by qualified health benefits plans offered through an exchange to encourage increased meaningful use of electronic health records by health care providers, including— <blockquote>(1) payment systems established by qualified health benefit plans that provide higher rates of reimbursement for health care providers that engage in meaningful use of electronic health records; and (2) promotion of low-cost electronic health record software packages that are available for use by health care providers, including software packages that are available to health care providers through the Veterans Administration.</blockquote> The VA system, VistA/CPRS ("computerized patient record system"), was developed with taxpayer money and is freely available. A free working demo is downloadable <a href="http://www1.va.gov/cprsdemo/">here</a> (Windows only). This represents a needed "public option" for healthcare IT, the estimates of cost of adoption of proprietary systems now at somewhere between $20 and $50 billion dollars, give or take. (I believe the actual figure to be far higher due to IT sector dyscompetence in HIT as I wrote at my post "<a href="http://hcrenewal.blogspot.com/2009/10/fuzzy-math-rising-costs-in-governments.html">Fuzzy Math Indeed</a>.") To put that figure in context, $50 billion is enough to build approximately five hundred shiny new 100-bed hospitals, or one hundred 500-bed hospitals, at ~$1 million per bed. Entrepreneurial companies have sprung up to adopt it for the private healthcare sector such as <a href="http://worldvista.sourceforge.net/About/indexworldvista.html">WorldVista</a>. They probably won't be charging the multimillion dollar rates that the private HIT sector does, and the quality will likely be higher. -- SS

HHS to promote low-cost electronic health record software packages including the VA's VistA

If I were a proprietary health IT vendor, the following bolded passage in the new Healthcare Bill (PDF here ) would make me a bit nervous: S...

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Flying in a WiFi wonderland: Free Internet from Google on Virgin America flights

We know the holiday season seems to come earlier every year (sorry, Halloween), but before you make your final travel plans, we're excited to let you know that we're partnering with <a href="http://www.virginamerica.com/va/home.do">Virgin America</a> to <a href="http://www.freeholidaywifi.com/">provide free WiFi</a> on every Virgin America flight between November 10, 2009 and January 15, 2010. The holidays can be full of dates and details to remember, and it's easy to get stressed out somewhere between planning a long distance, multi-generational family gathering and combing the Internet for the latest impossible-to-find furry contraption for your toddler. And when you have to do all that while coordinating air travel at the same time as several million of your closest friends, things can get <a href="http://images.google.com/images?hl=en&um=1&sa=1&q=home+alone&aq=f&oq=&aqi=g10&start=0">downright dramatic</a>. Whether it's using Gmail to confirm an airport pick up time with your brother, doing some last minute gift shopping for your niece on Google Product Search or searching Google.com for a good sweet potato pie recipe before touchdown — we hope this makes it a bit easier to stay connected with family and friends while you're up in the air. You can find out more about our partnership, where Virgin America flies and how the in-flight WiFi service works at <a href="http://www.freeholidaywifi.com/">www.freeholidaywifi.com</a>. Posted by Jeff Aguero, Product Marketing Manager

Flying in a WiFi wonderland: Free Internet from Google on Virgin America flights

We know the holiday season seems to come earlier every year (sorry, Halloween), but before you make your final travel plans, we're excit...

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"Going Google" with millions of businesses around the world

