High Costs and Poor Outcomes - A Lesson About the Suppression of Research

Last week, blogger Alison Bass was one of the few to<a href="http://alison-bass.blogspot.com/2009/08/study-confirms-that-antidepressants.html"> comment </a>on a new article on the risks of antidepressant medications published electronically last week by the British Medical Journal.[1] The article adds to the clinical evidence about these specific drugs. However, it also should remind us about why our health care costs seem to continue to inflate disproportionate to any improvements in health care outcomes.<br /><br /><strong>Background - Why Don't Doctors Diagnose and Treat Depression According to the Evidence?</strong><br /><br />Here is the background. Since the early 1990s, based on numerous published clinical trials that showed that the newer (mainly SSRI, that is, selective serotonin reuptake inhibitor) antidepressants seemed to be quite safe and effective, authoritative guidelines have urged physicians to screen patients for depression, and have a low threshold for beginning treatment, particularly with these then new drugs. (For example, see the 1993 AHCPR guidelines,[2] and the Ambulatory Care Quality Alliance Recommended Starter Set[3].) Such guidelines targeted primary care physicians as well as psychiatrists. As a primary care physician, I often felt guilty that I didn't screen all patients, including those who did not outwardly appear depressed, for depression, and was reluctant to be the primary prescriber of antidepressants for depressed patients. I was not alone. There was evidence that many primary care physicians failed to follow these apparently evidence-based guidelines.<br /><br /><strong>Suspicions that SSRIs Were Not as Effective or Safe as Thought</strong><br /><br />However, in 2004, internal documents from one drug company (Glaxo Smith Kline), published by the Canadian Medical Association Journal, suggested that the company had suppressed a study which failed to show its SSRI was effective for adolescent patients.[4] Also, then New York state attorney general Elliot Spitzer sued the company alleging it had suppressed such data.[5] Considerable anecdotal information thereafter came to light suggesting that drug companies may have suppressed data from clinical research (that is, studies done on patients, not in the laboratory) which tended to show the drugs were less effective, or more dangerous than previously thought. Many began to suspect that the drugs increased the risk of suicidal thoughts or behavior, even though one would think that if they were effective in treating depression, they should decrease such risks.<br /><br /><strong>How Does Uncovering Suppressed Trials Change the Evidence About the Benefits and Harms of SSRIs?</strong><br /><br />Then, an analysis of trials of SSRIs given to adolescent patients, which included unpublished as well as published trials, did show they increased the risk of suicide.[6] But what about adult patients?<br /><br />In 2008, Erick Turner and colleagues published a meta-analysis that included numerous trials of SSRIs and other antidepressants given to adult patients that had never been published, but whose results had been submitted to the US Food and Drug Administration (FDA).[7] When those trials were included in the analysis, the drugs seemed less effective than was previously believed.<br /><br />The new meta-analyis by Stone et al[1] suggested how adding evidence from the suppressed trials improves our knowledge about the possible harms of these drugs. Stone et al specifically addressed whether the drugs increased the risk of suicidal thoughts or actions for adult patients. It was based on data from 372 trials that included 99,231 patients. "Most of the studies were unpublished; those that had been published in some form seldom contained information concerning suicidality in the publication." Its main result was that SSRI drugs approximately doubled the risk of suicidal behavior for patients less than 25 years old, but decreased the risk for older patients.<br /><br /><strong>Suppressing Trials Distorted the Evidence-Base</strong><br /><br />Thus, the combined results of several meta-analyses suggests that SSRIs are neither as safe nor as effective for adult patients as they were previously touted to be. The drugs used to appear to be more safe and effective because the drug companies that sponsored (paid for) clinical trials of their own products suppressed the publication of studies whose results did not show their products in a favorable light. The guidelines once thought to be so authoritative are probably much to enthusiastic about the use of drugs to treat depression. It may be that those physicians who resisted pressure from these guidelines and other efforts by would-be quality improvers to diagnose more depressed patients and treat them with SSRIs weren't so dumb.