healthy4u

A galactic mentor

This month marks the 30th anniversary of the final quarter being dropped into the world’s first commercial video game, for it was in May of 1979 that <a href="http://en.wikipedia.org/wiki/Galaxy_Game">Galaxy Game</a> was removed from the Coffee House café at Stanford’s Tresidder student union. I spent a good part of five years feeding coins into Galaxy’s wondrous console, and in return it taught me and several other Silicon Valley denizens valuable lessons that laid the groundwork for much of what we have done since. I met Galaxy Game in the Summer of 1974. My family had just moved to Palo Alto and I had no friends, so my brother and I rode our bikes around the Stanford campus looking for things to do. I was in 8th grade and the bowling alley got boring quickly, but next door, amidst students and lattes (also a novelty at the time) stood two large consoles, side by side, with odd-looking little black screens. Behind those screens sat a DEC PDP-11/20 powering a riveting game built on a simple concept: use a joystick and a couple of buttons (one for torpedoes, one for hyperspace) to destroy the other spaceships. Best of all, unlike its descendants such as Asteroids, Galaxy was a multi-player game. Those opposing spaceships were controlled by the people sitting next to you, and if you won the game you kept your quarter. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlU1QE1lYMovOBIiJ5LvB0v3HULshc_OSgY_nyIoVyKg5JHwN7lP0cmgXliyAPn34zqT_3mTRVim53Hm6Xr7tNg8gY3cwa7iJbA_CbM9yXNFwU_dBdv-m0rFHgdyV2N1coAb9nN4OMHjpN/s1600-h/Picture+1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5337224008240126370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlU1QE1lYMovOBIiJ5LvB0v3HULshc_OSgY_nyIoVyKg5JHwN7lP0cmgXliyAPn34zqT_3mTRVim53Hm6Xr7tNg8gY3cwa7iJbA_CbM9yXNFwU_dBdv-m0rFHgdyV2N1coAb9nN4OMHjpN/s400/Picture+1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 293px; height: 221px;" /></a>I knew a good deal when I saw one, so I hung around the Coffee House and got to know the game’s co-creator, a Stanford grad named Bill Pitts. That's how I got my first job in high-tech: in exchange for keeping the consoles clean, I got a few dollars per day and a bunch of insider tips about how to play. For example, if your torpedo was on course to destroy an opponent’s ship and that opponent escaped into hyperspace, you could follow him there, shoot again, and destroy him. Imagine the face of a graduate student who thinks he has outwitted that annoying kid, only to find when he releases his finger from the hyperspace button that his ship is nothing but fragments of white floating randomly into the blackness of space. Nothing on Wii matches it! Galaxy's lessons have stayed with me. Its design was simple and easy to use but with the depth to satisfy the most committed players. Its on-screen dashboard fed players real-time information about fuel, torpedoes, and location, my first inkling that data is critical to making smart decisions. Finally, in Galaxy achieving your goals sometimes required a jump to hyperspace. My opponents thought hyperspace was a last resort, a refuge from a losing path. I discovered that it was a way to win — high risk and scary, but with a huge payoff. So when in doubt, press the button and make the jump! At worst you’ll lose a quarter, but at best you’ll rule the Galaxy. Posted by Jonathan Rosenberg, SVP, Product Management

A galactic mentor

This month marks the 30th anniversary of the final quarter being dropped into the world’s first commercial video game, for it was in May of ...

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Dangerous Games and Health IT Feudalism