Each day, thousands of companies choose to "<a href="http://www.google.com/apps/intl/en/business/gogoogle-ent.html#utm_campaign=gogoogle&utm_source=en-na-us-ogblog-gogoogle_101909&utm_medium=blog">go Google</a>" — that is, switch to Google Apps. Over two million business and 20 million users in over 100 countries and more than 40 languages have adopted <a href="http://www.google.com/apps/intl/en/business/gogoogle.html#utm_campaign=gogoogle&utm_source=en-na-us-ogblog-gogoogle_101909&utm_medium=blog">Apps for their workplace</a>, and we're happy to welcome companies around the world such as Konica Minolta, Rentokil Initial and TOTO that have just decided to go Google. These companies no longer have to deal with the hassles of managing email servers or rolling out software updates, and their employees now enjoy the convenience of shared documents and calendars, Gmail and more. Since we <a href="http://googleblog.blogspot.com/2009/08/going-google-with-google-apps.html">first asked</a> for your "gone Google" stories in August, we've seen thousands of <a href="http://twitter.com/GoogleAtWork/favorites">tweets</a> and hundreds of comments explaining how and why your company decided to go Google with Apps, as well as with other Google enterprise products such as <a href="http://www.google.com/postini/gogoogle.html#utm_campaign=gogoogle_pos&utm_source=en-na-us-ogblog-gogoogle_101909&utm_medium=blog">Google Postini Services</a> and the <a href="http://www.google.com/enterprise/search/gsa.html#utm_campaign=gogoogle&utm_source=en-na-us-ogblog-gogoogle_101909&utm_medium=blog">Google Search Appliance</a>. Jeffrey D. from Ottawa, Canada told us that with Apps, he "was able to set up a new business in minutes with email, calendar, docs, and sync with [his] BlackBerry." <a href="http://twitter.com/happymacs/status/3111574146">@happymacs</a> from San Diego, CA tweeted how they liked the ability to "search every single email received in the past 2.5 years in under 2 seconds"; while <a href="http://twitter.com/appfrica/status/3102474107">@Appfrica</a> highlighted the sobering fact that the cost of an alternative software solution would employ a person in Uganda for a month. Today, we're excited to support this global momentum with the expansion of the "Gone Google" initiative to additional countries including the U.K., France, Canada, Japan, Australia and Singapore. We hope our messages — in train stations such as Paddington, La Défense and Shinagawa, and at airports in Singapore, Toronto, Dallas and beyond — help companies, schools and organizations learn all about the benefits of going Google with our enterprise products. Here's a sneak peek at what you can expect to see both here in the U.S. and abroad: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/iP2oWfDMvqc&hl=en&fs=1&rel=0&hd=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/iP2oWfDMvqc&hl=en&fs=1&rel=0&hd=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> If you've already gone Google, you can <a href="http://www.youtube.com/watch?v=MdAMLEujm5M">share your company's Gone Google story</a> with us, or use some of our tools to help <a href="http://www.google.com/apps/intl/en/business/spreadtheword.html#utm_campaign=gogoogle&utm_source=en-na-us-ogblog-gogoogle_101909&utm_medium=blog">spread the word</a> about switching to Google Apps. We hope you'll be part of the story. Posted by Tom Oliveri and Vivian Leung, Google Enterprise Team

"Going Google" with millions of businesses around the world

Each day, thousands of companies choose to " go Google " — that is, switch to Google Apps. Over two million business and 20 millio...

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Our Policy Is To Always Have Unabashed Faith In The Computer ... Except When It Screws Up, And Then It's The Doctor's Fault

