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Contextual search within Wikipedia

We are excited to announce that we've built a <a href="http://en.wikipedia.org/wiki/Wikipedia:Google_Custom_Search">Custom Search Wikipedia skin</a> that makes it easier for you to complete your research on Wikipedia. Wikipedia allows users to register and personalize their Wikipedia environment via the configuration of options and the use of styles or skins. Just log in to Wikipedia, <a href="http://en.wikipedia.org/wiki/Wikipedia:Google_Custom_Search">enable the Custom Search skin</a> and you'll have quick access to relevant Google Custom Search results from Wikipedia. With the Custom Search skin, your search results are conveniently placed inline on the page. After you've reviewed the results, you can dismiss them and return to the current article of interest without having to switch to a different tab on your browser; you can access the relevant Wikipedia articles right within the Wikipedia interface. The Custom Search skin also features contextual search — searching across different sets of pages as you navigate Wikipedia. For Wikipedia pages with a lot of information and links, contextual search lets you limit your search to only those Wikipedia pages that are linked from the current article, focusing the results on the topic of the article. So, in addition to getting all matching Wikipedia articles, you can quickly drill down to contextually relevant results using the Linked Wikipedia Pages tab. For example, searching for [sequence] from a <a href="http://en.wikipedia.org/wiki/DNA">Wikipedia page on DNA</a> provides a list of relevant results about DNA sequences and DNA sequence alignment, instead of the <a href="http://en.wikipedia.org/wiki/Sequence_%28disambiguation%29">many pages about sequences</a> (in mathematics, poetry, music, games, etc.) that aren't relevant. Similarly, searching within the DNA page for [bonds] gives you results in chemistry and biochemistry, instead of other information about financial instruments and social sciences. This will help you perform more directed research, often with shorter queries, and get to relevant Wikipedia articles faster. As you can see from the screenshot below, the Linked Wikipedia Pages tab helps you get quickly to the article about DNA sequence from a search for [sequence] on the DNA page. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_XxukNkXWcE7ViprwV6A6F1FNsBX-0Gs3zAfhSrF1Gx6_xZUlADuUZNal0057ZvEWcVBuPGDkdCer1FqL_FBzF0FZ3uDMkVHjPiqpye6uBphzmkiWxYquRN8epk6ydbK6PsVX4i4ObZEm/s1600-h/w1" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5397037129679706658" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_XxukNkXWcE7ViprwV6A6F1FNsBX-0Gs3zAfhSrF1Gx6_xZUlADuUZNal0057ZvEWcVBuPGDkdCer1FqL_FBzF0FZ3uDMkVHjPiqpye6uBphzmkiWxYquRN8epk6ydbK6PsVX4i4ObZEm/s400/w1" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 230px;" /></a> To configure the new skin, follow the instructions on the <a href="http://en.wikipedia.org/wiki/Wikipedia:Google_Custom_Search">Custom Search skin page on Wikipedia</a>. It works with both Wikipedia's default Monobook style or the new Beta Vector style. You will need to <a href="http://en.wikipedia.org/w/index.php?title=Special:UserLogin">log in</a> to Wikipedia to customize your Wikipedia search. For more information about the technology behind this application release, read <a href="http://googlecustomsearch.blogspot.com/2009/10/contextual-search-experience-for.html">our post</a> on the Google Custom Search blog. Wikipedia <a href="http://blog.wikimedia.org/2009/10/26/google-experiments-with-new-ways-to-search-wikipedia/">encourages</a> technical innovation and tools to help you get improved access to knowledge, so please post your opinions about this contextual search experience at <a href="http://en.wikipedia.org/wiki/Wikipedia_talk:Google_Custom_Search#Google_Custom_search_gadget">Wikimedia</a> or give us <a href="http://www.google.com/support/forum/p/customsearch?hl=en">feedback</a> directly. Last Friday was the third anniversary of the launch of Custom Search — we would like to take a moment to thank the millions of you who have implemented Custom Search on your sites. To celebrate our birthday we're releasing two new features that we hope will help you better customize your search results: <a href="http://googlecustomsearch.blogspot.com/2009/10/plug-n-play-with-custom-search-themes.html">Custom Search Themes</a> and <a href="http://googlecustomsearch.blogspot.com/2009/10/structured-custom-search.html">Structured Custom Search</a>. Check out <a href="http://googlecustomsearch.blogspot.com/2009/10/three-birthday-candles-for-custom.html">this post</a> on the Google Custom Search blog to learn more about our third anniversary. Posted by Rajat Mukherjee, Group Product Manager, Search and Mathias Schindler, Wikimedia Foundation

Contextual search within Wikipedia

We are excited to announce that we've built a Custom Search Wikipedia skin that makes it easier for you to complete your research on Wi...