I am reposting a provocative open letter from Ignacio Valdes, MD, MSc (a proponent of Open Software and proprietor of the <a href="http://linuxmednews.com/">LinuxMedNews blog</a>) on the revelations about Health IT by Penn sociology professor Ross Koppel and by Washington Post reporter Robert O'Harrow, Jr. While I am not predicting nor recommending the elimination of the commercial HIT sector (just its major reformation!), Dr. Valdes makes many valid points about the current state of health IT and the value of open source solutions. VistA/CPRS and its derivatives are one example of an open source EHR. (Note: Dr. Valdes is an acquaintance from informatics meetings; I have no commercial connections or financial interests in his business affairs). I cannot add much more to the letter's sentiments: <blockquote>Dangerous Games and Health IT Feudalism. From: LinuxMedNews announce -- breaking news of Free/Open Source in medicine. <linuxmednews-announce@linuxmednews.com> To: linuxmednews-announce <linuxmednews-announce@linuxmednews.com> Date: Mon, 18 May 2009 12:43 pm Dr. Koppel, This is an open letter that I plan to publish on Linux Medical News and elsewhere. As you probably know, your JAMA 'Hold Harmless' article presents just the tip of the iceberg. Your article and more data from the Washington Post article (<a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid%3Dtopnews&sub=AR">link</a>) make it abundantly clear that proprietary vendors are intent on establishing private property rights for something that private property rights are clearly not appropriate for. It leads to the logical absurdities, expense, and moral hazards we are experiencing now. The obvious dangers, enormous conflict of interest, as well as highly practical considerations such as simple non-performance of proprietary Electronic Medical Record software is manifest. What the proprietary industry could not achieve with vendor lock-in, legislative help like Stark exceptions, trade secrets, and inadequate products they are attempting to achieve by pure politics. Politicians, proprietary vendors and its lobby are playing 'heads we win, tails you lose, we are king, it is good to be king' games with our safety, our privacy, taxpayer money, and our lives. This may well succeed in ushering in a kind of digital feudalism with the most intimate details of our lives. Such landlord type games are entirely inappropriate for the practice of medicine. They are antithetical to American history and values. A generous and virtuous society should not allow this to occur. The medical profession no longer condones even 15 cent pens with pharmaceutical company logos on them because of the moral hazard and the perception of untoward financial coercion. Yet we are now by law embarking on a program of essentially bribing physicians with approximately $40,000 each of taxpayer money and then punishing them if they cannot be bribed in order to implement problematic proprietary health IT loaded with legal, financial, and practical minefields. Have we as a nation taken leave of our senses? The Free/Open Source licensing in medicine crowd has been discussing these issues and showing demonstrable results for years but has received little attention and practically no funding. We have the legal, practical, and licensing means for achieving the transparency and rights guarantees that nearly everyone says that they want, solving many practical as well as moral issues. The AMIA Open Source working group white paper can be found here <a href="http://www.amia.org/files/Final-OS-WG%20White%20Paper_11_19_08.pdf"> http://www.amia.org/files/Final-OS-WG White Paper_11_19_08.pdf</a> Unfortunately, it was rejected from entering into the scientific literature by JAMIA on a technicality and voted down by the AMIA board of directors as AMIA policy on methodology and 'ideological' grounds. Such a stance and public declarations by AMIA's leaders seems to be in direct conflict with AMIA's mission. Relying on government bureaucrats, proprietary vendor lobbies, and marketing representatives giving "trust us" type guarantees versus legally enforceable Free/Open Source licenses is a recipe for national disaster. Again, a generous and virtuous society should not allow this to occur. A practical solution is a law that only allows taxpayer money to be expended only for Electronic Medical Record software that is licensed only with Free Software Foundation approved licenses. Preferably the Affero General Public License which closes the software as a service loophole. The nations health, privacy, safety, finances and destiny are at stake. Sincerely, -- Ignacio Valdes, MD, MSc</linuxmednews-announce@linuxmednews.com></linuxmednews-announce@linuxmednews.com></blockquote> -- SS

Dangerous Games and Health IT Feudalism

I am reposting a provocative open letter from Ignacio Valdes, MD, MSc (a proponent of Open Software and proprietor of the LinuxMedNews blog ...

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Wall Street Journal Letter Revisited

I believe yesterday's Washington Post article <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid=topnews">The Machinery Behind Health-Care Reform</a> confirms that my Feb. 18, 2009 <a href="http://online.wsj.com/article/SB123492035330205101.html">letter to the editor</a> published in the Wall Street Journal was on the money (yes, that is a pun): I wrote: <blockquote>Dear Wall Street Journal: You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill. I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants. For £12.7 billion the U.K., which already has socialized medicine, still does not have a working national HIT system, but instead has a major IT quagmire, some of it caused by U.S. HIT vendors. HIT (with a few exceptions) is largely a disaster. I'm far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine. The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker. I can only hope patients get something worthwhile for the $20 billion. </blockquote> Lobbyists do tend to present the rosiest picture possible to those with the gold. It appears the myths surrounding health IT have been deliberately engineered. I believe it now essential and indeed socially responsible for our medical professional societies to ensure the administration is aware of the difficulties and potential downsides of health IT. If the industry lobbyists have only presented one side of the story (and I believe that likely to be the case), then our government has been making critical social re-engineering decisions based on a dangerously and deceptively incomplete picture. I for one would like an accounting from HIMSS and other lobbyists of exactly what literature and viewpoints they presented to our government officials, especially in recent years, that led to the massive inclusion of funds and the use of government power to enforce rapid timelines (via economic sanctions for non-meaningful users) in H.R. 1 EH , a.k.a. the Economic Recovery Act of 2009 . I would also like to know what literature was not presented. -- SS

Wall Street Journal Letter Revisited

I believe yesterday's Washington Post article The Machinery Behind Health-Care Reform confirms that my Feb. 18, 2009 letter to the edit...

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The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians

