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Academic Freedom and ED EHR's Down Under: An Update

At the post "<a href="http://hcrenewal.blogspot.com/2009/10/academic-freedom-curtailed-down-under.html">Academic Freedom Curtailed?</a>" I wrote: <blockquote>The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney, that I referenced in my posts "<a href="http://hcrenewal.blogspot.com/2009/10/from-down-under-story-of-deployment-of.html">The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck</a>" and "<a href="http://hcrenewal.blogspot.com/2009/10/nsw-nightmare-and-overuse-of-computers.html">NSW Nightmare and Overuse of Computers</a>" appears to have been censored. This apparently occurred at the level of the the government.</blockquote> Professor Patrick has updated his <a href="http://www.it.usyd.edu.au/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">web page</a> that formerly contained a link to his essay on problems with EHR's in that state's EDs. He advises: <blockquote>... This document has been temporarily withdrawn by the university following a complaint from NSWHealth. I think the University has acted appropriately by investigating the complaint and I do not yet consider it an act of censorship. I am working through the issues with the University and expect that the essay will be re-published. I would like to thank all the people who have written to me to offer support and I would encourage you to write to me if you are interested in the matter so that i can demonstrate to the university the importance of this issue to both the Australian and international communities. I do not wish for people to write to anyone else but me. I have no wish to run a public campaign and I am not available for statements to the press about this particular matter. This matter has brought to light many interesting and illuminating things that i will be happy to share in the next version of the Critical Essay. Jon Patrick 27th October 2009 0930 Eastern Australian Summer time</blockquote> He then follows up with this: <blockquote>Update on the withdrawal of "Essay No.6" It is now two weeks since the original essay was withdrawn. In that time I have been able to establish confidently that NSWHealth phoned my Head of Department and asked him to remove the article without giving a specific complaint. He refused. Subsequently a person from another faculty took up the cause and succeeded in persuading an appropriate person to order withdrawal of the essay. To this time i have not received a specific complaint let alone a written complaint. The Univeristy's Office of General Counsel has studied the essay at my request through my Dean, and found that it is "consistent with the University's Public Comment Policy". I am awaiting further investigations by the University. Subsequently I have received many messages of support from around the world, and importantly much more information to be included in the essay. I am preparing a much enhanced version. 5th November 2009 1150 Eastern Australian Summer time </blockquote> I sincerely hope this matter will be resolved in favor of dissemination of the enhanced and updated piece. I think it contains information that is quite valuable to a worldwide audience of clinicians, IT vendors and patients. I also note that those who aim to suppress a document such as this in the age of informational computing, one product of which is the Internet, should be confined to using only the <a href="http://en.wikipedia.org/wiki/Commodore_PET">Commodore PET</a> due to their technological and sociological ineptitude: <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq0bGvOD7gFP0nD7_IxTfnqFZ4R_UFExPHfHOpz-CqoGReSVYFNa55ZN0VeNzN8x5j7aCJWLUiCetXZz27vFcRHe8U9NBcOlWkmsClyhove5d-trkir2WFLOeabRMA7_Gqxja8_bxm3YiH/s1600-h/pet.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5401003480085761234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq0bGvOD7gFP0nD7_IxTfnqFZ4R_UFExPHfHOpz-CqoGReSVYFNa55ZN0VeNzN8x5j7aCJWLUiCetXZz27vFcRHe8U9NBcOlWkmsClyhove5d-trkir2WFLOeabRMA7_Gqxja8_bxm3YiH/s320/pet.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 220px; height: 166px;" /></a>State-of-the-art computing for the would-be Health IT article police </div> -- SS Addendum Nov. 10, 2009, evening EST: The essay in version 5 is once again available as Item 6 at <a href="http://www.it.usyd.edu.au/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a> . -- SS

Academic Freedom and ED EHR's Down Under: An Update

At the post " Academic Freedom Curtailed? " I wrote: The essay on Emergency Department electronic health record (EHR) problems in ...

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Is Someone at Jefferson Regional Medical Center Lying About EHR Safety?