<br /><br /><strong>Health Policy Implications</strong><br /><br />The recently published meta-analysis of the risk of suicidal ideation or behavior due to SSRIs for adult patients[1] adds not just to the clinical evidence about the treatment of depression, but to the evidence that suppression of research by those with vested interests in its results may not be rare. There is no reason to think that suppression of research about other medical interventions used for other clinical problems does not occur just as often.<br /><br />This underscores why we as a society should not have handed over control of how new drugs and devices are evaluated to the companies that stand to profit by selling them. The apparent benefits and safety of most drugs and devices brought to the market in recent years may have been exaggerated by the ability of the corporations who sponsored the research to suppress those studies that were least favorable to their products. Thus, it is very likely that doctors have over prescribed newer (and more expensive) drugs and devices based on erroneous beliefs about their safety and effectiveness, beliefs supported by an evidence base which was distorted by suppression of studies whose results did not show the results their commercial sponsors wanted to see. Furthermore, we have likely collectively paid too much for these drugs and devices based on these same erroneous beliefs. Thus, the distortion of the clinical evidence base caused by putting the makers of medical products in charge of their evaluation has likely led to increased costs and worse outcomes for patients.<br /><br />Health care reformers serious about wanting to improve patient outcomes and reduce costs ought to be at the forefront of a movement to make clinical research more honest. All clinical trials completed and submitted to government regulators ought to be published in some form, so that the data they contain is available to guide clinical decisions. Going forward, all studies should be published in some form in a timely manner to prevent future research suppression. There ought to be better regulation of research sponsored, and de facto run by companies who have vested interests in the results being favorable to their products. It would not be unreasonable to prevent companies with such vested interests from running or otherwise directly influencing clinical research meant to evaluate their own products.<br /><br />But here in the States, we are probably too diverted by yelling at each other about whether a "public option" is vital or nefarious to worry about such issues.. Meanwhile, expect our health care to continue to get more expensive, less accessible, and less good for patients.<br /><br />ADDENDUM (25 August, 2009) - Also, see the <a href="http://brodyhooked.blogspot.com/2009/08/sifting-through-garbage-to-find-science.html">comments</a> by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma Blog<br /><br /><strong><span style="font-size:85%;">References</span></strong><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">1. Stone M, Laughren T, Jones ML et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. Brit Med J 2009; 339: b2880. Link </span><a href="http://www.bmj.com/cgi/content/full/339/aug11_2/b2880"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">. </span><br /><span style="font-size:85%;">2. Depression Guideline Panel. Depression in Primary Care: Volume 2 - Treatment of Major Depression. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1993. Link </span><a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.15593"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span><br /><span style="font-size:85%;">3. Ambulatory Care Quality Alliance. Recommended Starter Set: Clinical Performance Measures for Ambulatory Care. </span><a href="http://www.ahrq.gov/qual/aqastart.htm"><span style="font-size:85%;">http://www.ahrq.gov/qual/aqastart.htm</span></a><br /><span style="font-size:85%;">4. Kondro W. Drug company experts advised staff to withhold data about SSRI use in children. Can Med Assoc J 2004; 170: 783. Link </span><a href="http://www.cmaj.ca/cgi/content/full/170/5/783"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span><br /><span style="font-size:85%;">5. Wadman M. Sptizer sues drug giant for deceiving doctors. Nature 2004; 429: 589. Link </span><a href="http://www.nature.com/nature/journal/v429/n6992/full/429589a.html"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span><br /><span style="font-size:85%;">6. Hammad T, Laughren T, Racoosin JA. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006;63:332-9. Link </span><a href="http://archpsyc.ama-assn.org/cgi/content/full/63/3/332"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span><br /><span style="font-size:85%;">7. Turner EH, Matthews AM, Linardatos E et al. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252-260. Link </span><a href="http://content.nejm.org/cgi/content/full/358/3/252"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span>