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Liberate your Google Docs with Convert, Zip and Download

This past September, you may have heard about the launch of our <a href="http://dataliberation.blogspot.com/2009/09/welcome-to-data-liberation-front.html">Data Liberation</a> site, a central place on the web detailing how you can easily move your data into or away from Google's cloud. Today, we're adding another product to our growing list of liberations: the "Convert, Zip and Download" feature in Google Docs, which allows you to download a bunch — or all — of your Docs simultaneously. This new feature comes out of a collaboration between the Google Docs engineering team and Google's Data Liberation Front, a small team of engineers that aims to make it easy for you to transfer your personal data in and out of Google's services by building simple import and export functions. "Convert, Zip and Download" now joins dozens of other liberation features across our product offerings, ranging from Blogger's <a href="http://www.dataliberation.org/google/blogger">full blog downloads</a> to <a href="http://www.dataliberation.org/google/gmail">email export from Gmail</a> using IMAP and POP3. The feature lets you bundle your Google Docs in a format of your choice (MS Office, Open Office, PDF, etc.) and download them as a zip file. No longer do you have to download each document individually, which can take a lot of time if you have hundreds of documents like I do! All you need to do is select the relevant Docs, click on "Export" from the "More Actions" menu and download them in one go. (Check out the <a href="http://googledocs.blogspot.com/2009/10/data-liberation-mark-as-viewed-and-new.html">Google Docs Blog</a> for more details.) <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN0NgF-CVFFBAhiiSzpceFcNc3_dczLkdYVdu3bj70P8QNnWxWNuYZmzFOQ00qQ0Q38jH0n6BT524eQtJohJXnjkczHdjIP0vGox5eprl5l3qsCpvFOyKxDaPULJ09TyBV8bz_WLrVpg0u/s1600-h/ccs8p3jp_39s3ct2kg5_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5397020504016073522" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN0NgF-CVFFBAhiiSzpceFcNc3_dczLkdYVdu3bj70P8QNnWxWNuYZmzFOQ00qQ0Q38jH0n6BT524eQtJohJXnjkczHdjIP0vGox5eprl5l3qsCpvFOyKxDaPULJ09TyBV8bz_WLrVpg0u/s400/ccs8p3jp_39s3ct2kg5_b.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 168px;" /></a> We hope you find the new export feature useful. We strongly believe that you — not the products you use — should control your data, and be able to quickly and easily take that data out of any product without a hassle. We've already liberated more than half of our products, and are working hard to address the remaining challenges. Keep an eye out for more upcoming Data Liberations. You can also take a deeper look into product liberation at <a href="http://www.dataliberation.org/">dataliberation.org</a>, follow us on Twitter <a href="http://twitter.com/dataliberation">@dataliberation</a> or contribute suggestions for services that you think need to be liberated on our Data Liberation <a href="http://moderator.appspot.com/#16/e=43649">Moderator page</a>. Posted by Brian Fitzpatrick, Engineering Manager, the Data Liberation Front

Liberate your Google Docs with Convert, Zip and Download

This past September, you may have heard about the launch of our Data Liberation site, a central place on the web detailing how you can easi...

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Introducing Google Social Search: I finally found my friend's New York blog!