(To those who linked here from "<a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/05/microsoft-google-in-healthy-competition---cnet-news.html">The Health Care Blog</a>", see my footnote at the end of this post. Also, I suggest readers at least peek at each and every hyperlink I've placed in this essay. It takes time, but it's illuminating - ed.) <div><div> In many past posts on Healthcare Renewal I have commented on a bewildering healthcare and IT industry blindness to a growing body of literature and experiences of those "in the trenches" that throw doubts upon Utopian views of health IT as a panacea for healthcare's problems. Those responsible for this literature advise caution and the highest levels of scientific rigor in the large scale adoption of clinical information technology if that technology is to actually improve healthcare, myself included. We know the difficulties and risks. Bad healthcare informatics wastes money and distracts clinicians. <a href="http://iig.umit.at/efmi/badinformatics.htm">Bad healthcare informatics can kill</a>. "Primum non nocerum" is a critical ideology in health IT. I first wrote about these observations <a href="http://www.tinyurl.com/hit-misadventure">a decade ago</a> and was merely standing on the shoulders of those who preceded me with their own critical thoughts and observations regarding cybernetic miracles in medicine. I've also been puzzled about the sudden lurch by the current administration to commit tens of billions of dollars to national HIT, along with eventual penalties for resistance, within the ridiculously short time frame of 2014 and with little public discussion. The provisions seemed to simply "appear" in H.R. 1 EH, a.k.a. the Economic Recovery Act of 2009. I wrote about this <a href="http://hcrenewal.blogspot.com/2009/02/illusions-of-hope-over-experience.html">here</a>. Finally, I was curious about the timing of a remarkable set of reports from highly respected U.S. organizations on HIT issues, such as a Dec. 2008 Sentinel Events Alert from the <a href="http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm">Joint Commission</a> and a Jan. 2009 report from the <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">U.S. National Research Council</a>. What motivated their release? The answers to these questions have become bit clearer via a remarkable article from the Washington Post. It reveals an administration heavily influenced by - no surprise - powerful industry lobbyists. (I thought this administration had pledged a different mode of government conduct, but as has been said, campaigning is done with poetry, and governing is done with prose.) Here is an interesting explanation of how medicine has been cross-occupationally invaded by the IT industry, probably ten or more years before that industry really has the depth of understanding, depth of talent and capabilities to make useful, usable, safe, and cost effective national health IT a reality: <blockquote><a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid=topnews">The Machinery Behind Health-Care Reform</a> How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records By Robert O'Harrow Jr. Washington Post Staff Writer Saturday, May 16, 2009 When President Obama won approval for his $787 billion stimulus package in February, large sections of the 407-page bill focused on a push for new technology that would not stimulate the economy for years. The inclusion of as much as $36.5 billion in spending to create a nationwide network of electronic health records fulfilled one of Obama's key campaign promises -- to launch the reform of America's costly health-care system. But it was more than a political victory for the new administration. It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars. A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society (HIMSS), had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long [lobbying] campaign to shape public opinion and win over Washington's political machinery ... At the center of those efforts is the Healthcare Information and Management Systems Society. Started a half-century ago, it represents 350 companies and about 20,000 members. Corporate members include government contractors such as Lockheed Martin and Northrop Grumman, health-care technology giants such as McKesson, Ingenix and GE Healthcare, and drug industry leaders, including the Pharmaceutical Research and Manufacturers of America. With financial backing from the industry, they started advocacy groups, generated research to show the potential for massive savings and met routinely with lawmakers and other government officials.</blockquote> A lot of voices were left out of that trade group's lobbying, including the open source EHR proponents following the traditions of the <a href="http://www.va.gov/cprsdemo/">VistA effort</a>, as one can learn about in the book "<a href="http://www.amazon.com/Medical-Informatics-Electronic-Collaboration-Innovation/dp/0763739251">Medical Informatics 20/20</a>" by VA pioneers Goldstein, Groen et al. These traditions are largely alien to the commercial IT sector as evidenced by the mission hostile clinical IT products they put out (see my series on that issue <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>) and even known <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">grossly defective software</a> for use on live patients. The HIMSS trade group's massive conflicts of interest also seem to have blinded it to the longstanding concerns of many experts in medical informatics, social science and related fields that <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">current approaches to health IT are insufficient</a> and may impair healthcare quality initiatives (let's be frank about what that really means - it means patient harm). The creation of advocacy groups backed by industry financing also seems eerily similar to many stories on HC Renewal and other blogs about the pharmaceutical industry, as does "generated research." That "research" may also have been industry funded, and it is my belief the impartiality and soundness of such research needs to be critically and impartially re-examined. <blockquote>Their proposals made little headway in Congress, in part because of the complexity of the issues and questions about whether the technology and federal subsidies would work as billed. </blockquote>In other words, Congress was doing its job regarding lobbying by proponents of an experimental technology in which they had a major financial stake. Until... <blockquote>As the downturn worsened last year, advocates helped persuade Obama's advisers to dust off [i.e., uncritically accept lock, stock and barrel - ed.] electronic records legislation that had stalled in Congress -- legislation that the advocates had a hand in writing, the Post review found. Their sudden success shows how the economic crisis created a remarkable opening for a political and financial windfall: the enactment of a sweeping new policy with no bureaucratic delays and virtually no public debate about an initiative aimed at transforming a sector that accounts for more than a sixth of the American economy.