High Costs and Poor Outcomes - A Lesson About the Suppression of Research

Last week, blogger Alison Bass was one of the few to comment on a new article on the risks of antidepressant medications published electron...

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Getting connected Side-by-Side with enterprise search

People use search to find what they need, and the same holds true in the business world. We want searching your company intranet to be comparable to searching on Google.com, and the <a href="http://google.com/gsa">Google Search Appliance (GSA)</a> to have the most relevant, high quality results possible. That's why today we're announcing two new tools for Google Enterprise Search: Side-by-Side search comparison and new connectors for the GSA, both in <a href="http://google.com/enterprise/labs">Enterprise Labs</a>. Enterprise Labs is where you can find the latest-and-greatest tips and tools for better enterprise searching — tools like Side-by-Side.<br /><br />Side-by-Side lets employees test and rate results from two different search queries on the same body of data, to see which gives better results. In the example below, the admin has set up two different GSA configurations to search [google].<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTqyKe9AOXxpsKvQP4uye13r_7_Iw97k8nFlS-LO5AvkkNhE8cf9BPg1XKYXfGmJYq27ABpgy70-0OJfPgWAQiPWpCY0VwXFFQbbtmuB7g3j66_ZCv6O-J6t2ch6OcKUmkgbcY6WmeOjKT/s1600-h/side_by_side.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371454967711952418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTqyKe9AOXxpsKvQP4uye13r_7_Iw97k8nFlS-LO5AvkkNhE8cf9BPg1XKYXfGmJYq27ABpgy70-0OJfPgWAQiPWpCY0VwXFFQbbtmuB7g3j66_ZCv6O-J6t2ch6OcKUmkgbcY6WmeOjKT/s400/side_by_side.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 305px; height: 400px;" /></a><br />Employees can then vote on their preferred results, by choosing the Policy A or B buttons, and the administrator can then use that information to choose and set up the right search solution for the business. Product manager (and Enterprise Labs guru) Cyrus Mistry explains more:<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/XeG3-n9u-3c&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/XeG3-n9u-3c&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br />In the enterprise, search engines crawl more than just the Internet — they're also searching across all sorts of data stores and offline content. Today we're also announcing GSA connector updates to the major content management systems, as well as a cool new GSA connector for <a href="http://www.salesforce.com/">Salesforce</a> data, so the GSA can search and provide employees access to the internal Salesforce info they need in search results. Connectors integrate data from all different kinds of file and content systems (like SharePoint, FileNet, Documentum) so an employee searching their company intranet can see a single, unified search results page, even if the results are drawn from a wide variety of company data systems.<br /><br />Enterprise search is about the fundamentals: organizing information so that people can do their jobs more easily. You can read more about today's launches on the <a href="http://googleenterprise.blogspot.com/">Google Enterprise Blog</a>, and download Side-by-Side and other search tools in <a href="http://www.google.com/enterprise/labs/">Google Enterprise Labs</a>.<br /><br /><span class="byline-author">Posted by Michael Parker and Salmaan Rashid, Engineering team</span>

Getting connected Side-by-Side with enterprise search

People use search to find what they need, and the same holds true in the business world. We want searching your company intranet to be compa...

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CCHIT Has Company