This curious story appeared about apparent clinician health IT safety concerns at <a href="http://www.jeffersonregional.com/">Jefferson Regional Medical Center</a> near Pittsburgh: <div class="headline"></div><blockquote><div class="headline"><a href="http://www.pittsburghlive.com/x/pittsburghtrib/news/s_650606.html">Switch to electronic records alarms Jefferson Regional physicians</a> By Walter F. Roche Jr. PITTSBURGH TRIBUNE-REVIEW Friday, October 30, 2009 Jefferson Regional Medical Center's attempts to convert to electronic medical records have some doctors concerned about patient safety. </div> In a memo issued this month, the hospital's Health Information Technology Committee announced the 373-bed facility in Jefferson Hills would revert to printed versions of patients' consultant reports "due to patient safety concerns from the majority of physicians." Jefferson executives downplayed the memo and said they found no evidence that patient safety has been impacted, arguing a small group of physicians expressed concerns and not a majority, as the memo claimed. "It was a very small number that were concerned. It wasn't the majority," said Dr. Richard F. Collins, Jefferson's vice president for medical affairs. "To this point, we haven't identified any issue of patient safety."</blockquote> Now, one or the other must be true. Either a majority of physicians expressed concerns, or a small number did. Both cannot be true. Assuming the account in the Pittsburgh Tribune Review is accurate, someone is lying. I should point out that the numbers ultimately do not matter - patient safety issues should never be determined via a headcount, and in fact hospital governance obligations under the Joint Commission and their own fiduciary responsibilities mandate the utmost conservatism and due diligence on safety concerns. Perhaps the executives did find "no evidence" of safety issues. Regardless, I raise the following questions: <ul><li>How was such a study performed, how were physicians and other clinicians involved in the study, and was it a rigorous study using validated methodologies, or cursory?</li></ul><ul><li>Who is most motivated to find an HIT system "safe", the HIT Committee and clinicians, or the administration?</li></ul> I have served on HIT Committees; led them, in fact. Those committees "have the pulse" of clinician sentiment, even when they do not conduct formal surveys. In hospitals, the walls have ears, and the clinicians on HIT Committees understand what their colleagues are feeling - usually via direct and sometimes confrontational conversations. HIT Committees charged with making HIT successful do not generally pull back from HIT projects without very good reason. On the other hand, hospital executives who have signed off on investments of millions or tens of millions of dollars in IT investments do have a strong motive to ensure all goes well - either in reality or in the narrative they proffer. This is especially true when conflicts of interest exist. <blockquote>According to [VP for Medical Affairs] Collins and James Witenske, Jefferson's chief information officer, the transition [to EHR] began about a year ago and was completed in May. The hospital uses a system developed by Siemens, Collins said. He declined to disclose the cost.</blockquote> I find this an interesting finding. After a short Google search, the following appeared: <blockquote>Western Pennsylvania Hospital News<a href="http://www.wpahospitalnews.com/archives/default.asp?page=18&articleID=486">20 Years of Hospital Information Technology</a> by John Fries (December 2005) ... James Witenske is chief information officer at Jefferson Regional Medical Center, having left Arthur Andersen four years ago to accept the position. Before working at the Big Eight firm, he served as chief information officer at UPMC Health System. At Jefferson, IT takes place a bit differently that at other healthcare institutions. Where most hospitals have an IT department with staff, Witenske works almost exclusively with outside experts, one of whom is Ron Forys, a Siemens site executive who is based at Jefferson. It’s a complementary relationship – Witenske’s role is strategic and Forys’ is operational. Both are longtime technology professionals who have seen huge changes take place during the past two decades. </blockquote> The hospital had/has its own vendor representative in a front line role, and apparently shied away from having its own IT staff. A person who comes from a consulting firm uses consultants whose loyalty is to the vendor, not the hospital, one of them as his operations guy. This raises a number of questions: <ul><li>Who paid/pays the Siemens Site Executive? The hospital, the vendor, or both?</li><li>Who did/does the Site Executive report to?</li><li>Did/does not the Site Executive have a conflict of interest with regard to physician opposition to the vendor's system?</li><li>What was/is the financial relationship between hospital executive leadership and the Site Executive? Between hospital executive leadership and the vendor?</li></ul> These type of arrangements do raise my eyebrows, and the discrepancy between the HIT Committee's memo and the hospital executive's account, both of which cannot be true, could certainly be a symptom of conflicts of interest. I have noted that a <a href="http://hcrenewal.blogspot.com/2009/10/washington-post-emrs-no-cure-all-sen.html">Congressional investigation of the health IT industry</a> is now underway. This would not be a good time for hospital governance to downplay physician concerns about HIT, overruling their own HIT committee. For if a patient is injured or dies as a result of physician HIT concerns that were ignored, the executives could likely find themselves in a very unpleasant situation - and not just from malpractice attorneys. <blockquote> Collins and other hospital officials who support the conversion say that once adopted and accepted, electronic records will increase patient safety and efficiency, and eliminate "piles of paper."</blockquote> He apparently forgot the word "perfected." HIT in an experimental medical device. This VP for Medical Affairs makes no mention of the unintended consequences of poorly designed or implemented HIT. He either doesn't know about them (i.e., is dyscompetent regarding HIT) or is suffering the syndrome of inappropriate overconfidence in computers in the face of what seems like his own staff's concerns. This is typical of the Wild West environment of Health IT. -- SS

