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2009 a Pivotal Year in Healthcare IT

2009 is proving to be a pivotal year in healthcare IT. Recent authoritative articles and reports on health IT problems largely validate the issues presented at this blog and others focusing on health IT issues, and at my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">academic website on HIT difficulties</a> started over a decade ago, in 1998, freely available to the industry. These articles and reports have ultimately led to a U.S. Senate investigation of the healthcare IT industry initiated in Oct. 2009 (link below).2009 may be the year that healthcare IT vendors will finally begin to understand that not lending credence to decades of teachings from Medical Informatics professionals on healthcare IT design, implementation, lifecycle support, involvement of end users, and sales and marketing has been harmful to their businesses and to their investors. Instead, the commercial health IT companies took a simplistic management information systems-based approach to building medical devices in an incomparably complex environment they did not -- or did not care to – understand. These devices are, in fact, virtual medical devices that happen to reside on a computer, not business computing systems that happen to be used by clinicians. These medical devices are soon to undergo regulation as such in the EU (pdf report from the Swedish Medical Products Agency <a href="http://www.lakemedelsverket.se/upload/foretag/medicinteknik/en/Medical-Information-Systems-Report_2009-06-18.pdf">here</a>), <a href="http://www.hc-sc.gc.ca/dhp-mps/md-im/activit/announce-annonce/md_notice_software_im_avis_logicels-eng.php">Canada</a>, the <a href="http://www.genomeweb.com/dxpgx/electronic-health-record-systems-will-require-some-form-oversight-government-adv">U.S.</a> and other countries as well. <o:p></o:p>The teachings of Medical Informatics about such devices have been documented in the extensive literature of Medical Informatics. For example, the book “<a href="http://www.amazon.com/History-Medical-Informatics-United-States/dp/0964774305">A History of Medical Informatics in the United States, 1950 to 1990</a>” by informatics pioneer Morris F. Collen (published in 1995) explicitly demonstrates the progression of the field and the wisdom of the pioneers dating back to the 1950’s, as in the bons mots <a href="http://hcrenewal.blogspot.com/2009/10/medical-informatics-pharma-health-it.html">here</a>.<o:p></o:p>The 2009 articles and reports below demonstrate numerous undesirable outcomes of the management information systems approach to development and implementation of virtual clinical devices:<o:p></o:p> <ul><li><o:p></o:p>The Joint Commission’s “Sentinel Event Alert on Healthcare IT” is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=JointCommissionAlert">here</a>. <o:p></o:p></li></ul> <ul><li>The U.S. National Research Council’s "Current Approaches to U.S. Health Care Information Technology are Insufficient" and link to a full report on an investigation of healthcare IT lack of progress is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">here</a>.</li></ul><ul><li><o:p></o:p>The <st1:place st="on"><st1:country-region st="on">UK</st1:country-region></st1:place> Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program is <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">here</a>. <o:p></o:p></li></ul> <ul><li><o:p> </o:p>The Washington Post’s article on the influential HIT vendor lobby “The Machinery Behind Healthcare Reform” is <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid=topnews">here</a>. <o:p></o:p></li></ul> <ul><li><o:p> </o:p>Hoffman and Podgurski’s paper from Case Western entitled “e-Health Hazards: Provider Liability and Electronic Health Record Systems” on EHR medical and legal risks is <a href="http://works.bepress.com/sharona_hoffman/7/">here</a>.<o:p></o:p></li></ul> <ul><li><o:p> </o:p>My commentary on the May 2009 AMIA workshop report on healthcare IT failure with free PDF is available <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=workshop">here</a>. <o:p></o:p></li></ul> <ul><li><o:p> </o:p>My commentary on a sentinel Mar. 2009 JAMA article by University of Pennsylvania researchers Ross Koppel and David Kreda “Health Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians” on unsafe contract terms demanded by healthcare IT, and the violations of Joint Commission safety standards and fiduciary responsibilities committed by hospital governance personnel who agree to such terms, is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">here</a>.<o:p></o:p></li></ul> <ul><li><o:p></o:p>A link to the Oct. 25, 2009 Washington Post article “Electronic medical records not seen as a cure-all” and my commentary are <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=mostrous">here</a>.</li></ul> Finally, and perhaps most importantly, the Oct. 16, 2009 letter to major healthcare IT vendors from Senator Charles E. Grassley (ranking member of the United States Senate Committee on Finance) initiating a Senate investigation of corporate practices is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/grassley_erecords102409.pdf">here</a> (PDF). I have used this medieval illustration in a <a href="http://hcrenewal.blogspot.com/2009/02/informatics-or-infomagic-health-it.html">prior post</a> on these pages, but sadly in this case it is probably even more highly appropriate: <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtBOBSKjv3jO8esiFH_27ncerTqdo8KToEafFT-2PdwIAW5JpBk2QElIbkqklwitc9JgjCgEfA2GzUGWVezRa6ZVoZ4QSB9N1fWxQWYEh1uAIdsEyY1ZYtcddFUFAIgAFCoUu_AtMAzkQk/s1600-h/pearls.gif"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400267553459634098" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtBOBSKjv3jO8esiFH_27ncerTqdo8KToEafFT-2PdwIAW5JpBk2QElIbkqklwitc9JgjCgEfA2GzUGWVezRa6ZVoZ4QSB9N1fWxQWYEh1uAIdsEyY1ZYtcddFUFAIgAFCoUu_AtMAzkQk/s320/pearls.gif" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 314px; height: 212px;" /></a>"Margaritas ante Porcos" - click to enlarge </div> Not to be gratuitously impolite, but hard truths are often an unpleasant medicine, especially when ignoring those truths results in adverse consequences to patients and their caregivers. -- SS <o:p></o:p> <o:p> </o:p>