It appears CCHIT, an offspring of the large HIT trade association HIMSS, won't get its wish for Health IT Certification hegemony. I think the outcome of a multidisciplinary HIT policy workgroup's deliberations on this issue reasonable:<br /><h2 face="Georgia,'Times New Roman',Times,serif" size="1.333em" style="border-width: 0px; margin: 0em 0.5em; padding: 0.05em 0em; outline-width: 0px; font-weight: bold; font-style: inherit; vertical-align: baseline; line-height: 1.15em;"></h2> <blockquote>Aug. 17, 2009<br /><br />iHealthBeat.org<br /><br /><a style="font-weight: bold;" href="http://www.ihealthbeat.org/Articles/2009/8/17/Policy-Committee-OKs-Plan-To-Establish-Multiple-EHR-Certifiers.aspx">Policy Committee OKs Plan To Establish Multiple EHR Certifiers</a><br /><br />On Friday, the [HHS] Health IT Policy Committee adopted recommendations that called for multiple entities to certify electronic health record systems, Health Data Management reports.<br /><br />The committee's certification and adoption work group issued the recommendations (Goedert [1], Health Data Management , 8/14).<br /><br />To receive official certification, EHR systems must meet a minimum set of criteria and achieve the "meaningful use" objectives of the federal economic stimulus package. Under the stimulus law, health care providers who demonstrate meaningful use of EHRs will receive Medicare and Medicaid incentive payments (O'Harrow, Washington Post , 8/15).<br /><br />Recommendations<br /><br />The work group recommended that:<br /><br />* Certification criteria allow for open-source software;<br />* Certification processes should let health care organizations qualify for EHR subsidies under Stark Law exceptions that allow organizations to subsidize the cost of EHRs for physicians;<br />* Certification should last for four years;<br /><span style="font-weight: bold;"> * Multiple groups perform HHS certification under a single set of criteria;</span><br />* The National Institute for Standards and Technology should participate in accreditation and certification decisions;<br />* The Office of the National Coordinator for Health IT should define certification criteria;<br />* ONC should create an accreditation process for certification groups;<br />* Officials develop alternative certification processes for self-developed software; and<br />* Vendors are required to receive certification from only one group ( Health Data Management , 8/14).<br /><br /><span style="font-weight: bold;">The work group said it envisions the establishment of 10 to 12 different EHR certification groups</span>, in addition to the Certification Commission for Health IT (Manos, Healthcare IT News , 8/14).<br /><br />The recommendations now go to HHS for consideration ( Health Data Management, 8/14).</blockquote><br />The workgroup said CCHIT is too closely aligned with the health IT industry, noted that the industry trade group HIMSS helped found CCHIT, and noted that CCHIT's members includes several people with ties to HIMSS and health IT companies. They were clearly uncomfortable with the potential conflicts of interest, especially if CCHIT gained sole responsibility for HIT "certification." <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[A term I put in quotes since it really is "features qualification" at this point, not certification such as a physician receives after passing Specialty Boards - ed.]</span><br /><br />Having been on the receiving end of CCHIT bullying myself ("<a href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html">Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-Certified HIT</a>"), it's clear most Americans don't like bullies, especially bullying from powerful lobbying organizations such as HIMSS and its progeny. (It's also become clear they don't like 1000+ page healthcare reform plans shoved, unread, down their throats by political bullies.)<br /><br />By the way, since the July 21, 2009 publication of my JAMA letter "<a href="http://hcrenewal.blogspot.com/2009/07/health-care-information-technology.html">Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>" and Koppel and Kreda's reply, pointing out the terrible situation that HIT "defects nondisclosure" and "hold harmless" clauses create for hospital executives, physicians and patients, I have heard from the Joint Commission, but not from HIMSS.<br /><br />Perhaps HIMSS leadership believes I have nothing worthy to add to the discussion. (Perhaps another 'Open Letter' is called for.)<br /><br />-- SS