Is Someone at Jefferson Regional Medical Center Lying About EHR Safety?

This curious story appeared about apparent clinician health IT safety concerns at Jefferson Regional Medical Center near Pittsburgh: Switch...

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Transparency, choice and control — now complete with a Dashboard!

Today, we are excited to announce the launch of Google Dashboard. Have you ever wondered what data is stored with your Google Account? The Google Dashboard offers a simple view into the data associated with your account — easily and concisely in one location. Over the past 11 years, Google has focused on building innovative products for our users. Today, with hundreds of millions of people using those products around the world, we are very aware of the trust that you have placed in us, and our responsibility to protect your privacy and data. In the past, we've taken numerous steps in this area, investing in educating our users with our <a href="http://www.google.com/privacy.html">Privacy Center</a>, making it easier to move data in and out of Google with our <a href="http://www.dataliberation.org/">Data Liberation Front</a>, and allowing you to control the ads you see with <a href="http://www.youtube.com/watch?v=aUkm_gKgdQc">interest-based advertising</a>. Transparency, choice and control have become a key part of Google's philosophy, and today, we're happy to announce that we're doing even more. In an effort to provide you with greater transparency and control over your own data, we've built the Google Dashboard. Designed to be simple and useful, the Dashboard summarizes data for each product that you use (when signed in to your account) and provides you direct links to control your personal settings. Today, the Dashboard covers more than 20 products and services, including Gmail, Calendar, Docs, Web History, Orkut, YouTube, Picasa, Talk, Reader, Alerts, Latitude and many more. The scale and level of detail of the Dashboard is unprecedented, and we're delighted to be the first Internet company to offer this — and we hope it will become the standard. Watch this quick video to learn more and then try it out for yourself at <a href="http://www.google.com/dashboard">www.google.com/dashboard</a>. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/ZPaJPxhPq_g&hl=en&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/ZPaJPxhPq_g&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> Posted by Alma Whitten, Software Engineer, Yariv Adan, Product Manager, and Marissa Mayer, VP of Search Products and User Experience

Transparency, choice and control — now complete with a Dashboard!

Today, we are excited to announce the launch of Google Dashboard. Have you ever wondered what data is stored with your Google Account? The G...

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Introducing Google Commerce Search: Finding holiday gifts faster

The holiday season is right around the corner, so online retailers are gearing up for spikes in traffic. When people go to shop online, search is big part of finding the right product, whether they're looking for a gift or just something for themselves. Today we're aiming to make e-commerce searching as easy as using Google.com with a new enterprise product, <a href="http://google.com/commercesearch">Google Commerce Search</a>. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/gj7qrotOmVY&hl=en&fs=1&"><paramname="allowfullscreen" value="true"><paramname="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/gj7qrotOmVY&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></paramname="allowscriptaccess"></paramname="allowfullscreen"></object> Search quality is a big factor in changing visitors to buyers online, and in making customers happy too. Visitors spend <a href="https://www.marketingsherpa.com/barrier.html?ident=29929">an average of just eight seconds</a> before deciding whether or not to remain on a website, so having a good search tool is important for turning visitors into buyers. Google Commerce Search is hosted by and uses Google search technology to make online retail searching both fast and customizable — visitors to your online store can sort by category, price, brand or any other attribute. E-store administrators can highlight special products or connect related ones so searching is easier for their customers. Google Commerce Search includes a built-in spellchecker and synonyms so if visitors can't remember exactly how to spell the particular toy or perfume or anything else they're hunting for, Google Commerce Search will make some suggestions. Choosing the right one is up to them, though. Google Commerce Search is hosted in the cloud, meaning it lives online, so e-commerce sites can get up and running quickly. Using a cloud search tool will also help site owners meet the rise in demand from the holiday rush without having to devote extra time or resources to worrying about their capacity or infrastructure. Online retailers are free to focus on their business, while Google focuses on search, and shoppers can find what they need faster. For more information check out <a href="http://google.com/commercesearch">google.com/commercesearch</a>. Posted by Alex Dovlecel and Nicholas Weininger, Engineers, Google Commerce Search

Introducing Google Commerce Search: Finding holiday gifts faster

The holiday season is right around the corner, so online retailers are gearing up for spikes in traffic. When people go to shop online, sear...