</blockquote> Let me add that while the advocates "had a hand" in writing the legislation [i.e., they wrote the legislation - ed.], researchers and critical thinkers regarding the downsides of health IT industry in its present state seem to have had little voice in this legislation. <blockquote>"It was perhaps a once-in-a-generation opportunity to make something happen," said H. Stephen Lieber, the trade group's president. Obama "identified the vehicle that he could use to move his policy agenda forward without the crippling policy debate."</blockquote> I find this simply outrageous. The reason for policy debates in healthcare and especially healthcare IT is to avoid crippling or killing patients. Lieber is not a clinician. Who is he to cheer (and perhaps to have spearheaded) the short circuiting of "policy debate" on health IT? According to his <a href="http://www.himss.org/Content/files/SLieber_bio.pdf">bio</a>, he holds an MA from the School of Social Service Administration at the University of Chicago, a BA in Psychology from the University of Arkansas, and has completed additional course work at the graduate schools of business at both universities and at the Keller Graduate School of Management. <blockquote>... Many technology advocates, including health policy specialists, say that networked electronic patient records that can be transmitted instantly would make health care more efficient and provide valuable insights about costs and care.... Some advocates also say the savings could amount to tens of billions of dollars each year from reduced paperwork, faster communication and the prevention of harmful drug interactions. An equally important benefit, they say, could be to enable researchers to determine the most effective procedures for an ailment. Such an approach would rely on unprecedented data-mining into medical records and the practices of doctors, a kind of surveillance that also would enable insurers to cut costs by controlling more precisely the care that patients receive [Leading to rationing to increase profits? - ed.]</blockquote> These assertions have never been proven in a scientifically robust manner. Further, there is a growing body of literature expressing significant doubts about these predictions of cybernetic miracles from health IT (see short partial lists of examples <a href="http://hcrenewal.blogspot.com/2009/03/reader-on-why-we-have-busywork.html">here</a> and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">here</a>) that has largely been ignored - in the worst traditions of pseudoscience and scientific fraud - by the industry and its lobbyists. In fact, the latter assertion - comparative effectiveness research based on EHR data - may have moved from scientific possibility (e.g., better detection of major adverse drug and therapy events) to anti-scientific pipe dream, as in my essay "<a href="http://hcrenewal.blogspot.com/2009/04/have-we-suffered-complete-breakdown-in.html">Have we suffered a complete breakdown in the scientific method with regard to EHR and clinical IT?</a>" I am not even considering massive potential for abuses created by online national health records. <blockquote>"Finally, we're going to have access to millions and millions of patient records online," said Blackford Middleton, a physician, Harvard professor and chairman of the Center for Information Technology Leadership, whose studies have concluded the health-care system could save $77.8 billion each year through the universal use of information technology networks. "This is the biggest step for health-care information technology in this country's history." But others said the case was far from being so clear. Some observers said the projected savings are overly optimistic and that launching such vast computer networks under tight deadlines is risky, a lesson learned by the Bush administration when it botched a variety of homeland security systems rushed into place after the Sept. 11 terrorist attacks. </blockquote> While I respect Blackford Middleton as a former leader of the EHR company from which I selected the EHR for Christiana Care Health System in the late 1990's, I also respect those "others" who say the case is far from clear. It is through science and an open political process that such debates need to be resolved, not through lobbying and utopianism. The potential for adverse, unexpected consequences in such a major social re-engineering effort are simply too great for cavalier attitudes or utopianism. We are already seeing adverse consequences - just the most recent examples are <a href="http://hcrenewal.blogspot.com/2009/05/dangerous-health-it-mismanagement-spin.html">here</a> and <a href="http://hcrenewal.blogspot.com/2009/05/medical-cyber-piracy.html">here</a>. Industry "roll out HIT no matter what, patient and clinician <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">informed consent</a> be damned" attitudes also teeter on the precipice of human rights violation. In fact, the corporatization of health IT and the treatment of health IT as if it were any other IT not involving third parties with special rights (i.e., patients) may have already resulted in serious breaches of hospital executive fiduciary responsibilities towards safety and (in the U.S.) of their Joint Commission safety standards obligations as well; see my essay <a href="http://hcrenewal.blogspot.com/2009/03/health-it-hold-harmless-and-defects-gag.html">here</a>. <blockquote>Some proponents said they worry that an over-reliance on technology as a solution could distract the health-care system from difficult questions about quality of care. They said efforts to find a quick technological fix will likely run up against complex cultural challenges.</blockquote> The latter quote sounds like me, stating the obvious. Allow me to translate the applied, real world meaning of "cultural challenges." It means increased political infighting between stakeholders, power grabs, distractions and chaos on the medical floor and in the medical office, and other social and political upheavals within medicine that will likely distract from the ability of already harried clinicians to provide care. <blockquote>"I would like to believe that the effective use of technology to augment health care will lead to substantial savings and improvements in the quality of care," said Mark Frisse, a physician and professor of biomedical informatics at Vanderbilt University, who leads an electronic health record program in Nashville. "But the evidence does not consistently bear this out."</blockquote> Dr. Frisse is quite correct, although I would add that the evidence that does not bear out these beliefs is many, many times stronger than that which, say, caused VIOXX to be pulled off the market. <blockquote> "HIMSS has a very effective grass roots advocacy program that reaches all levels of government," Dave Roberts, a senior executive, said in the group's literature... HIMSS has a "strategic alliance" with the Center for Information Technology Leadership, a nonprofit that produces research reports -- which HIMSS prints and distributes to Congress and elsewhere.</blockquote> I agree with that description. Missing from the description, and one I would not add, is a "scientific organization." <blockquote>After volunteering on John Kerry's presidential campaign in 2004, [now-chairman of the board of HIMSS and their ally, the Center for Information Technology Leadership] Middleton said he was recruited as an Obama volunteer last year and provided information about electronic records to the candidate's health-care policy group. Middleton said he worked with several campaign officials, including David Blumenthal, a colleague at Partners HealthCare and a Harvard professor, who was Obama's health-care adviser and is now the administration's national coordinator for health technology. "We didn't have to go very far to get our information," said one senior Obama adviser, who was not authorized to speak publicly and discussed the campaign on the condition of anonymity. Blumenthal "taught all the rest of us everything we know."