CCHIT Has Company

It appears CCHIT, an offspring of the large HIT trade association HIMSS, won't get its wish for Health IT Certification hegemony. I thi...

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Philips Medical: A Followup

In a Nov. 2008 post entitled "<a href="http://hcrenewal.blogspot.com/2008/11/who-leads-in-intellectually-challenged.html">Who Leads in Intellectually Challenged Responses to Medical Informatics Backgrounds, The U.S. or Europe?</a>", I chastised Philips Medical for their ossified and uninspired approach to biomedical informatics talent management (by nonmedical "experts", in fact), and that ossification's deleterious effect on innovation.<br /><br />I forwarded the post to Philips management. Needless to say, I never received a response.<br /><br />This appeared on Aug. 5, 2009 at layofftracker.blogspot.com:<br /><br /><h2 class="date-header"><span style="font-size:100%;"></span></h2><blockquote><h2 class="date-header"><span style="font-size:100%;">Wednesday, August 5, 2009</span></h2> <a name="3426548320135672823"></a> <h3 class="post-title entry-title"> <a href="http://layofftracker.blogspot.com/2009/08/philips-healthcare-announces-layoffs.html">Philips Healthcare announces layoffs</a> </h3> <div>Got via a <a href="http://visakhcr.googlepages.com/layofftracker-tipme">Tip</a>. </div><div><br /></div><div><b>Philips Healthcare announces layoffs. Memo below.</b></div><div><br /></div><div>Message from Steve Rusckowski</div><div><br /></div><div>Dear Colleague,</div><div><br /></div><div>In our Q2 and Semi-Annual 2009 Report released on July 13, Philips reported a year-on-year decline in Healthcare sales. While we are substantially lower in our profitability as compared to Q2 2008, material improvements were made in our profitability from Q1 2009 to now, due to our sustained efforts on cost-containment. However, we still fell short of our targets and there is risk for further deterioration in several of our markets.</div><div><br /></div><div>To build a stronger organization for our future, we need to be a simpler, leaner, more flexible organization, while continuing to bring costs and capacity in line with current demand levels. Our long-term success will be measured by our ability to pro-actively and purposefully navigate through the lingering economic slowdown.</div><div><br /></div><div>The Healthcare Executive Team, in collaboration with our extended management across the sector, will adapt our organization to the needs of the markets. Where we see opportunities we will seize them, where markets change we will take the necessary steps to enable profitable growth.</div><div><br /></div><div>To safeguard and strengthen our business, our sector will expand, and where possible, accelerate our efforts to cut further operating costs, <span style="font-weight: bold;">including an additional reduction in our workforce. After careful analysis and consideration, this action will impact nearly all of our businesses and functions within North America beginning this month.</span></div><div><br /></div><div>The necessity of this workforce reduction is driven by <span style="font-weight: bold;">increasing double-digit declines in equipment orders across all of our businesses in North America.</span> The combination of tightening credit markets, persistent delays in capital equipment purchases, reimbursement pressures and the uncertainty of health care reform, are contributing to a weak overall U.S. health care market. <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[He forgot to mention innovation failure - ed.]</span> Responding to these dynamics is crucial to secure our immediate business performance and preparation for our future.</div><div><br /></div><div>In North America, the vast majority of employees affected by the workforce reduction will be notified next week. Some employees will be notified as early as this week, with others notified later, as business needs dictate. Impacted employees will be notified by management and/or representatives from Human Resources.</div><div><br /></div><div>As always, Philips is fully committed to supporting all employees through this process and will treat everyone fairly, professionally and with respect. In accordance with local legislation and procedures, affected employees will be offered severance packages and other appropriate assistance and support.<span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"> [Being treated with "respect" at a time of massive unemployment, of course, means being handed a few months' salary -- unless you are an executive -- and then being booted out the door - ed.].</span></div><div><br /></div><div>I recognize the impact of these decisions is difficult and distracting on a personal and business level.<span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"> [Getting laid off is indeed somewhat "personally distracting" - ed.]</span> On behalf of the Executive Team, I want to thank you for pulling together and giving your best effort to stay focused during these challenging times.</div><div><br /></div><div>It is important to recognize, we are battling a global recession, with impact extending across all sectors and geographies. While we are taking these measures within the North American region, we will continue to assess economic conditions and business challenges across our sector and will implement further cost measures whenever needed.</div><div><br /></div><div>I will continue to keep our lines of communication open <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[to survivors - ed.]</span>, as we proceed ahead. As we do, let’s continue to focus on our customers, as we commit to supporting one another.</div><div><br /></div><div>I remain confident in our business strategy and our collective passion to make a positive difference in health care.</div><div><br /></div><div>Best regards,</div><div><br /></div><div>Steve Rusckowski</div><div>CEO</div><div>Philips Healthcare</div></blockquote><div></div><br />I suggest that to "build a stronger organization for our future" ("our" referring to those who actually retain their positions for now), Philips management start reforms at the top. One reform would be to re-evaluate just how "expert" their experts are.<br /><br />Philips shareholders, take note.<br /><br />-- SS

Philips Medical: A Followup

In a Nov. 2008 post entitled " Who Leads in Intellectually Challenged Responses to Medical Informatics Backgrounds, The U.S. or Europe?...

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Lessons Unlearned: Health IT Failure, Act 2