Your friends and contacts are a key part of your life online. Most people on the web today make social connections and publish web content in many different ways, including blogs, status updates and tweets. This translates to a public social web of content that has special relevance to each person. Unfortunately, that information isn't always very easy to find in one simple place. That's why today we're rolling out a new <a href="http://www.google.com/experimental/">experiment on Google Labs</a> called Google Social Search that helps you find more relevant public content from your broader social circle. It should be available for everyone to try by the end of the day, so be sure to check back. A lot of people write about New York, so if I do a search for [new york] on Google, my best friend's New York blog probably isn't going to show up on the first page of my results. Probably what I'll find are some well-known and official sites. We've taken steps to improve the relevance of our search results with <a href="http://googleblog.blogspot.com/2007/02/personally-speaking.html">personalization</a>, but today's launch takes that one step further. With Social Search, Google finds relevant public content from your friends and contacts and highlights it for you at the bottom of your search results. When I do a simple query for [new york], Google Social Search includes my friend's blog on the results page under the heading "Results from people in your social circle for New York." I can also filter my results to see only content from my social circle by clicking "Show options" on the results page and clicking "Social." Check out this video for a demo: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/ZqWJxgp-_mU&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/ZqWJxgp-_mU&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> All the information that appears as part of Google Social Search is published publicly on the web — you can find it without Social Search if you really want to. What we've done is surface that content together in one single place to make your results more relevant. The way we do it is by building a social circle of your friends and contacts using the connections linked from your public Google profile, such as the people you're following on Twitter or FriendFeed. The results are specific to you, so you need to be signed in to your Google Account to use Social Search. If you use Gmail, we'll also include your chat buddies and contacts in your friends, family, and coworkers groups. And if you use Google Reader, we'll include some websites from your subscriptions as part of your social search results. To learn more about how Social Search works behind the scenes, including the choices and control you have over the content you see and share, read our <a href="http://www.google.com/support/websearch/bin/answer.py?hl=en&answer=165228">help center article</a> or watch this video: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/BlpTjP6h6Ms&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/BlpTjP6h6Ms&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> This feature is an experiment, but we've been using it at Google and the results have been exciting. We'd love to hear your <a href="http://www.google.com/support/forum/p/Web+Search/thread?tid=5818e141dc58c2bd&hl=en">feedback</a>. Oh, and don't forget to <a href="http://www.google.com/profiles">create a public Google profile</a> to expand your social circle and more easily find the information you're looking for (including that New York blog). Posted by Maureen Heymans, Technical Lead and Murali Viswanathan, Product Manager

Introducing Google Social Search: I finally found my friend's New York blog!

Your friends and contacts are a key part of your life online. Most people on the web today make social connections and publish web content i...

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Who Should Sponsor Comparative Effectiveness Research?

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in <a href="http://hcrenewal.blogspot.com/2007/09/comparative-effectiveness-kerfuffle.html">a previous post</a>, <blockquote> Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done compared individual treatments to placebos, and when even those were restricted to narrow patient populations unlike those patient usually seen in daily practice, physicians are left juggling oranges, tomatoes, and carburetors. Comparative effectiveness studies are simply studies that compare plausible treatments that could be used for patients with particular problems, and which are designed to be generalizable to the sorts of patients usually seen in practice. As a physician, I welcome such studies, because they may provide very useful information that could help me select the optimal treatments for individual patients. Because I believe that comparative effectiveness studies could be very useful to improve patient care, it upsets me to see this particular kind of clinical study get caught in political, ideological, and economic battles. </blockquote> In particular, we have discussed a number of high profile attacks on comparative effectiveness research, which often have featured arguments based on logical fallacies. While some of the people making the attacks have assumed a conservative or libertarian ideological mantle, one wonders whether the attacks were more driven by personal financial interests. For example, see our blog posts <a href="http://hcrenewal.blogspot.com/2007/09/over-top-denunciation-of-comparative.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/09/comparative-effectiveness-kerfuffle.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/10/whose-opinions-did-new-york-times.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/02/attack-on-government-funded-comparative.html">here</a>. On the other hand, we discussed a clear-headed defense of comparative effectiveness research by a well-known economist most would regard as libertarian <a href="http://hcrenewal.blogspot.com/2009/06/clear-headed-defense-of-comparative.html">here</a>. Comparative effectiveness research has been discussed as an element of health care reform in the US. It turns out that the current version of the health care reform bill in the US Senate has a provision to create a Patient Centered Outcome Research Institute, which presumably would become the major organization which could sponsor comparative effectiveness research. This institute, however, would not be a government agency (despite the name that makes it sound like it would be part of the National Institutes of Health). Moreover, here is a description of the Board of Governors who would run the institute from the <a href="http://finance.senate.gov/sitepages/leg/LEG%202009/101909%20America">current version of the bill </a>: <blockquote> BOARD OF GOVERNORS.— (1) IN GENERAL.—The Institute shall have a Board of Governors, which shall consist of 15 members appointed by the Comptroller General of the United States not later than 6 months after the date of enactment of this section, as follows: (A) 3 members representing patients and health care consumers. (B) 3 members representing practicing physicians, including surgeons. (C) 3 members representing private payers, of whom at least 1 member shall represent health insurance issuers and at least 1 member shall represent employers who self-insure employee benefits. (D) 3 members representing pharmaceutical, device, and diagnostic manufacturers or developers. (E) 1 member representing nonprofit organizations involved in health services research. (F) 1 member representing organizations that focus on quality measurement and improvement or decision support. (G) 1 member representing independent health services researchers. </blockquote> Thus, only 3/15 members of the governing board would represent the patients who ultimately reap the benefits or suffer the harms produced by medical diagnosis and treatment. Further, 6/15 members represent for-profit corporations which stand to make more or less money depending on how particular comparative effectiveness studies come out. Also, 3/15 members would be physicians, some of who may get paid more to deliver particular treatments (e.g., procedures) than others (e.g., providing advice about diet and exercise). We often discuss how clinical research sponsored by organizations with vested interest in the research turning out to favor their products or services may be <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">manipulated</a> to favor these interests, and sometimes <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">suppressed</a> if it does not. In the US, there are few unconflicted sources of sparse funds to support comparative effectiveness research. (The most significant current source is the <a href="http://www.ahrq.gov/">Agency for Healthcare Research and Quality</a>, AHRQ. For full disclosure, I have been an ad hoc reviewer of grants for that agency.) The current draft of legislation would create the largest potential sponsor for comparative effectiveness research, but would make that organization report to representatives of for-profit companies whose profits may be affected by the results of such research. In my humble opinion, this is not much of an advance. Comparative effectiveness research controlled by corporations that stand to profit or lose depending on its results will forever be suspect. If the government is going to support comparative effectiveness research, it ought to make sure such research is not run by people with vested interests in the outcomes coming out a certain way. I may be biased myself, but why not let the research be sponsored by AHRQ, an agency with relevant experience and no axe to grind vis a vis any particular product or service?