2009 a Pivotal Year in Healthcare IT

2009 is proving to be a pivotal year in healthcare IT. Recent authoritative articles and reports on health IT problems largely validate...

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A la peanut butter sandwiches!

Google doodles celebrate events and anniversaries around the world, while reflecting the personality, interests and quirkiness of Google employees. Today, you likely noticed a pair of familiar feet on the <a href="http://www.google.com/">Google homepage</a>. Leading up to Sesame Street's 40th anniversary on November 10th, we're excited to be featuring some of our favorite characters over the next seven days. Today: Big Bird! <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrk4AmijXY8SCHpGMbqbGFOAUmaV_yazFFACn-HLHX0V3F2wPE8mqkfpfUapJd2OoOY0Qn-mPzsLlCJpxl8LkCC9Shd6GnDU3vD5AdDGE5NjxD_uAdZiaYNn4JSu6AXpCVMhWgKpBIfVA/s1600-h/big_bird_google_logo-highres.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400244978433386642" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrk4AmijXY8SCHpGMbqbGFOAUmaV_yazFFACn-HLHX0V3F2wPE8mqkfpfUapJd2OoOY0Qn-mPzsLlCJpxl8LkCC9Shd6GnDU3vD5AdDGE5NjxD_uAdZiaYNn4JSu6AXpCVMhWgKpBIfVA/s400/big_bird_google_logo-highres.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 232px;" /></a>Many Googlers grew up on Sesame Street, watching the colorful, seamless blend of education and entertainment. We're delighted to have partnered with Sesame Street to create this special series of doodles, particularly since we share the same values of education, diversity and accessibility. And here's a fun find from the crew at Sesame; they found a little known video clip of Cookie Monster <a href="http://www.sesamestreet.org/video_player?p_p_lifecycle=0&p_p_id=videoPlayer_WAR_sesameportlets4369&p_p_uid=ad8ad695-155a-11dd-a62f-919b98326687&t=1256774601698&">singing about Google</a> (rhyming it with bugle) way back in 1982 — 16 years before our company even existed. <object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/SdRkdvKy5WI&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/SdRkdvKy5WI&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object> So, happy 40th anniversary, Sesame Street. For those Sesame lovers out there, be sure to check back as we'll feature a different character each day. Posted by Marissa Mayer, VP, Search Products & User Experience

A la peanut butter sandwiches!

Google doodles celebrate events and anniversaries around the world, while reflecting the personality, interests and quirkiness of Google emp...