Healthcare IT such as electronic medical records (EMR/EHR) and computerized physician order entry (CPOE) systems are a perfected, safe technology, one might think, from the almost hagiographic and entirely uncritical P.R. about HIT, all the way up to the President of the United States. (Not bad for an entirely unregulated industry. Pharma IT should only have it so well.) Paraphrasing Capt. Chesley Sullenberger in a <a href="http://online.wsj.com/article/SB10001424052748703790404574469160016077646.html">recent WSJ article</a>, however, I'm a long term optimist about HIT, but a short term realist. Healthcare cannot be 'transformed' by a technology that itself has major problems and needs transformation. These issues should have been substantially remediated before forced national rollouts, I feel. That's especially true given the inherent dangers in medicine. You can't be a wishful thinker. You have to know what you know, and perhaps more importantly in medicine, what you don't know (this is especially true both for those in IT who lack formal clinical or biomedical backgrounds, and for those in medicine who lack formal biomedical informatics or computer science backgrounds). You also need to know what your tools can and can't do. Sticking one's head in the sand is no way to approach HIT. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIqCS12K1usmZMlxOoFAud0IU-EE_YeYoCGMIjhSRmlO2uIdWpffcisgn5KDlF1pN8ND6cslVzDqpu-OFmMANL6O2NEY5haMuuDLuSR6vpQ9rQ_3qxYv-Fps4KU43lqGEwVflq89aB4abY/s1600-h/headinsand.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5394097962244199106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIqCS12K1usmZMlxOoFAud0IU-EE_YeYoCGMIjhSRmlO2uIdWpffcisgn5KDlF1pN8ND6cslVzDqpu-OFmMANL6O2NEY5haMuuDLuSR6vpQ9rQ_3qxYv-Fps4KU43lqGEwVflq89aB4abY/s320/headinsand.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 171px; height: 150px;" /></a> That said, here are some sample voluntary reports on HIT malfunctions from just one vendor, taken from the FDA Medical Devices database, the <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFM">Manufacturer and User Facility Device Experience (MAUDE) database</a>, links included. These are production systems used on real, live patients, not prototypes: <blockquote> MAUDE data represents reports of adverse events involving medical devices. The data consists of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996. MAUDE may not include reports made according to exemptions, variances, or alternative reporting requirements granted under 21 CFR 803.19.</blockquote> Emphases below are mine. My comments are in [red italic]. Case 1: (note - added to this post 7/2010) <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1656460">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1656460</a> CERNER MILLENIUM POWERCHART CPOE Event Date 11/19/2006 Event Type: Death Patient Outcome: Death The medication review screen of the subject device does not specify the exact dose in milligrams of combination medications. For example, narcotics are combined with tylenol in at least two strengths. Liquid narcotic tylenol-oxycodone combination is reported in ml, not mg. The exact dose of tylenol is not specified and requires knowledge of the combination medication dose in the volume specified. Certain fields of the grid do not specify the volume, but rather state "date/time" requiring another click or pop up screen. The immediate knowledge of tylenol dosage in mg is directly related to understanding and preventing excessive doses. In the subject, 10 ml of acetaminophen-oxycodone is indicated as having been given 3 times over 4 hours. That means that 1950 mg of tylenol was administered in 4 hours while the patient was in a state of starvation and receiving other medication that increase the effects of tylenol. This dose would equate to 11,700 mg of tylenol over 24 hours, nearly 3 times the maximum daily dose in otherwise health people. In the ensuing days, the patient developed acute renal failure, presumably acute tubular necrosis, and died. In the absence of other etiology, the excess tylenol was the culprit. This was not considered as etiology ante-mortem. The counterintuitive screen impaired the professionals. The pharmacist did not recognize and stop the medication, the nurses administered it, and the excessive dose, clinically meaninglessly listed as a volume of 10 ml -given 3 times in 4 hours- of acetaminophen-oxycodone, was missed by the physicians. Adverse events have been ascribed to "user error" by vendors. The device offers a potent propensity to life endangering oversights. There are other screens on this device which present information that interfere with clinically useful visualization of data. [Who designed these screens, I ask? Clinicians, or business IT personnel used to designing inventory systems for widget control? - ed.] The data does not flow to the professionals. It is not represented in a meaningfully useful manner. The professionals need to hunt for it. As such, the user unfriendly screens [see <a href="http://www.tinyurl.com/hostileuserexper">this link</a> on mission hostile HIT - ed.] impair safe medical care consistent with the impediment to expedient professional understanding of what, exactly, is the dose of medication and how much was administered to the patient. This sentinel case of death is directly attributed to user unfriendly screens on this device. Case 2: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm?id=64345">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm?id=64345</a> Cerner Millennium RadNet Auto Launch Study and Auto Launch Report software functionalities. Defects in the Auto Launch functionality make it possible for a mismatch of patient data. [That is, in radiology reports. The dangers of transpositions is obvious.] Case 3: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=722614">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=722614</a> The issue involves powerchart