The following appeared on the <a href="http://histalk2.com/2009/08/13/news-81309/">HISTalk site on 8/14/2009</a> from a writer with the screen name UCSFWatch:<br /><br /><blockquote>From <strong>UCSFWatch</strong>:<span style="color: rgb(0, 0, 255);"> “Re: UCSF CIO’s e-mail. The GE Centricity Enterprise project is in full stop mode.”</span> The attached and unverified e-mail from CIO Larry Lotenero says this: “The medical center’s Senior Management Group has engaged Kurt Salmon Associates (KSA) to assist us with a review of our IT clinical strategy. We are doing the review because we are dissatisfied with our progress to implement clinical applications to support the care of our patients. KSA will arrange interviews with many of you to capture your insights for the strategy planning. They will be on-site to begin their interviews on August 18. If KSA contacts you, I ask that you be as flexible as possible with your schedule to accommodate this process. We expect to receive a final report before November. For now, all activities associated with developing the GE clinical system should immediately be put on hold. Despite this action, we remain fully focused on our goal to complement our excellent clinical care providers with equally excellent clinical applications as soon as possible.”</blockquote><br />If true (as it likely is), I find this remarkable.<br /><br />I would have to refer to it as "UCSF Healthcare IT Failure, Act 2" for reasons just below.<br /><br />I find it remarkable that this resource- and money-wasting scenario (with possible adverse patient care repercussions) can occur:<br /><br /><ul><li>In a state that's in a severe economic crisis, </li></ul><ul><li>At an organization that failed severely in a HIT and administrative IT merger just ten years ago (in the failed, late 1990's attempted merger between UCSF and Stanford's medical centers, see the 2000 stories "<span style="font-style: italic; font-weight: bold;">UCSF/Stanford: Marriage was rough; divorce is expensive</span>" <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2000/04/24/focus4.html">here</a> and <a name="thousand"><span style=";font-family:Arial;color:brown;">"<span style="font-style: italic; font-weight: bold;font-family:georgia;">A thousand MIS personnel cannot merge two healthcare systems</span>" </span></a><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=A%20thousand%20MIS%20personnel%20cannot%20merge%20two%20healthcare%20systems">here</a>),</li></ul><ul><li>With an EHR product, Centricity, that is the descendant of Logician that others have implemented successfully (including myself, speaking from experience), </li></ul><ul><li>With GE, a major global high technology vendor, presiding over this new failure at a major academic medical center,<br /></li></ul><ul><li>With ample preventive material available in books, journals on the web about such failures (e.g., at the many pages and links <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/">here</a> and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">here</a>, as just a few examples).<br /></li></ul><br />This last point raises additional questions:<br /><br /><ul><li>Do IT managers at UCSF and GE actually read the HIT literature and the web, I wonder? Have they ever done a Google search on "<a href="http://www.google.com/search?q=healthcare+IT+difficulties">healthcare IT difficulties</a>" or "<a href="http://www.google.com/search?q=healthcare+IT+failure">healthcare IT failure</a>", or related concepts?<br /></li></ul><ul><li>Do they think the materials found via such searches frivolous, useless, or not credible?<br /></li></ul><br />Finally, it is quite remarkable that the best UCSF can do is hire yet another expensive management consulting firm to try to remediate this failure. What are UCSF IT personnel paid to do, exactly?<br /><br />Perhaps AMIA, AHRQ, HHS and others in the administration need to focus less on <span style="font-weight: bold;">new</span> research on figuring why these situations occur, and devote resources to ensuring modern knowledge of HIT failure scenarios <span style="font-weight: bold;">already extant</span> is leveraged.<br /><br />If not, we're likely (as I fear) to have a lot of UCSF Act 2's in the next few years, as organizations attempt to implement HIT by 2014 so as to not be penalized by HIT provisions in the ARRA act.<br /><br />Perhaps (again, if the HISTalk note is true), we need to bring back the likes of "Neutron Jack" (Jack Welch, well known for laying off less than stellar divisions at GE), and perhaps the Governator needs to "terminate" the roles of the leadership of this project.<br /><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPKkFydtEwFSr1xBQrpGpQ_rZYsdiD6F7MGLodU3tmu7YRQHKigYF5fE_f-l8aVkiaW81KYuuZbwQSi6qo71toXjZCFGzMVjC5QxlTQ2rfEu1HvcW-x5YwgBtcIjACGBue6sIbAOKycrC1/s1600-h/the-terminator.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371329041525853522" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPKkFydtEwFSr1xBQrpGpQ_rZYsdiD6F7MGLodU3tmu7YRQHKigYF5fE_f-l8aVkiaW81KYuuZbwQSi6qo71toXjZCFGzMVjC5QxlTQ2rfEu1HvcW-x5YwgBtcIjACGBue6sIbAOKycrC1/s320/the-terminator.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 157px; height: 200px;" /></a><span style="font-size:85%;">Gov. Schwarzenegger had a way with those<br />who fiddled around destructively with computers...</span><br /></div><br /><br /><div>See other disappointing stories about events at UCSF on this blog at <a href="http://hcrenewal.blogspot.com/search?q=ucsf">this link</a>.<br /><div><br /></div><div>-- SS</div></div>

Lessons Unlearned: Health IT Failure, Act 2

The following appeared on the HISTalk site on 8/14/2009 from a writer with the screen name UCSFWatch: From UCSFWatch : “Re: UCSF CIO’s e-m...