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Google Friend Connect, now more personalized

(Cross-posted with the <a href="http://googlesocialweb.blogspot.com/2009/11/google-friend-connect-now-more.html">Social Web Blog</a>) On the subway, I bump elbows with a guy for 20 city blocks without exchanging a single word. Forty-five minutes later, I find the same guy at the local guitar shop, and we start to talk — turns out he plays a Gibson Les Paul just like I do. We may have been strangers on the train, but in the guitar shop, we discover our shared passion for guitars. Often, the web can feel like that subway. There are probably people commuting to the places you regularly visit, but you don’t know who those people are, and your paths may never cross. With <a href="http://www.google.com/friendconnect/">Google Friend Connect</a>, we've been helping millions of website owners make their sites more like that guitar shop — a social place where visitors can get to know each other — and less like the anonymous subway ride. With this in mind, we're thrilled to introduce a new set of Friend Connect features that let site owners help their visitors get to know each other and personalize their site's experience and content. Break the ice Visitors to your site can get to know each other better by sharing details about themselves that are relevant to the site they're on. As a site owner, you can help them do this by visiting the new "Interests" section of your Friend Connect account, where you can add site-relevant questions that people can answer when joining your website or via the poll gadget. For instance, if you have a music website, you might ask people to share their favorite bands, the last concert they attended, or where they discover new music. Or if you run a hiking site, you can ask them about a favorite hike or national park. The details people share are added to their Friend Connect public profiles for your site, which are seen by other site visitors. This way, your visitors can learn more about each other in the context of the interests that bring them to your website. We've also added the ability for people to send private messages to each other. That way, when a user discovers someone who shares their interests, they can send a message to that person via their Friend Connect profile to start a dialogue. And as with any data you collect on Friend Connect, you can use open export tools and APIs to integrate this information with any other systems you might use. The interests people share on your website are also made available in the new "Community data" section of your account in the form of easy-to-read charts. Personalize your website experience The ice-breaking isn't limited to your visitors; you'll learn more about them too. The interests people share make it possible for you to create a more personalized experience on your website in a number of ways: <ul><li>Send custom newsletters: The new "Newsletter" section of your account lets you create, send and manage newsletters. And with the help of "Interests," you can either send out newsletters to all your subscribers, or send out custom newsletters to different segments of your subscribers, based on the interest responses they submit.</li><li>Personalized content gadget: This new Friend Connect gadget automatically presents a dynamic personalized set of links to your site's content that matches each visitor's specific interests. Is a visitor learning how to play swing music? Links to articles your site has published about playing swing are presented to him or her.</li><li>Google ads: For those of you who display ads on your website, your Friend Connect account now includes an "AdSense" section that lets you enable Google ad units that are matched both to your site's content and to the interests users publicly share on your website. </li></ul>All these new features are easy to implement and require no coding whatsoever. Here's a quick tour of what Friend Connect now has to offer: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/NlKEWHcW5QE&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/NlKEWHcW5QE&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> If you'd like to see the new features in action, check out some of our partners' sites, like <a href="http://www.sfstation.com/">sfstation.com</a>, <a href="http://www.metrolyrics.com/party-in-the-usa-lyrics-miley-cyrus.html">metrolyrics.com</a> and <a href="http://www.pachakam.com/">pachakam.com</a>. We're excited to see the web evolve into a place where visitors of all websites can get to know each other — to share and discuss the things they care about most. To get started with Friend Connect, visit <a href="http://google.com/friendconnect">http://google.com/friendconnect</a>.<div> </div><div>Update 11/15: Updated list of partners.  Posted by Mussie Shore, Product Manager, Google Friend Connect</div>

Google Friend Connect, now more personalized

(Cross-posted with the Social Web Blog ) On the subway, I bump elbows with a guy for 20 city blocks without exchanging a single word. Forty-...

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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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