local access medication administration task, used when certain cerner millennium solutions are not available. At powerchart local access sites that utilize coordinated universal time (utc) functionality, medication administration tasks might be displayed with incorrect times. When a pt download occurs from cerner millennium servers to powerchart local access, and there is no cerner millennium application session active, powerchart local access adds or subtracts the number of hours equal to the time zone difference from greenwich mean time. Scheduled medication administration tasks may show an incorrect administration time and the possibility exists for a pt to receive medications earlier or later than intended. [As just one example of the dangers with this type of defect, an elderly patient with sepsis might get an early dose of <a style="font-weight: bold; font-style: italic;" href="http://www.uptodate.com/patients/content/topic.do?topicKey=%7E33VV7w5pdwZSOF">aminoglycoside</a>, causing peak levels to rise to nephrotoxic and ototoxic levels - ed.] Case 4: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=946706">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=946706</a> Patient care delay. The issue involves functionality in cerner millennium powerchart office and powerchart core and affects users that utilize the powerchart inbox and message center inbox. In results to endorse or sign and review, if the user clicks ok and next multiple times in quick succession [e.g., a busy clinician with sick patients, waiting for the computer to respond - ed.] while attempting to sign a result or a document, the display could lag behind the system's processing of the action [that is to say, the human-programmed and supposedly tested and validated computer "system" -ed.], and multiple results or documents could be signed without the user's review. In message center, when clicking ok and next or accept and next, or when deleting or completing messages and moving to the next task, a document could be signed or a message could be deleted without the user's review. Results could be endorsed or documents could be signed without physician review, which could impact patient care. Cerner received communication that a patient's follow-up care was delayed as a result of this issue. [Luck prevailed that no injury occurred - in this reported case. One wonders if that is true of all the users who experienced this problem. Also, I do not recall such errors happening on paper order forms due to, say, a busy clinician tapping his pen on the paper - ed.] Case 5: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=888215">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=888215</a> The issue involves the pharmacy medmanager functionality. If the user performs a modify action on an order with an existing duration and duration unit, the order's stop date might not be recalculated. Specifically, this occurs when only the duration value is changed prior to entering the original duration unit. Pt care could be adversely affected, as medication therapy could be concluded prematurely or could last longer than intended based on the order details prior to the modification. This issue can be avoided if the user performs a renew action instead of a modify action to change an order's duration. If performing a modify action is required, users can manually set the stop date and time during the modify action. Cerner received communication that a pt's surgery required rescheduling as a result of this issue. [Again, was the lack of patient harm due to careful clinicians who at that moment just happened to not be distracted or cognitively overloaded or overworked or exhausted from on-call, or an act of Providence? Were other non-reported users at other organizations less lucky? - ed.] Case 6: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=920819">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=920819</a> The issue involves the results to endorse (rte) inbox functionality in powerchart, powerchart office and firstnet and affects users that use the rte inbox to view radiology reports that have been created in radnet. Radiology results might fail to be displayed in the ordering provider's results to endorse folder in the inbox. Treatment or diagnosis decisions could be delayed if the clinician is relying on the display of a result in the inbox results to endorse folder to initiate patient follow-up. Note: the final results are posted to the flowsheet and are available on the patient's chart. Cerner received communication that a patient's follow-up care was delayed as a result of this issue. [Were any diagnoses of, say, cancer missed by other organizations affected? -ed.] Case 7: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=700117">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=700117</a> The issue involves the direct charting flowsheet and icu flowsheet, used within the powerchart system. When the result details box is accessed for a negative result value in either the icu flowsheet or the direct charting flowsheet in powerchart, either by right-clicking a negative, unsigned result value and selecting chart details from the context menu, or by right-clicking a negative signed result value and selecting modify, the dialog box displays a blank result value. When the user clicks ok in the result details dialog box, the value is changed to zero in the result cell in the flowsheet. [Of all places, health IT in ICU's should be extensively validated before going into production - ed.] Case 8: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=715963">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=715963</a> The issue involves the careadmin medication administration wizard used within the carenet system. When scanning a medication in careadmin, the system fails to recognize mckesson identifiers or other miscelaneous identifiers and properly identify the scanned product, which