</blockquote> He may have taught them "everything they know", but he apparently did not teach them everything that is important to know. Obama's team has seemingly thrown a significant body of literature on HIT drawbacks and risks under the bus. This is the essence of scientific naïveté and quackery. <blockquote>Middleton said he provided many of those details. "I sent them a LOT of stuff, many papers and most of the reports. I probably spoke or communicated with David Blumenthal, David Cutler (the health economist on the team), or Dora Hughes about every other week during the heat of the campaign," Middleton said in an e-mail. </blockquote> While Blumenthal goes on in the article to minimize Middleton's influence, I can only wonder if any of the HIT industry lobbyists sent "<a href="http://iig.umit.at/efmi/badinformatics.htm">this stuff</a>" to the campaign. <blockquote>The stimulus bill suggests that the government will recoup about a third of the spending allocated for electronic health records over the next decade, an assumption that some health-care observers question, in part because of a critical analysis by the Congressional Budget Office last year. The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.</blockquote> I can add that not only is there much unknown about the potential, but there is much unknown about the true difficulties of making it all actually work as promised. See <a href="http://www.ctlab.org/documents/Hiding%20in%20plain%20sight.pdf">this seminal short article</a> on why this is so. This is a spectacularly poor way to run major national initiatives costing tens of billions of dollars and upon which patient wellbeing rides. Blindly. <blockquote>Joseph Antos, a health-care policy specialist who has examined the legislation, said the risks of the technology plan are high because of the haste with which it is being implemented and the special interests seeking to profit from it. "This is the real way things get done [and the "real" way true disasters such as our recent world wide financial chaos get initiated - ed.]," said Antos, of the American Enterprise Institute, a Washington think tank. "The stimulus bill looked like a bonanza to an awful lot of people." [I tend to take "awful lot of people" quite literally in this case.]</blockquote> Haste is an understatement. A more reasonable timeframe might have been <a href="http://www.jamia.org/cgi/content/abstract/13/1/106">2024</a>, not 2014. I can add that if this initiative blows up as it has in the UK, then the only triumph will be the financial triumph of the trade group and its apparatchiks. The losers will be the administration, patients, clinicians, and everyone else in the healthcare system. [6/29/09 addendum: it's worse than I thought. The UK's NPfIT in the NHS was suspected to have been doomed from the start, but proceeded anyway; see "<a href="http://www.computerweekly.com/blogs/tony_collins/2009/06/16-key-points-in-gateway-revie.html">16 key points in Gateway Reviews on NHS IT scheme</a>" and the <a href="http://www.connectingforhealth.nhs.uk/about/foi">Gateway Reviews themselves</a>, released under a UK FOI request - ed.] In all seriousness, and with recognition of the harshness of this observation, I add that the patients who might die as a result of hastily and poorly designed and implemented health IT under this rushed "real way" initiative, will have in effect been murdered by this lobby. -- SS Footnote: It is interesting to watch the "circling of the wagons" that is starting over the WaPO story. It is in fact predictable that ad hominem, distortion of views, etc. will follow. For example, Matthew Holt of The Health Care Blog, <a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/05/microsoft-google-in-healthy-competition---cnet-news.html">who writes</a> (emphases mine): <blockquote>I draw your attention to a troika of articles, all of which show how things can be slightly misinterpreted. First, who knew that Blackford Middleton was either the most influential health policy wonk out there, or single-handedly responsible for the Haliburtonization of health IT? If you read <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?sub=AR">the WaPo article about it</a>, it looks as though there was some kind of terrible conspiracy to impose an evil fraud in terms of unnecessary health IT spending on the taxpayer. And for example MedinfomaticsMD over at Health Care Renewal (who appears to have jumped from the position that some health IT installations have real problems to the less tenable one that all EMRs kill) is just one <a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">going loopy about it</a>.</blockquote> "Loopy?" Merriam-Webster: <blockquote><a href="http://www.merriam-webster.com/dictionary/loopy">Loopy</a>: 1 : having or characterized by loops 2 : <a class="lookup" href="http://www.merriam-webster.com/dictionary/crazy">crazy</a>, <a class="lookup" href="http://www.merriam-webster.com/dictionary/bizarre">bizarre</a> <div class="run_on" mwref="http://www.m-w.com/mwref">— loop·i·ly <a class="audio" href="http://www.merriam-webster.com/cgi-bin/audio.pl?loopi01v.wav=loopily%27" onclick=" popWin('/cgi-bin/audio.pl?loopi01v.wav=loopily'); return false; "><img alt=" Listen to the pronunciation of loopily" src="http://www.merriam-webster.com/images/audio.gif" title=" Listen to the pronunciation of loopily" /></a> \-pə-lē\ adverb </div><div class="run_on" mwref="http://www.m-w.com/mwref">— loop·i·ness <a class="audio" href="http://www.merriam-webster.com/cgi-bin/audio.pl?loopi02v.wav=loopiness%27" onclick=" popWin('/cgi-bin/audio.pl?loopi02v.wav=loopiness'); return false; "><img alt=" Listen to the pronunciation of loopiness" src="http://www.merriam-webster.com/images/audio.gif" title=" Listen to the pronunciation of loopiness" /></a> \-pē-nəs\ noun</div></blockquote><div class="run_on" mwref="http://www.m-w.com/mwref"> </div> Ad hominem (<a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">link</a>) is no substitute for a logical argument, in fact it is a logical fallacy. Further, an over the top statement that I've "jumped to a less tenable position that all EMR's kill" is quite disappointing from someone who clearly has the intellect to know how amateurishly political an attack that is on a physician-informaticist in this field for almost two decades. One who is trying to take a strong pro-patient, ethical stance while balancing the need to develop safe and effective health IT along <a href="http://www.jamia.org/cgi/content/abstract/13/1/106">more reasonable timelines</a>, and without the behind-the-scenes corporate influence we write about at Healthcare Renewal. -- SS 2012 Addendum:  see the end of my post regarding my keynote presentation to the Health Informatics Society of Australia <a href="http://hcrenewal.blogspot.com/2012/08/my-presentation-to-health-informatics.html" target="_blank">at this link</a> for more on Matthew Holt's apparent disdain for my positions regarding HIT ethcs.</div></div>