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Cutting back on your long list of passwords

Does anyone actually like passwords? Most people can't stand them because they end up having to keep track of a long (and often memorized) list of usernames and passwords to sign into the websites they visit. Website owners hate them because it's hard to get people to create a new account on their website, and almost half of those account registrations are never completed. Thanks to the utilization of new technology, we're now seeing large-scale success in eliminating the need for passwords while increasing the successful registration rate at websites to over 90%. The most visible examples come from Plaxo, Facebook, Yahoo! and Google using a technique the industry calls hybrid onboarding. In the past, if you're a Gmail user who got an invitation to use Plaxo or Facebook, you were asked to perform the traditional process of creating a new account with yet another password, and then you might also have been asked to provide the password of your email account so Plaxo or Facebook could look up the list of your friends. With hybrid onboarding, if you click on such an invitation in your Gmail, you'll see a page like one of these: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRIX2UACLWYxxDIWcaGV2T85nZRfFIGU-ziuwgn-Ykr107olTN4AFq-P2WEG8GJqJ7APU5mkqKSgpQ4OjZE35Sdj1Ua8W4vq-4FBk0YysxRSkdvvUMLpugxPM9lkcNQEhRpB481pEOc88/s1600-h/agnvhqdt23_39dvzd6kgx_b.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399903403389908882" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRIX2UACLWYxxDIWcaGV2T85nZRfFIGU-ziuwgn-Ykr107olTN4AFq-P2WEG8GJqJ7APU5mkqKSgpQ4OjZE35Sdj1Ua8W4vq-4FBk0YysxRSkdvvUMLpugxPM9lkcNQEhRpB481pEOc88/s400/agnvhqdt23_39dvzd6kgx_b.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 142px;" /></a> Clicking the large button on the Plaxo page takes you to a page at Google like this: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv3eCsEytDkk7Ar-Cilz0Dz0dM95aIg21igZo8iNcsAIHlYgfvf0kLCqwSKpzurXVYCEEeIt6L2op-8nr0a0qbfsRcXCpVh0zQ9Qlif3fUAAx3Rrp4DckefsG1R9PSh4Kxo0YMm7vcBLs/s1600-h/agnvhqdt23_36dnz3jjfh_b.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399903405767630210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv3eCsEytDkk7Ar-Cilz0Dz0dM95aIg21igZo8iNcsAIHlYgfvf0kLCqwSKpzurXVYCEEeIt6L2op-8nr0a0qbfsRcXCpVh0zQ9Qlif3fUAAx3Rrp4DckefsG1R9PSh4Kxo0YMm7vcBLs/s400/agnvhqdt23_36dnz3jjfh_b.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 301px;" /></a> If you give consent to share a few pieces of information, you are sent back to Plaxo with all key registration steps finished. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgCnIxb-RSaOiYgUjXmw1JhDp5Pn0EKiyNgbyyko11bSXUpCvuq08vWAo9NBiNTNlsBSg8SIVyP792ZCJDz51_lxGhUuBF3X1LTe_auY2tLp7yzKcJRKcsFZOf_b5Oe1UrdO5ZnbviNP4/s1600-h/agnvhqdt23_37c3n7pmdn_b.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399903409826444162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgCnIxb-RSaOiYgUjXmw1JhDp5Pn0EKiyNgbyyko11bSXUpCvuq08vWAo9NBiNTNlsBSg8SIVyP792ZCJDz51_lxGhUuBF3X1LTe_auY2tLp7yzKcJRKcsFZOf_b5Oe1UrdO5ZnbviNP4/s400/agnvhqdt23_37c3n7pmdn_b.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 223px;" /></a> <div>The registration process used to involve more than 10 steps, including requiring you to find one of those "email validation" messages in your inbox. If you've followed the steps above, you can now sign into Plaxo more easily — by simply clicking a button. While Plaxo showed the <a href="http://www.readwriteweb.com/archives/comcast_property_sees_92_success_rate_openid.php">first successful results</a> of this technique in early 2009, other companies like Facebook are starting to use the same model and to recognize its business value potential. At the same time, the hybrid onboarding model improves authentication security because websites like Plaxo that use this technique never see a password from you at all. Since you don't have to enter your password on additional sites, your password remains closer to you and is less likely to be misused. We'd like to applaud Plaxo and Facebook's work in designing the user experience needed for this technique as well as pushing us to create the optimizations needed to carry out their design. Today we're happy to announce that all of these login flow designs are now available to any website operator. All of these hybrid onboarding techniques are based on industry standards that both Google and Yahoo! support, and that other email providers are beginning to support as well. For more technical details, check out our <a href="http://googlecode.blogspot.com/2009/11/hybrid-onboarding.html">Google Code Blog post</a>. Hybrid onboarding is also being used by Enterprise Software-as-a-Service vendors — such as ZoHo — that want to eliminate the need for employees at their customers' businesses to create another password. More details are available on our <a href="http://googleenterprise.blogspot.com/2009/11/single-sign-on-to-zoho-tripit-socialwok.html">Enterprise Blog</a>. In addition, after a thorough evaluation of the security and privacy of these technologies, the same techniques are being piloted by <a href="http://openid.net/2009/09/09/yahoo-paypal-google-equifax-aol-verisign-acxiom-citi-privo-wave-systems-pilot-open-identity-for-open-government-2/">President Obama's open identity initiative</a> to enable citizens to sign in more easily to government-operated websites. There is still a long way to go before you'll be able to trim down your long list of website passwords, but this progress demonstrates the potential for even the largest websites to adopt to adopt the hybrid onboarding model. We hope many other websites will follow. Posted by Eric Sachs, Product Manager, Google Security</div>