could result in the documentation of an incorrect dose in the careadmini window. In such situations, the system does not display overdose or underdose or route/form compatibility warnings as it should. Patients could receive an inappropriate dose of medication. Cerner has not been made aware of any adverse patient care events that resulted from this issue. [Thank god for that - but were any unreported by other organizations? - ed.] Case 9: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=753029">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=753029</a> Microbiology set up a program within the cerner computer system to automate the reporting system for hsv (herpes simplex virus)testing. The system was tested with the assistance of cerner and found to be working appropriately. The new system was operational for approximately 3 weeks when it was determined that the first word of the sentence, "no" was inappropriately dropping off of the following sentence: "no herpes simplex virus type 1 or herpes simplex virus type 2 detected by dna amplification. " as such, two of five patients were incorrectly informed that they had hsv before the error was detected. One had started an antiviral creme treatment. The other three did not have follow-up visits until after the correct results were determined. Cerner has looked at the program and has not provided an answer for the system issue. In the interim, the previous manual review and entry process is being used. [How does the word "no", an essential descriptor in a medical test, simply get "dropped?" Does <a style="font-style: italic; font-weight: bold;" href="http://www.norad.mil/">NORAD's</a> ballistic missile warning system ever do that, i.e., "no ICBM's incoming" reported as "ICBM's incoming"?- ed.] --------------------------------- Additional reported errors can be seen in a file downloadable by clicking <a style="font-weight: bold;" href="http://www.ischool.drexel.edu/faculty/ssilverstein/maude/Adverse_Event_CPOE__MAUDE.pdf">on this link</a> (PDF). Some of these are a bit startling. --------------------------------- Still others can be seen at: <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=695436"> </a><a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=695436" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=695436</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=688925" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=688925</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=996685"> </a><a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=996685" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=996685</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1075747" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1075747</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=574578" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=574578</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1288623"> </a><a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1288623" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1288623</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1370640" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1370640</a> <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=834678" target="_blank">http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=834678</a> Again, these are reports about just one HIT vendor but this piece is not just about them. Other HIT vendor products have similar issues. Health IT remains an experimental technology. The MAUDE reports are voluntary, however, so the absence of a report does not mean an absence of a problem. (I note MAUDE queries on a number of major HIT vendors produce no results, or results limited to HIT that is closely associated with physical "medical devices" -- as opposed to virtual ones -- such as radiology systems.) For example, while a query on mfg. "Cerner" brings up hits, a query on another vendor shows this result: <blockquote>No records were found with Manufacturer: Allscripts Report Date From: 10/01/1998 Report Date To: 09/30/2009 </blockquote> ... and this: <blockquote>No records were found with Manufacturer: Nextgen Report Date From: 10/01/1997 Report Date To: 09/30/2009 </blockquote> ... while a <a href="http://google2.fda.gov/search?q=nextgen&x=0&y=0&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*">broader FDA search on "Nextgen"</a> brings up exactly <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1055515">one relevant hit</a> on "Nextgen EMR - Medical Device" -- without specifics as to the "malfunction" noted under product code "<a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=3355">HGM</a>" - which on lookup is a perinatal monitoring system. A <a href="http://google2.fda.gov/search?q=allscripts&x=0&y=0&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*">broader search on Allscripts</a> only brings up drug related issues such as this curious 2002 <a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2002/ucm145211.htm">warning letter</a> about the marketing of guaifenesin, a cough medicine, from FDA's Center for Drug Evaluation and Research. Either these vendors are not reporting HIT problems, or are listed under another name. Rather unlikely is that they have <a href="http://www.healthcareitnews.com/news/allscripts-shareholders-file-class-action-suit">no problems</a> to <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">report</a> (latter hyperlink is PDF). As another example, a search on brand name "Centricity" brings up "hits" mostly on specialized GE products such as PACS. So, is HIT safe, or can "glitches" affect patient care? Should this industry be entirely unregulated, or its products "certified" by groups with conflicts of interest such as those affiliated with industry trade groups? Should vendors be <a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">held harmless</a> for HIT defects that harm patients? I report, you decide. -- SS