The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians

(To those who linked here from " The Health Care Blog ", see my footnote at the end of this post. Also, I suggest readers at leas...

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Step into the spotlight with YouTube Insight

This post is the latest in an ongoing series on <a href="http://googleblog.blogspot.com/search/label/measurement">The Power of Measurement</a>. Previous topics have covered ways to make your website as successful as possible through tools such as <a href="http://googleblog.blogspot.com/2008/03/insight-into-youtube-videos.html">Analytics</a> and <a href="http://googleblog.blogspot.com/2009/03/make-sense-of-your-site-tips-for.html">Website Optimizer</a>. – Ed. Online video has become increasingly popular and it is now recognized as a very powerful medium for delivering a message. As more and more media companies and advertisers are embracing online video, and millions of people are uploading their own videos every day, building a following and reaching your target audience can be very challenging. We developed a free analytics tool, YouTube Insight, as one way to help you do just that. Since the <a href="http://googleblog.blogspot.com/2008/03/insight-into-youtube-videos.html">launch of Insight</a> just over a year ago, we've been adding more features to help you better understand how the YouTube community is interacting with your video and grow your audience. Just like there is a <a href="http://googleblog.blogspot.com/2009/05/tuning-in-to-tv-data.html">"science" behind programming on TV</a>, content owners and advertisers are becoming more sophisticated about how to gain optimal exposure for their content on YouTube. So how do you master this "science"? First, let's start with the basics. Monitoring viewing trends through Insight's "Views" tab can help you nail down the best time to upload your new videos. For example, <a href="http://www.youtube.com/mondominishows">Mondo Media</a> uses Insight to monitor and predict surges in views of their strongest videos. They then time the launch of new episodes with these "waves" of traffic, making it easier for their existing audience to discover new favorites. Using Insight to increase their momentum on the site is one of the practices that have helped Mondo Media become the 6th most viewed YouTube Channel of all time. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGtTew-o81PEd7RYbXfiUYOc5jbZktotZ-w0acOOMcjVJBQx9WTcv8V93l09m8CKTZ4vMoSxgXdmnPXeS4JfJvwySwVbYxSmfhdsoAYPU6UMdrRUrr_4JYy0oivpYvi6OHODZfa8_9uAmH/s1600-h/HappyTreeFriends.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5334586083944712146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGtTew-o81PEd7RYbXfiUYOc5jbZktotZ-w0acOOMcjVJBQx9WTcv8V93l09m8CKTZ4vMoSxgXdmnPXeS4JfJvwySwVbYxSmfhdsoAYPU6UMdrRUrr_4JYy0oivpYvi6OHODZfa8_9uAmH/s400/HappyTreeFriends.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 166px;" /></a>Insight has even more sophisticated features, like the "Discovery" feature, which shows you how your viewers found your videos (i.e., through search, an embedded player, related videos or viral sharing). Just like with websites, figuring out how visitors are coming to your videos can help you grow your audience. Using "Discovery," the band Weezer <a href="http://www.latimes.com/technology/la-fi-youtube4-2008jun04,0,3627512.story?track=rss">was surprised to find out</a> that many of their followers were actually techies and not indie rockers: a large number of people had discovered their <a href="http://www.youtube.com/watch?v=muP9eH2p2PI">"Pork & Beans" video</a> on YouTube through the embedded player on tech blogs. This finding led them to optimize their marketing strategy and shift funds in their budget to tech blogs for promoting their summer tour. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuk7LXPGK_-PBR4knpxERiXmJvlvYYSvjhjMti_Bc5Pa4-KrikrIVtuuBk5XX2x9Vrh7DAf1yyRTBiqlzMRJaNay9hP2Hhq-xMHqUvjSL8MmhWTV35t2hBrJEevZ9DlJT9vsK228Pav59U/s1600-h/weezer+discovery.JPG"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5334382172817195506" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuk7LXPGK_-PBR4knpxERiXmJvlvYYSvjhjMti_Bc5Pa4-KrikrIVtuuBk5XX2x9Vrh7DAf1yyRTBiqlzMRJaNay9hP2Hhq-xMHqUvjSL8MmhWTV35t2hBrJEevZ9DlJT9vsK228Pav59U/s400/weezer+discovery.JPG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 199px;" /></a>Using "Discovery," you can also see which keywords are driving views and then advertise against these keywords using <a href="https://ads.youtube.com/">YouTube's Promoted Video product</a>. You can see exactly how effective this method of promotion is and optimize your a spend in the future. Understanding which parts of your video people liked can be difficult, so we created the <a href="http://googleblog.blogspot.com/2008/09/your-youtube-video-hot-or-not.html">"Hot Spots" feature</a> in Insight to show you the ups-and-downs of viewership for every single moment of your video, compared to videos of similar length. The higher the graph, the hotter your video, meaning fewer viewers are leaving your video and they may also be rewinding to watch that point in the video again. Understanding which parts of your video your audience likes enables you to make better content. The better the content, the more likely it is that viewers will send your video to their friends, kicking off the cycle of virality and helping you grow your audience. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6NzyryhPcC2ivDc2w_mKNsrwFf9ZiuY9B1PDTseD9EgKYFiJZabZYRNkFH2tlzfClPL2JJVyTLzZzQxzXneouITz-KHnOJ7WQU-yRD3_qQkVZ1y-13fW3VVQjRLGSiR0FjLGGBM6F9qVb/s1600-h/OGB_Screenshot_HotSpots.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5334382940741150818" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6NzyryhPcC2ivDc2w_mKNsrwFf9ZiuY9B1PDTseD9EgKYFiJZabZYRNkFH2tlzfClPL2JJVyTLzZzQxzXneouITz-KHnOJ7WQU-yRD3_qQkVZ1y-13fW3VVQjRLGSiR0FjLGGBM6F9qVb/s400/OGB_Screenshot_HotSpots.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 246px;" /></a>There are countless ways to use the data gathered from Insight to improve your YouTube numbers. Someone using YouTube to share a video of their vacation can just as easily use these tools as an advertiser working on a major campaign. And with our <a href="http://www.youtube.com/blog?entry=IH_EDPBv7Ng">latest addition to YouTube Insight</a>, you will no longer have to rely exclusively on the information you can get from the features described above. Last week we opened Insight, making your data exportable into CSV files. CSV files are open-format files that organize data so it can be moved and analyzed using common spreadsheet software such as Google Docs and Microsoft Excel. Now you can view and manipulate your data any way you like. Looking for ideas? Try comparing the view count for different videos side by side, mapping out where your viewers are coming from over time, or comparing discovery sources by country. Good luck to all the hopeful YouTube stars among you! Posted by Tracy Chan and Kenny Stoltz, YouTube Product Managers