Cutting back on your long list of passwords

Does anyone actually like passwords? Most people can't stand them because they end up having to keep track of a long (and often memorize...

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Investing in innovation at Google

<a href="http://www.google.com/corporate/execs.html#eric">Eric</a> said during our <a href="http://www.google.com/intl/en/press/pressrel/2009Q3_google_earnings.html">third quarter earnings call</a> that "innovation is the technological pre-condition for growth." He was talking about the kind of innovation that's only possible when you can attract and retain the world's finest minds. Some come to Google through acquisition, like the people who created Google Earth (formerly Keyhole), or the folks at Android Inc. — but most innovation coming out of Google is homegrown. A good example is <a href="http://googleblog.blogspot.com/2008/09/google-chrome-now-live.html">Google Chrome</a>, which in only a year, has more than 30 million active users. Larry and Sergey recently gave the Chrome team a Founders Award, a multimillion-dollar stock bonus shared by the Googlers who worked across functions and regions to create and launch that product. As its name suggests, this award is presented by our founders to celebrate the kind of large-scale, game-changing achievements that Google stands for. The Chrome team joined a long list of teams — including Gmail, AdSense for Content, Google Maps and parts of our sales and marketing units — who have won this award (and could win again!). We want to continue to create products that rethink industry standards, challenge the status quo and make people's lives easier — and we know that there are great minds out there with the same goal. Recently, we announced that we're starting to ramp up hiring for positions across the company, continuing our investment in the future as we imagine it. That future is shaped by small teams of creative people who want to make a difference. We're on the hunt for these kind of people — <a href="http://www.google.com/intl/en/jobs/index.html">let us know</a> if you think you're one of them. Posted by Alan Eustace, Senior Vice President, Engineering & Research

Investing in innovation at Google

Eric said during our third quarter earnings call that "innovation is the technological pre-condition for growth." He was talking...

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Did a Yakuza Boss Pay "A Million Dollars for One Liver?"