Our Policy Is To Always Have Unabashed Faith In The Computer ... Except When It Screws Up, And Then It's The Doctor's Fault

Healthcare IT such as electronic medical records (EMR/EHR) and computerized physician order entry (CPOE) systems are a perfected, safe techn...

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This week in search 10/16/09

This is part of a regular series of posts on search experience updates that runs on Fridays. Look for the label "<a href="http://googleblog.blogspot.com/search/label/This%20Week%20in%20Search">This week in search</a>" and subscribe to the series. - Ed. This week, we made a few improvements to help webmasters better understand how their pages interact with Google search. Here's an overview: Fetch as Googlebot As a webmaster, have you ever wondered what Google "sees" when we visit your site? Our understanding of your web page affects which searches your page is returned for and its relevance rank. New this week, we're providing a tool as part of our Webmaster Tools Lab that lets you to <a href="http://googlewebmastercentral.blogspot.com/2009/10/fetch-as-googlebot-and-malware-details.html">see what Googlebot sees</a> in the hope that this will help site owners better understand why we think your pages are relevant, and to what. We think this can help webmasters design pages that are easier for Googlebot to understand, and more importantly, easier for users to understand. Malware details You may occasionally see on Google a notice that says "This site may harm your computer." We place this warning in search result snippets when we see signals that a particular web page may be spreading malware. Webmasters occasionally will see this warning on one of their pages that wasn't intended to be malicious. This is because sometimes your site could be distributing malware — and you might not even know it or be able to easily find it. <a href="http://googlewebmastercentral.blogspot.com/2009/10/fetch-as-googlebot-and-malware-details.html">Malware details</a> is designed to help webmasters track down what on their site is triggering this label and clear the problem — thus, making their page (and the web) safer for users. Hope you enjoyed this week's features. Stay tuned for what's next! Posted by Marissa Mayer, VP, Search Products & User Experience

This week in search 10/16/09

This is part of a regular series of posts on search experience updates that runs on Fridays. Look for the label " This week in search ...

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A new home for accessibility at Google

Information access is at the core of <a href="http://www.google.com/corporate/facts.html">Google’s mission</a>, which is why we work to make the world's content available to people with disabilities, such as blindness, visual impairment, color deficiency, deafness, hearing loss and limited dexterity. Building accessible products isn't only the right thing to do, it also opens up Google services to very significant populations of people. According to the United Nations, <a href="http://www.un.org/disabilities/default.asp?id=18">650 million people</a> live with a disability, which makes them the world's largest minority. We regularly develop and release accessibility features and improvements. Sometimes these are snazzy new applications like the a new <a href="http://google-opensource.blogspot.com/2009/09/talking-rss-reader-for-android.html">talking RSS reader</a> for Android devices. Other times the changes aren't flashy, but they're still important, such as our recent incremental improvements to <a href="http://dev.chromium.org/developers/design-documents/accessibility#TOC-WAI-ARIA-Support">WAI-ARIA support in Google Chrome</a> (adding support for ARIA roles and labels). We also work on more foundational research to improve customization and access for our users, such as <a href="http://code.google.com/p/google-axsjax/">AxsJax</a> (an Open Source framework for injecting usability enhancements into Web 2.0 applications). We've <a href="http://googleblog.blogspot.com/search/label/accessibility">written frequently</a> about accessibility on our various blogs and help forums, but this information has never been easily accessible (pun intended) in one central place. This week we've launched a handy new website for Accessibility at Google to pull all our existing resources together: <a href="http://www.google.com/accessibility/">www.google.com/accessibility</a>. Here you can follow the latest accessibility updates from our blogs, find resources from our help center, participate in a discussion group, or send us your feedback and feature requests. Around here, we often say, "launch early and iterate" — meaning, get something out the door, get feedback, and then improve it. In that tradition, our accessibility website is pretty simple, and we expect this site to be the first of many iterations. We're excited about the possibilities. The thing we're most excited about is getting <a href="https://services.google.com/fb/forms/accessibility/">your feedback</a> about Google products and services so we can make them better for the future. Take a look and let us know what you think. Posted by Jonas Klink, Accessibility Product Manager

A new home for accessibility at Google

Information access is at the core of Google’s mission , which is why we work to make the world's content available to people with disabi...

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Fuzzy Math Indeed: Rising Costs in Government's Digital Health Stimulus