Who Should Sponsor Comparative Effectiveness Research?

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post , Physicians ...

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Clinic's medical files vanish

At "<a href="http://hcrenewal.blogspot.com/2009/10/data-malpractice-on-t-mobile-sidekick.html">Data Malpractice on T-Mobile Sidekick: But Don't Worry, Your Medical Data is Safe</a>", on Oct. 16 I wrote: <blockquote> One of the promises made about healthcare IT is that your medical data is "safer" in electronic form than in paper form. The Hurricane Katrina example of paper records being destroyed is often used as a poster example of the dangers of paper records. However, the risk of electronic storage of information, especially the talk of national EMR's stored on the "cloud" (an amorphous term meaning distributed storage "out there" whose physical sites and boundaries are supposedly irrelevant from the user's perspective) has also been under-reported.</blockquote> Personal customer data had been "lost" from many of T-Mobile USA's Sidekick devices due to a computer malfunction, although the data was apparently recovered eventually, apparently through luck rather than good engineering. I expressed concern that such mishaps could affect clinical IT. I did not have to wait long for such a case to appear. Less than one week. Below is a story of a Canadian clinic that lost two years of electronic health records: <blockquote> <a href="http://www.edmontonjournal.com/health/Clinic+medical+files+vanish/2127101/story.html">Clinic's medical files vanish</a> By Ryan Cormier, Edmonton Journal October 21, 2009During a recent investigation into whether a patient's confidentiality had been breached at the Fairview Medical Clinic, an investigator asked for a log of who had accessed the complainant's file. When the clinic responded that it had automated his records in 2004 but only had files from 2006 on, alarm bells rang."That raised a lot of questions," said Leahann McElveen, an investigator with the office of the information and privacy commissioner.The clinic had permanently lost two years worth of health files that include patient information on visits, prescriptions, lab reports, doctor's notes and other information. The loss happened when the clinic switched from one electronic medical records system to another."They were two similar systems intended to do the same thing," McElveen said. "However, they weren't coded the same way behind the scenes. It's not that the records fall into the wrong hands, they just don't exist anymore."</blockquote> *POOF*. Deinstallation of one system in favor of another is not uncommon. EHR data may become unavailable due to lack of data portability and the expense of data migration, or in this case apparently due to preventable technical problems. It is essential for clinical IT users to have robust disaster recovery and business continuity solutions, and take great care when performing actions that can lose large amounts of data very fast. This adds to clinical IT cost, and a concern is that some users might skimp on these capabilities. This must be discouraged. (To the reader: do you back up your own PC or Mac reliably?) -- SS

Clinic's medical files vanish

At " Data Malpractice on T-Mobile Sidekick: But Don't Worry, Your Medical Data is Safe ", on Oct. 16 I wrote: One of the prom...