One of the more bizarre stories to appear on Health Care Renewal just resurfaced.  To summarize, in June, 2008, we <a href="http://hcrenewal.blogspot.com/2008/06/for-few-yen-more-ucla-liver-transplants.html">posted</a> about the strange case of four Japanese men, allegedly affiliated with Yakuza criminal organizations, who received liver transplants from the UCLA Medical Center, apparently with some alacrity. All likely paid full list prices for their procedures, and two later donated $100,000 each to the medical center. The case raised concerns by several notables (including Senator Charles Grassley, and Professor Arthur Caplan) about the integrity of the transplant system. Presumably these concerns were based on suspicions that the four may have received a higher priority than others on the list. More concerns should have been raised after it was revealed that shadowy characters threatened a reporter who started to investigate the case in Japan, and the reporter's family (see post <a href="http://hcrenewal.blogspot.com/2008/06/worst-example-of-anechoic-effect-erase.html">here</a>).  Later, the Chancellor for Medical Sciences and Dean of the David Geffen School of Medicine's public response to the case side-stepped all the important concerns while deploying a series of logical fallacies (see post <a href="http://hcrenewal.blogspot.com/2008/06/strawmen-red-herrings-and-liver.html">here</a>). Then, despite all the colorful details and ethical concerns presented by this story, it faded from view for a year and a half.  Last night, the US investigative reporting television show "60 Minutes" aired a follow-up on the Yakuza transplants, following closely on the publication of a book, Tokyo Vice, by Jake Adelstein, the reporter who first broke the story. The <a href="http://www.cbsnews.com/stories/2009/11/01/60minutes/main5484118.shtml?tag=contentMain;contentBody">web-based version</a> of the 60 Minutes story reprised the main points, but added emphasis to a few of interest to Health Care Renewal.  First, the 60 Minutes piece raised suspicions that the Yakuza members paid a premium to jump the UCLA liver transplant priority list: <blockquote>Getting into the U.S. was one thing, but getting a liver transplant at a leading American medical center like UCLA was something else altogether. 'What's the average waiting time for someone in California waiting for a liver transplant?' [CBS correspondent Lara] Logan asked California attorney Larry Eisenberg. 'It's probably realistically three years. And it could be much longer,' he replied. Not for Tadamasa Goto, who got a liver in just six weeks. Eisenberg finds that surprising, especially since Goto was number 80 on the waiting list. 'It should not be possible that an unsavory character from out of the country, with ties to organized crime, comes into the United States and gets a priority and obtains a transplant,' Eisenberg said. Two families, Eisenberg's clients, both lost loved ones waiting for livers at another transplant center in the same area: Salvador Ceja was number two on the waiting list; John Rader was number five. 'Do you think, for one second, that this was legitimate? That they stood in line and waited just like your husband did?' Logan asked Rader's widow Cheryl. 'Absolutely not,' she replied. 'No. Because nobody gets a liver that quickly.' 'I think they were playing God,' Yolanda Carballo, Ceja's stepdaughter, added. 'Now, I think they were picking and choosing who they wanted to give a liver to.' 'So, in your minds, what was this about?' Logan asked. 'Money,' Rader said. 'Spoke loud and clear. And they listened.' 'That's what it was all about. Money,' Carballo agreed. Three of Goto's Yakuza cronies also got liver transplants at UCLA. For them, money was no object. UCLA says each of their transplants cost about $400,000 dollars; the Yakuza all paid cash. The hospital also acknowledged Goto and another Yakuza each made $100,000 donations to the transplant center. Adelstein says Goto paid even more. 'According to police documents and sources, a million dollars for Goto. A million dollars,' he told Logan. 'A million dollars for one liver?' she asked. 'A million dollars for one liver,' Adelstein said. </blockquote> Second, 60 Minutes emphasized the risk Mr Adelstein faced after he drew attention to the story of the Yakuza liver transplants at UCLA: <blockquote>Tadamasa Goto returned to his life of crime as a Yakuza godfather and it all stayed hidden until Adelstein was tipped off. It took him years to piece together the details for a newspaper story. Then, when word got out that Adelstein knew, the Yakuza tried to buy his silence, offering him half a million dollars. Asked if he was tempted by the cash offer, Adelstein said, 'Of course I'm tempted. You know? When someone offers you half a million dollars not to write something, but then again, you know I don't want to be owned by organized crime the rest of my life.' Adelstein wrote the story for 'The Washington Post' and it eventually made its way back to Japan. The news infuriated the Yakuza bosses. For Goto, it was a humiliating blow from which he would never recover. 'I heard from someone very close to him that as he was leaving and getting in his car he said, 'That goddamn American Jew reporter, I wanna kill him,'' Adelstein said. Japanese and U.S. law enforcement agents took Goto's threat seriously. Adelstein now lives alone, under Tokyo police protection; his wife and children are in hiding. 'Are you concerned that there is an American citizen here whose life is at risk?' Logan asked the U.S. Embassy's Mike Cox. 