Seen in the blog of the Huffington Post Investigative Fund: <blockquote><a href="http://huffpostfund.org/stories/2009/10/fuzzy-math-rising-costs-governments-digital-health-stimulus">Fuzzy Math? Rising Costs in Government's Digital Health Stimulus</a>  <div id="node-880" class="node odd full-node node-type-article"> <div class="subtitle">Spending Could Be Double The Obama Administration's Public Estimate of $19 Billion </div></div> <div class="author">By <a href="http://huffpostfund.org/users/fred-schulte" title="View user profile.">Fred Schulte</a> Huffington Post Investigative Fund </div> <div class="post-date">15 Oct 2009</div> Creating digital medical records for every American within the next five years – a key provision of President Obama’s stimulus package -- could cost more than twice the $19.5 billion figure that has been cited by federal officials. Federal budget documents show that actual spending for the plan, which will use stimulus money to help doctors and hospitals defray the cost of installing high-tech records systems, could hit nearly $47 billion. The discrepancy between the Obama administration’s <a href="http://huffpostfund.org/stories/2009/10/fuzzy-math-rising-costs-governments-digital-health-stimulus#cost">$19.5 billion public estimate</a> and the entry in the budget of the U.S. Department of Health and Human Services mostly arises from the government’s calculation that it will recoup some of the cost of subsidizing digital systems through billions of dollars in reduced federal health spending. But many health analysts are highly skeptical that such savings can be accurately predicted.</blockquote><div id="TixyyLink" style="border: medium none ; overflow: hidden; color: rgb(0, 0, 0); background-color: transparent; text-align: left; text-decoration: none;"> </div>It's worse. Far worse. I believe the government is underestimating EHR costs by a factor of 5 to 10, due to implementation failure and remediation costs. I'm a long term optimist on health IT, but a short term realist. I believe we will be having an avalanche of failed/stalled projects such as this one in years to come: "<a href="http://hcrenewal.blogspot.com/2009/10/another-major-hit-project-setback.html">Another Major HIT Project Setback at UCSF</a>". The incompetence in this industry is worse than I imagined when I started writing about HIT dysfunction a decade ago. Worse are the coverups of problems that occur in implementation and in use. At least in the U.S. military, there is transparency about health IT problems (e.g., see <a href="http://hcrenewal.blogspot.com/2009/06/if-military-cant-get-electronic-health.html">here</a>). In the private sector, forget about publicity of what actually goes on in the U.S. (The U.K. has increased its own transparency to <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=UK">some extent</a>.) <blockquote>A spokesman for the department [U.S. Department of Health and Human Services], Nicholas Papas, said that the $47 billion figure is “undergoing revision and we anticipate it will decrease.” He said the agency expects to generate a “firmer figure” by the end of the year, but declined to say how much it would be. Papas said there was no attempt to lowball the number for public consumption. Calculating both cost and benefits in the government’s estimate is a sound way to explain the price of the plan, he said.</blockquote> Unfortunately, these calculations do not factor in the cost of dyscompetence, incompetence and failures created by lack of essential cross disciplinary expertise and talent in the HIT industry. <blockquote>Many health policy experts agree that electronic health records can cut costs by reducing harmful medical errors and wasteful spending.</blockquote> I would bet these "policy experts" have never tried to implement clinical IT. <blockquote>The $19 billion figure has appeared in numerous news articles and been widely picked up and repeated by many bloggers covering the fast-growing health information technology industry. Earlier this month President Obama’s chief technology officer, Aneesh Chopra, mentioned the $19 billion figure twice in a live video cast from the White House. But it’s “totally hypothetical,” said Sharona Hoffman, a professor of law and ethic at Case Western Reserve University School of Law. She said it counts on savings “with no concrete evidence they will occur.”</blockquote><div id="TixyyLink" style="border: medium none ; overflow: hidden; color: rgb(0, 0, 0); background-color: transparent; text-align: left; text-decoration: none;"> </div>It's worse than "totally hypothetical." A major confounding variable is simply missing - the cost of HIT failures, false starts, delays, and remediation. More can be read about those risks <a href="http://www.tinyurl.com/hit-misadventure">here</a>. That site has been online for a decade now, and ironically is nearly the only relevant "hit" on a search engine query on "<a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=healthcare+IT+failure&btnG=Google+Search">healthcare IT failure</a>" or similar concept. Has anyone in government been paying attention? A slide deck I recently presented entitled "Health IT Promises and Threats" provides a dose of reality on supposed cybernetic miracles. It is at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/EHR_benefit_peril_final.ppt">this link</a> (PPT). -- SS

Fuzzy Math Indeed: Rising Costs in Government's Digital Health Stimulus

Seen in the blog of the Huffington Post Investigative Fund: Fuzzy Math? Rising Costs in Government's Digital Health Stimulus ...

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