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Washington Post Article: Electronic medical records not seen as a cure-all

Regarding the very well done Sunday Oct. 25, 2009 story in the Washington Post "<a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102400967.html?hpid%3Dtopnews&sub=AR">Electronic medical records not seen as a cure-all</a>" by staff writer <a href="http://projects.washingtonpost.com/staff/articles/alexi+mostrous/">Alexi Mostrous</a> - signup may be required for access - I have several observations. (Not including the observation that Mr. Mostrous probably deserves an award for being the first major newspaper reporter to broach this topic in a serious and balanced manner.) First, I believe healthcare IT can live up to all the predictions made about its benefits - but only if done well. There is massive complexity behind those two words "done well", and that is HIT's key stumbling block in 2009. I believe we are only in the adolescent stage of knowing how to "do health IT well." Second, I should point out that the intended consequences of health IT include, among many other things, the following "hiding in plain sight" (i.e., not often verbalized) intended consequences: <ul><li>The improvement of medicine ... in the context of protection of patient rights established over centuries of development of modern medicine. </li></ul><ul><li>The improvement of IT itself through cross disciplinary collaboration between IT and medicine, of the science of IT (computer science), the social aspects of computerization ("sociotechnical issues"), and improvement of the our understanding of the intersection of medicine and computers.</li></ul> Instead, we largely have the opposite. Patients' rights are trampled, and hostility and territoriality has arisen between clinicians (including medical informaticists) and IT, groups that rarely if ever interacted in hospitals ten or twenty years ago. Of concern, when scientific study sections evaluate NIH grant proposals calling for testing of new IT that involves patients, patient protections and informed consent processes are a paramount concern since such activities are considered research. Yet, in implementing large clinical IT system in a hospital with new features, there are no formal regulations, and I'm not sure there's even IRB involvement in most cases. Patients do not get the chance to give informed consent to the use of these IT devices mediating their care. Why the difference? The unintended results of computerization efforts have also included suppression of research on sociotechnical issues and on informatics, which must include study of the downsides of HIT, and of the failures in addition to the study of the successes. That is scientific fact - there is no room for debate, no room for spin on the need for careful study of the downsides of any mission critical domain. One would think there to be a vibrant literature on these issues, Yet searches on massive biomedical databases such as PubMed on, say, "cerner electronic health record" (or other vendors as well) are disappointing to say the least. Further, my own website on HIT difficulties remains <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">nearly unique</a> (PPT) after ten years online. That is not bragging; it is a disturbing finding to me - symptomatic of an industry that somehow has managed to avoid serious scrutiny. In a field with downsides, there are: 1) those who know about the problems but fail to speak, 2) those who see the problems but fail to act, and 3) those who see, know and speak/write/research the problems. That said, now on to the Washington Post article: <blockquote>... bipartisan enthusiasm has obscured questions about the effectiveness of health information technology products, critics say. Interviews with more than two dozen doctors, academics, patients and computer programmers suggest that computer systems can increase errors, add hours to doctors' workloads and compromise patient care. </blockquote> I would include the bipartisan enthusiasm under the subject header of "irrational exuberance", which itself falls under the header of "lack of domain knowledge." That itself is a consequence of both failure to study the issues, and suppression of those issues by those with an interest in doing so. <blockquote>health IT's effectiveness is unclear. </blockquote> The literature is indeed conflicting, and the need for rigorous scientific study has never been more essential considering the commitment of tens of billions of dollars towards health IT. The time for story telling, marketing based on opinion, name calling, leap-of-faith extrapolations of light year dimensions, and other forms of pseudoscience and non-science are over. The time for objective study is now. <blockquote>The Senate Finance Committee has amassed a thick file of testimony alleging serious computer flaws from doctors, patients and engineers unhappy with current systems. </blockquote> Being the ranking member of that committee, Sen. Grassley has a fiduciary responsibility to protect Medicare and Medicaid patients (and one might argue, to protect all patients since those programs often serve as models for private insurers). In that regard, the investigation he has initiated is part of his responsibility as a ranking member of Congress. Politics aside (and there are those who will resort to ad hominem "political witch hunt" arguments), he would have been negligent if he had not initiated an inquiry. Sen. Grassley has taken on the pharma industry and the government's Food and Drug Administration itself, such as in this recent article "<a href="http://news.yahoo.com/s/ap/20091026/ap_on_he_me/us_fda_unproven_drugs">FDA fails to follow up on unproven drugs</a>" where he concluded from a GAO study he ordered that "FDA has fallen far short of where it should be for patient safety." He seems quite serious about medical safety. If only others in Congress had done their job similarly regarding national finance, we might now not be in the worst economic crisis since '29 with many major industries failing. <blockquote>David Blumenthal, the head of health technology at the Department of Health and Human Services, acknowledged that the systems had flaws. "But the critical question is whether, on balance, care is better than before," he said. "I think the answer is yes." </blockquote> This sounds uncomfortably like how a pharmaceutical company might respond to doubts about drug effectiveness and safety. In reality it's really irrelevant what he "thinks." Where's the data? Is this a political statement, a personal belief, or a statement backed up by scientific fact that is not cast into doubt by other research results? Our own National Research Council, Joint Commission, and other international organizations have written about their doubts and concerns about HIT [as that IT is designed and implemented in 2009]. If there is rigorous, systematic research weighing pro's and con's to back this assertion, I wish it would be published. For his statement is really saying "we don't really know how many systems have flaws, we know some do, and we don't really know the full extent of the impact of those flaws, but because there can be some benefits, let's spend $50+ billion before we know the extent of the problems and fix them." I point out research from Harvard forty years ago, when Harvard informatics pioneer Dr. Octo Barnett published the "Ten Commandments of HIT." Two of those commandments were: <blockquote>... 