'Very much so. I mean, we think the Japanese police are doing what they can to make sure that no harm comes to Mr. Adelstein. I mean, we certainly don't want to see anything happen to him,' Cox said. 'What do you have to do in your daily life to stay alive?' Logan asked Adelstein. 'You have to keep your rooms shuttered, because you don't want a sniper to pick you off across from somebody’s house,' he said. Asked if he lives in darkness, Adelstein said, 'When I'm up in my room typing, yes. All the rooms are shuttered. You gotta be very careful on rainy days. Because when Yakuza take people out, they like to do it on rainy days, because fewer people are on the streets and the rain washes away trace evidence.' Even in disgrace, Tadamasa Goto still has a small army of loyal soldiers and a hit out on Jake Adelstein. The Yakuza say he will never be safe. 'When someone does something that causes them (Yakuza) to lose face, they will use any means possible, legal or illegal, to crush the person who has gotten in their way, who has humiliated them,' the disguised Yakuza boss told Logan. </blockquote> Finally, 60 Minutes found that the UCLA Medical Center continued to be uncooperative, cloaking its refusal to categorically refute allegations that it sold a liver for a million dollars in concerns with patient confidentiality: <blockquote>Asked if UCLA knew who these people were, Adelstein said, 'When you see guys with lots of tattoos, missing fingers, wouldn't it occur to you, like, 'Oh, this guy is a gangster.' I can't believe they didn't know.' Attorney Eisenberg says transplant rules require extensive background checks on every patient. Yet, UCLA insisted to federal investigators they had 'no knowledge' that Goto or his cronies had ties to Japanese organized crime. UCLA declined all of 60 Minutes' requests for interviews. The only thing the medical center will say on the record is that their program has been reviewed and found to be in 'total compliance' with liver transplant rules. The hospital told us, 'state and federal patient confidentiality laws prohibit UCLA from responding to the…issues raised by 60 Minutes.' 'In my opinion, the medical center has a moral and ethical obligation to determine the source of those funds,' Eisenberg said. 'A moral and ethical obligation, but apparently no legal obligation?' Logan asked. 'Well, it's not addressed in the rules specifically,' Eisenberg said </blockquote> As I wrote in my first post on this case, you just can't make this stuff up... However, the colorfulness of the case should not distract from its very serious implications.  We have written a lot in this blog about the <a href="http://hcrenewal.blogspot.com/2007/08/bling-bling-poltical-correctness-and.html">anechoic effect</a>, how cases with important implications about ethics, governance and leadership in health care often fail to attract the attention they deserve.  We have opined that academics and professionals have realized that it is simply "not done" to discuss cases which might offend the powerful leaders of health care organizations.  We have written about whistle-blowers who have lost jobs or been theatened with lawsuits.  But in this case, the journalist who wrote about the case allegedly has received death threats and lives in hiding under police protection.  This may be the most serious case of the anechoic effect known. Furthermore, we have written a lot in this blog about how leaders of health care organizations ought to uphold their organizations' mission and the core values to which physicians and other health care professionals have sworn devotion.  The continued disinclination of UCLA leadership to respond to charges that its medical center accepted $1 million to put Japanese gangsters at the head of the liver transplant list may reflect fear of gangsters who also allegedly threatened the life of the journalist who reported the case.  But by failing to rebut such charges, the leadership leaves the impression that they cannot claim to be better than the moral equivalents of gangsters.  Institutions that aspire to join "<a href="http://dgsom.healthsciences.ucla.edu/about/">the ranks of the nations [sic] elite medical schools</a>" ought also to aspire to have leaders that have better ethics than Yakuza bosses.   <a href="http://www.transparency.org./global_priorities/health/">Transparency International</a> has <a href="http://www.transparency.org/publications/gcr/gcr_2006">suggested</a> that health care corruption is a global scourge that costs lives.  Serious health care reform cannot ignore health care corruption as a cause of excess costs, denied access, and poor quality.  Health care organizations ought to be held to a higher standard of ethics, and be less prone to corruption than, for example, garbage hauling firms.  Health care organizations ought to subscribe to rigorous codes of ethics, impartially enforced, which apply to all within the organizations, including top leaders.  While the accused need to be afforded due process, whistle-blowers must also be protected.  In my humble opinion, true health care reform requires so confronting health care corruption.  Maybe the leadership of the Gefen School of Medicine might want to consider setting an example in this regard.  Note: Jake Adelstein's book is available <a href="http://www.randomhouse.com/acmart/catalog/display.pperl?isbn=9780307378798">here</a>, and it was reviewed by Reuters <a href="http://in.reuters.com/article/lifestyleMolt/idINTRE59C0NX20091013">here</a> and by the AP (via the Canadian Press) <a href="http://www.google.com/hostednews/canadianpress/article/ALeqM5im14v74_JcALAnj5xqPbv_2PGGYA">here</a>.