Step into the spotlight with YouTube Insight

This post is the latest in an ongoing series on The Power of Measurement . Previous topics have covered ways to make your website as success...

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The best and the brightest

I can't think of a better environment than academia for asking hard questions and trying to solve the unsolvable. It's at universities that graduate students perform some of the most exciting and game-changing research in computer science and technology. These university labs foster the students that are going to be the next innovators and leaders in research. We started the Google Fellowship Program this year to support graduate students in their quest to discover and achieve great things. Our goal was to find the best and brightest PhD students and award them a unique fellowship that highlights their contributions to research and supports them through their graduate studies. Several top universities submitted their students for consideration by research scientists, distinguished engineers and executives at Google. The breadth of research covered by these students and the scope of their vision was astounding. Learning about them was exciting; choosing from among them was truly difficult. After careful review, we are proud to announce the 2009 Google Fellowship recipients: <ul><li> Roxana Geambasu, Google Fellowship in Cloud Computing (University of Washington)</li><li> Michael Piatek, Google Fellowship in Computer Networking (University of Washington)</li><li> David Sontag, Google Fellowship in Machine Learning (Massachusetts Institute of Technology)</li><li> Ali Farhadi, Google Fellowship in Computer Vision Image Interpretation (University of Illinois at Urbana-Champaign)</li><li> Nicholas Chen, Google Fellowship in Human-Computer Interaction (University of Maryland)</li><li> Siddhartha Sen, Google Fellowship in Fault Tolerant Computing (Princeton University)</li><li> Ryan Peterson, Google Fellowship in Distributed Systems (Cornell University)</li><li> Eric Gilbert, Google Fellowship in Social Computing (University of Illinois at Urbana-Champaign)</li><li> Micha Elsner, Google Fellowship in Natural Language Processing (Brown University)</li><li> Subhransu Maji, Google Fellowship in Computer Vision Object Recognition (University of California, Berkeley)</li><li> Nicolas Lambert, Google Fellowship in Market Algorithms (Stanford University)</li><li> Han Liu, Google Fellowship in Statistics (Carnegie Mellon University)</li><li> Lixia Liu, Google Fellowship in Compiler Technology (Purdue University)</li></ul>These students exemplify excellence in all areas, and we look forward to the impact that they are sure to have on their fields and the world. The Google Fellowship will provide them with funding to cover their tuition and expenses, plus an Android-powered phone and a Google mentor. Our sincere congratulations to all of them! Posted by Leslie Yeh Johnson, Google University Relations

The best and the brightest

I can't think of a better environment than academia for asking hard questions and trying to solve the unsolvable. It's at universiti...