8. Thou shall be concerned with realities of the cost and projected benefit of the computer system [i.e., ROI - ed.] 10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.</blockquote> The full set is in <a href="http://hcrenewal.blogspot.com/2009/10/medical-informatics-pharma-health-it.html">this post</a>. Somewhere in the past 40 years, the rigorous ROI evaluations (which also must include systematic evaluations of risk, as any businessperson knows) and the fundamental skepticism seem to have gotten lost. <blockquote>Over the next two months, Blumenthal will finalize the definition of "meaningful use," the standard that hospitals and physicians will have to reach before qualifying for health IT stimulus funds.</blockquote> This is an example of putting the cart before the horse, and is a semantically-based, self contained logical fallacy of sorts. If a health IT system is harmful, the term "meaningful use" is itself Orwellian. If we don't know if HIT is beneficial, or have doubts, then such as term presupposes that health IT is inherently beneficial. A better term would have been "good faith use" - use based on the faith or hope that health IT will have an overall positive effect. The term "meaningful use" jumps the gun and is more a political slogan than a "meaningful term." <blockquote>"If you look at other high-risk industries, like drug regulation or aviation, there's a requirement to report problems," said David C. Classen, an associate professor of medicine at the University of Utah who recently completed a study on health IT installations. </blockquote> This is obvious, the reasons for it are obvious, and the reasons why health IT needs a requirement for problems reporting (one aspect of post-marketing surveillance, the "Phase IV" study as it is known in pharma) is obvious. Yet in 2009, no such requirement exists (see my post "<a href="http://hcrenewal.blogspot.com/2009/10/out-policy-is-to-always-have-unabashed.html">Our Policy Is To Always Have Unabashed Faith In The Computer</a>" for more on why we need reporting requirements.) Why do these requirements simply not exist in HIT? <blockquote>"It's been a complete nightmare," said Steve Chabala, an emergency room physician at St. Mary Mercy Hospital in Livonia, Mich., which switched to electronic records three years ago. "I can't see my patients because I'm at a screen entering data." Last year, his department found that physicians spent nearly five of every 10 hours on a computer, he said. "I sit down and log on to a computer 60 times every shift. Physician productivity and satisfaction have fallen off a cliff." </blockquote> The industry in the past has called such physicians "luddites", "resistant to change", "stubborn" etc. However, <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">argumentum ad hominem</a> is a fallacious mode of argument that has no place in a scientific field such as biomedicine. There also seems to be quite a lot of such concerns expressed by a large number of physicians, nurses, etc., and dismissing their concerns with a wave of the hand is cavalier in the extreme - again, these are first principles, without room for argument or debate. Let's study the issues rigorously and scientifically before resorting to ad hominem. <blockquote>Other doctors spoke of cluttered screens, unresponsive vendors and illogical displays. "It's a huge safety issue," said Christine Sinsky, an internist in Dubuque, Iowa, whose practice implemented electronic records six years ago.</blockquote> See my eight part series on mission hostile clinical IT <a href="http://www.tinyurl.com/hostileuserexper">here</a> for examples of what Dr. Sinsky is referring to. <blockquote>She emphasized that electronic records have improved her practice. "We wouldn't want to go back," she said. "But EHRs are still in need of significant improvement."</blockquote> Yes, not cancellation, but improvement. And, quite importantly, before tens of billions of dollars are spent. Hospitals and physician offices are not an IT development laboratory, since the users of these facilities (patients) have very special rights and the clinicians, very special obligations and responsibilities. <blockquote>Legal experts say it is impossible to know how often health IT mishaps occur. Electronic medical records are not classified as medical devices, so hospitals are not required to report problems.</blockquote> That after decades of HIT development, sales and implementation we cannot know with certainty how often mishaps occur is, quite simply, a scandal of major proportions. Quoting an old <a href="http://en.wikipedia.org/wiki/The_House_of_God">House of God</a> law, #10: "if you don't take a temperature, you can't find a fever." Another applicable aphorism seen on another discussion board: "you can only be so negligent or craven before the only remaining rationale is that you intended the result." <blockquote>"Doctors who report problems can lose their jobs," Hoffman said. </blockquote> I've taken risks with my own career in criticizing health IT, as have my colleagues. Hoffman is not exaggerating. <blockquote>"Hospitals don't have any incentive to do so [speak out about problems with HIT] and may be in breach of contract if they do." </blockquote> Imagine the outcry if the same prevailed regarding drugs or medical devices. The cemeteries would be lined with people whose epitaph could read "we bury our mistakes." <blockquote>While orange-shirted vendor employees "ran around with no idea how to work their own equipment," the internist said, doctors struggled to keep chronically ill patients alive. "I didn't go through all my training to have my ability to take care of patients destroyed by devices that are an impediment to medical care." </blockquote> This gets to issues I first raised in my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">website on HIT difficulties</a>: who are these IT personnel, and what are their qualifications, exactly, to be working in mission critical medical environments? How is their competence evaluated? I think these are questions that need to be answered. -- SS