Did a Yakuza Boss Pay "A Million Dollars for One Liver?"

One of the more bizarre stories to appear on Health Care Renewal just resurfaced. To summarize, in June, 2008, we posted about the strange...

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Next steps in cyber security awareness

(Cross-posted from the <a href="http://googlepublicpolicy.blogspot.com/2009/11/next-steps-in-cyber-security-awareness.html">Public Policy blog</a>) Last week I joined several industry experts to speak at a cyber security panel on Capitol Hill organized by Congresswoman Yvette Clarke and sponsored by the Committee on Homeland Security. The conversation focused on things everyday Internet users can do to help protect their computers and stay safe online. Given that we just wrapped up our observation of <a href="http://googleblog.blogspot.com/2009/10/celebrating-national-cyber-security.html">National Cyber Security Awareness Month</a>, I thought I'd share some of the key recommendations from the panel: What are the most important things we all need to do to protect our computers and mobile devices? You should have the same expectations when using the Internet as you would when exploring a city: you don't give your credit card to the person selling watches on the street just because you recognize the brand, you don't let your kids wander around by themselves and you don't give personal information unless you know who's getting it. If an offer is "urgent" or seems too good to be true, take a step back and research the offer. Add a password to your mobile phone, and browse cautiously on open WiFi networks as you would when using a computer. What are the most common misconceptions about cyber security? Many dangerous websites are not designed to be dangerous. In fact, most of the sites that serve malware (malicious software) are innocent sites that have been compromised in one way or another. Your computer isn't necessarily safe just because you're avoiding sites that contain adult content or pirated software. Use reputable anti-virus and anti-spyware programs, and keep your computer operating system and applications updated with the latest software versions. How do I know if my computer or network has been compromised? First, disconnect it from the Internet. Take note of any slowness, and if you're not sure how to proceed, get someone with technical expertise to check your network logs for high traffic appearing during times when you're not using the computer. When in doubt, contact a computer support expert. As President Obama recently stated, <a href="http://www.youtube.com/watch?v=UIIY9AQSqbY">cyber security is a shared responsibility</a>. At Google, we recognize how important awareness and education are because many online security threats can only be avoided if we work together. We spent the month of October exploring cyber security and talking about how to use Google products in a more secure manner. If you haven't seen them already, take a look at the posts we've released over the last month: <ul><li><a href="http://googleblog.blogspot.com/2009/10/celebrating-national-cyber-security.html">Kick-off and YouTube Cyber Security Awareness Channel</a></li><li><a href="http://gmailblog.blogspot.com/2009/10/choosing-smart-password.html">Choosing smart passwords</a></li><li><a href="http://googleonlinesecurity.blogspot.com/2009/10/malware-warning-review-process.html">How the website malware review process works</a></li><li><a href="http://buzz.blogger.com/2009/10/keeping-your-blog-secure_09.html">Blogging security tips</a></li><li><a href="http://googleonlinesecurity.blogspot.com/2009/10/show-me-malware.html">New malware snippets feature for webmasters</a></li><li><a href="http://googleonlinesecurity.blogspot.com/2009/10/protecting-users-and-ads-from-malware.html">Protecting users and ads from malware</a></li><li><a href="http://googleonlinesecurity.blogspot.com/2009/10/best-practices-for-verifying-and.html">Best practices for verifying and cleaning up a malware-infected site</a></li><li><a href="http://gmailblog.blogspot.com/2009/10/gmail-account-security-tips.html">Gmail account security tips</a></li><li><a href="http://googlecheckout.blogspot.com/2009/10/google-checkout-security-tips-for.html">Online commerce security</a></li><li><a href="http://en.blog.orkut.com/2009/10/update-your-browser-and-stay-safe.html">Updating your web browser</a></li><li><a href="http://googledocs.blogspot.com/2009/10/taking-charge-of-your-document-sharing.html">Taking charge of document sharing with Google Docs</a></li><li><a href="http://chrome.blogspot.com/2009/10/are-you-seeing-red.html">Web browser security and Google Chrome security messages</a></li></ul>Be sure to share the tips you find most helpful with others, and remember to stay safe online. Posted by Eric Davis, Head of Anti-Malvertising

Next steps in cyber security awareness

(Cross-posted from the Public Policy blog ) Last week I joined several industry experts to speak at a cyber security panel on Capitol Hill o...