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Behind the scenes of the Search Options panel

On Tuesday, we announced <a href="http://googleblog.blogspot.com/2009/05/more-search-options-and-other-updates.html">Search Options</a>, which are a collection of tools that let you slice and dice your results and generate different views to find what you need faster and easier. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_xZ3CbA675HRnN-7hncbxEcGVwc5jGXYr-mgZUlrJJFBsk6DVccrvzUC10QjIQjfkVDzP1wOH9s_cSlS9uXwNdJaX53_EBfcU5OYlYDxReM1i05kKe0EwWpYFyHcZT4w9wrmvS1Jx1_TG/s1600-h/searchoptions.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5335434598569892786" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_xZ3CbA675HRnN-7hncbxEcGVwc5jGXYr-mgZUlrJJFBsk6DVccrvzUC10QjIQjfkVDzP1wOH9s_cSlS9uXwNdJaX53_EBfcU5OYlYDxReM1i05kKe0EwWpYFyHcZT4w9wrmvS1Jx1_TG/s400/searchoptions.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 272px;" /></a> We know that people search for a wide variety of things and we're continually thinking of new search features to help them find information more quickly and easily. The idea for the Search Options panel originated as a way to accommodate the functionality offered by these new features within the search results page. While it might seem like the panel was simple to put together, a lot of collaboration between design, research, and engineering happened behind the scenes in order to produce the best experience possible. The team began by generating a broad range of directions, which we refined through design sessions and reviews. Confident about a handful of concepts, we began to seek out user feedback using <a href="http://googleblog.blogspot.com/2009/02/eye-tracking-studies-more-than-meets.html">eye-tracking</a> and <a href="http://en.wikipedia.org/wiki/Usability_testing">usability studies</a>. These studies provided us with valuable feedback about how people understood the options in the panel and interacted with them.<div> Here's an example of an eye-tracking path that illustrates how a participant wanted to get a sense of the quality of the results before deciding what search option to apply:<div> <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgweceFX3mgQDe4_P3VH16mBKF3vpYIY3z6nisLuczdlv7a7rXV8144UgzeOeJiRSLUCVAN-G3Ac1-jQiZ2qDauGCVFfWbe8m9UAsnxG5NPGKpCMj4HAlUpxU2adIRXuQFLK0UOfzWOKt9Y/s1600-h/eyetracking.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5335434598208468770" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgweceFX3mgQDe4_P3VH16mBKF3vpYIY3z6nisLuczdlv7a7rXV8144UgzeOeJiRSLUCVAN-G3Ac1-jQiZ2qDauGCVFfWbe8m9UAsnxG5NPGKpCMj4HAlUpxU2adIRXuQFLK0UOfzWOKt9Y/s400/eyetracking.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 153px;" /></a> After each study, we iterated on the designs, making changes to everything from the order and behavior of the options, to the location of the panel and the way people opened and closed it. We also paid close attention to the visual design of the options panel. We wanted it to feel familiar –- not only to work the way you expect from Google, but to look and feel like Google, too. Even though you just started using the panel, we hope it will seem as if it were there all along. Below, you can see some of our initial concepts for the Search Options panel: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrcIUh1MuBBJn0QckV17iNEhX59C4OeYkStqw0vKmVnG-F0OEqgEI-QtHcRXfOvqvBhQUkw326FStjvRV1XrXllbVwFoYbUpa_2uXyXXC2yutPM_aVT_ofRQT1rYvOi9bHwQel6brYqci_/s1600-h/concepts.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5335872692003686242" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrcIUh1MuBBJn0QckV17iNEhX59C4OeYkStqw0vKmVnG-F0OEqgEI-QtHcRXfOvqvBhQUkw326FStjvRV1XrXllbVwFoYbUpa_2uXyXXC2yutPM_aVT_ofRQT1rYvOi9bHwQel6brYqci_/s400/concepts.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 305px; height: 400px;" /></a> And here are examples of various iterations, once we had a firm concept in mind: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8CZD-y8SyiJ4CSm_kRdxw5aPtPFCP3nNevXYd7NKPrVLzCy8ZKhpIK81bB5EzAVvedrdD9mYyPJBbZ657KtPBGXBOc8E1Ful93aKIFPba1z-YkvRe2CLjhKlmDWPj4zoaZcrePJ1AXOvS/s1600-h/iterations.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5335872688058777682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8CZD-y8SyiJ4CSm_kRdxw5aPtPFCP3nNevXYd7NKPrVLzCy8ZKhpIK81bB5EzAVvedrdD9mYyPJBbZ657KtPBGXBOc8E1Ful93aKIFPba1z-YkvRe2CLjhKlmDWPj4zoaZcrePJ1AXOvS/s400/iterations.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 305px; height: 400px;" /></a> Once the designs were further solidified, we ran a number of tests with a small portion of our live searches to see how many visitors used the Search Options panel and which options were most popular. This quantitative research complemented qualitative feedback to give us a more complete idea of people’s understanding of Search Options. This process brought us to what you see today. Even now that the Search Options panel has launched, the work is not over. We’ll continue to monitor how people interact with Google Search, find ways to improve the user experience, listen to <a href="http://www.google.com/support/websearch/bin/answer.py?hl=en&answer=142143">your feedback</a>, come up with new tools, and, who knows, maybe even add more wonder to the wonder wheel. Posted by Jen Kozenski Devins, Jamie Divine, Melanie Kellar, and Marcin Wichary, User Experience Team</div></div>

Behind the scenes of the Search Options panel

On Tuesday, we announced Search Options , which are a collection of tools that let you slice and dice your results and generate different vi...

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