Washington Post Article: Electronic medical records not seen as a cure-all

Regarding the very well done Sunday Oct. 25, 2009 story in the Washington Post " Electronic medical records not seen as a cure-all ...

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This week in search 10/24/09

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" and subscribe to the series. - Ed. Twitter On Wednesday, we announced our <a href="http://googleblog.blogspot.com/2009/10/rt-google-tweets-and-updates-and-search.html">newly-formed partnership with Twitter</a>. This will help Google users find more up-to-the-minute, real-time data in the search results. We will be including tweets in our search results and bringing them to you when they are most relevant, and we will also be building a real-time search that includes Twitter and other providers. This week's announcement is just the beginning of our collaboration; stay tuned for upcoming products and features that focus on real-time search. Social Search demo At the Web 2.0 conference this week, we demonstrated a new product called Social Search. Due to the ever-increasing popularity of social networks, we've been thinking about how your social network could influence and improve your search results. Social Search does just that by surfacing content in your search results that is written by your friends or people you follow. That way, you get the best resources from the web overall, plus the best results (blogs, reviews, travelogues) that are relevant to you, since they were written by people you know. Social Search will be launching soon on Google Experimental and Google Labs. Recommendations in Google Reader This week, we also launched <a href="http://googleblog.blogspot.com/2009/10/reading-gets-personal-with-popular.html">recommendations in Google Reader</a>. This may seem far from search, but it is actually built using technology pioneered in search. The personalized ranking piece uses some of the same techniques as personalized search. The "Popular items" piece builds on our <a href="http://www.google.com/ig/directory?hl=en&type=gadgets&url=www.google.com/ig/modules/pop/pop.xml">"What's Popular"</a> gadget from iGoogle. We're very proud of both of these features, as we think they represent an interesting application of search that will help users more easily find content that they want to read. New look-and-feel on maps We have updated the way that maps render on Google Maps, and it is our biggest change in almost 5 years. The changes are subtle but significant. The blog post with the announcement has some very interesting <a href="http://google-latlong.blogspot.com/2009/10/evolving-look-of-google-maps.html">before and after examples</a>. The impetus of this change is to improve usability and readability and literally help people find where they are going faster — our goal both on the web with search, and in the physical world with maps. 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 10/24/09

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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