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Google Search by voice travels the world, finds Nokia, learns Chinese

<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_IevKNrO7uCY/Su5VPA2bpAI/AAAAAAAAALk/TwJmJ-KCH58/s1600-h/google-mobile-app-movie-times.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399346719678505986" src="http://4.bp.blogspot.com/_IevKNrO7uCY/Su5VPA2bpAI/AAAAAAAAALk/TwJmJ-KCH58/s200/google-mobile-app-movie-times.jpg" style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 150px; height: 200px;" /></a>(Cross-posted from the <a href="http://googlemobile.blogspot.com/2009/11/google-search-by-voice-travels-world.html">Google Mobile Blog</a>) Google Search by voice has grown up quickly. Some might say that search by voice has matured from a toddler to a tween. It's certainly been traveling across the English-speaking world and getting better at understanding a range of accents, from the US, U.K., India and Australia. Today it's taking another big step — we're happy to announce that Google search by voice is available for Nokia S60 phones, and now understands Mandarin Chinese. Nokia S60 phones are popular around the world. If you have an Nseries or Eseries phone such as the N95 or E71, you're using S60. Many of these phones have 12-digit keypads — good for making calls, but not so easy when you need to type a few words. Many of you have asked if we could build our search by voice feature for these phones, and we've been working on this feature for a while. The new version of <a href="http://www.google.com/intl/en_uk/mobile/default/app.html">Google Mobile App</a> places a shortcut to Google search on your Nokia phone's home screen, allowing you to search using your voice or by typing. You can search for anything — from "movie times", to "fish 'n chips", to "masala dosa." It doesn't matter if you're in London or Bangalore: we'll use your location to give you nearby results. And Google Mobile App shows search results in the application, so you don't have to wait for a web browser to launch to get an answer. We always use Google products ourselves before we share them with users. We like to think of this process as "eating our own dogfood" and you can see a video of some early testing here. <object height="350" width="425"> <param name="movie" value="http://www.youtube.com/v/IiL2wEMVzYk"> <embed src="http://www.youtube.com/v/IiL2wEMVzYk" type="application/x-shockwave-flash" width="425" height="350"></embed> </object> Up until now voice search has only been available in English, but the new version of Google Mobile App for Nokia S60 devices works for Mandarin speakers, too. We're really proud of the work we've done with Mandarin speech recognition, both because it's the most spoken language in the world, and because of the engineering challenge. To get Mandarin speech recognition to work, we had to learn a lot about this fascinating language — the differences between traditional and simplified Chinese, its tonal characteristics, automatic segmentation of text into words, pinyin representations of Chinese characters, sandhi rules, the different accents and languages in China, unicode representations of Chinese character sets...the list goes on and on. Mandarin speakers can now search by voice for complex queries like 清华大学附近的水煮鱼 (which translates to "water-boiled fish near Tsinghua University"). Although this only works on the Nokia S60 at the moment, we're working on adding support for Mandarin speech recognition to our products on other mobile platforms, such as Android and iPhone. And bear in mind that this is a first version of our system in Mandarin, and it might not be as polished as our English version. For example, if you have a strong southern Chinese accent, it might not work as well as for people with a Beijing accent. However, our system will improve over time, so please give it a try! <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_IevKNrO7uCY/Su5UUGicg4I/AAAAAAAAALU/-z0DqqHr2-4/s1600-h/google-mobile-app-chinese-home.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399345707593008002" src="http://1.bp.blogspot.com/_IevKNrO7uCY/Su5UUGicg4I/AAAAAAAAALU/-z0DqqHr2-4/s200/google-mobile-app-chinese-home.jpg" style="cursor: pointer; width: 150px; height: 200px; margin-right: 20px;" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_IevKNrO7uCY/Su5UmNXeGAI/AAAAAAAAALc/DJyo4fJf3_s/s1600-h/google-mobile-app-chinese-results.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399346018663667714" src="http://3.bp.blogspot.com/_IevKNrO7uCY/Su5UmNXeGAI/AAAAAAAAALc/DJyo4fJf3_s/s200/google-mobile-app-chinese-results.jpg" style="cursor: pointer; width: 150px; height: 200px;" /></a> Google Mobile App in Mandarin Chinese Note that the application is for version 3 of Nokia S60 — more recent phones running version 5 (touch screen) are not yet supported. To download the new version of Google Mobile App on your Nokia S60 phone, visit m.google.com from your phone's browser. Posted by Elke Michlmayr, Software Engineer

Google Search by voice travels the world, finds Nokia, learns Chinese

(Cross-posted from the Google Mobile Blog ) Google Search by voice has grown up quickly. Some might say that search by voice has matured fro...

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