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Sharing with Google Groups

As more and more businesses and organizations "<a href="http://googleblog.blogspot.com/2009/08/going-google-with-google-apps.html">go Google</a>," we find that many of the features we develop based on feedback from large enterprises end up benefiting all of our users. We recently <a href="http://googleenterprise.blogspot.com/2009/08/sharing-with-groups.html">rolled out improvements</a> to the way <a href="http://groups.google.com/">Google Groups</a> interacts with several of our applications. Now, sharing <a href="http://calendar.google.com/">calendars</a>, <a href="http://sites.google.com/">sites</a> and <a href="http://docs.google.com/">documents</a> with multiple people is easy — instead of adding people one at a time, you can simply share with an entire Google Group.<br /><br />As an example, imagine you're organizing a local intramural softball team tournament. You use Google Docs to keep track of the rosters for each team as well as each team's performance.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbakI1Me2G_drSp9BSWu7u8GOiivtNEGEbOS1_TgpAN9OxHB-zFoSxzwTs1L08VV-3KDAa48TzTk5pomxJsCqODfMtWmClAGwRSStbSYU2MIWibFPzuBbC2zP0P5C8DjxKs9Ow9ComgGc9/s1600-h/1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055130392786930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbakI1Me2G_drSp9BSWu7u8GOiivtNEGEbOS1_TgpAN9OxHB-zFoSxzwTs1L08VV-3KDAa48TzTk5pomxJsCqODfMtWmClAGwRSStbSYU2MIWibFPzuBbC2zP0P5C8DjxKs9Ow9ComgGc9/s400/1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 345px;" /></a><br />You want all the players, but only the players, to have editing access. You already have a Google Group set up with the tournament participants, so you simply share the spreadsheet with the group itself, granting the group members permission to edit.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHJuGFxJv_l3vkDlwx5Lz27K154bxvH8V6kx3GuyGEsUUsjtok6EYWZVAnW2GT-PWhHxiOj3miC6hiABykkf7e38TvO2tSMTkV-Si7X9A99oxri9Xl1smqot0SPME4nmQBN7DMFulvfi8u/s1600-h/2.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055141565926946" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHJuGFxJv_l3vkDlwx5Lz27K154bxvH8V6kx3GuyGEsUUsjtok6EYWZVAnW2GT-PWhHxiOj3miC6hiABykkf7e38TvO2tSMTkV-Si7X9A99oxri9Xl1smqot0SPME4nmQBN7DMFulvfi8u/s400/2.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 280px; height: 218px;" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIP3Ars5gkI-tqkhWjbpy1rG4dBtA6UrSzy1lL9TLPp5xP3qwFjP7aryVdsxjEqTE0bKYWLcVYH65XrlbV_moQu2xp7WVI_xakazcbzXp07-gCBZ9PF0hy4ye9gdYXVqc3bCNkV3gJCH7/s1600-h/3.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5371055143333679058" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjIP3Ars5gkI-tqkhWjbpy1rG4dBtA6UrSzy1lL9TLPp5xP3qwFjP7aryVdsxjEqTE0bKYWLcVYH65XrlbV_moQu2xp7WVI_xakazcbzXp07-gCBZ9PF0hy4ye9gdYXVqc3bCNkV3gJCH7/s400/3.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 274px;" /></a><br />Now, when people join or leave the Google Group, they will automatically gain or lose editing access to the spreadsheet. It's that easy.<br /><br />This was a feature that people wanted to "just work" — and now it does. Go ahead and try it out with your sites, calendars and documents!<br /><br /><span class="byline-author">Posted by Jeffrey Chang, Associate Product Manager, Google Groups</span>

Sharing with Google Groups

As more and more businesses and organizations " go Google ," we find that many of the features we develop based on feedback from l...

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New features and languages for Google Insights for Search

Since <a href="http://adwords.blogspot.com/2008/08/announcing-google-insights-for-search.html">launching</a> Google Insights for Search a year ago, we've been providing daily insight into what the world is searching for. Whether you're an advertiser looking to <a href="http://analytics.blogspot.com/2009/02/tips-and-tools-for-expanding-keywords.html">expand keyword lists</a>, an economist <a href="http://googleresearch.blogspot.com/2009/04/predicting-present-with-google-trends.html">analyzing economic trends</a> or just looking to settle a <a href="http://www.google.com/insights/search/#q=batman%2Csuperman%2Cspiderman&cmpt=q">popularity contest</a>, Google Insights for Search can help provide the answers.<br /><br />Looking at search trends helps you understand when, where and how the world's interests have changed. Simply type in search terms to see how search query volume has evolved over time, in which geographic regions search interest is greatest and other related searches.<br /><br />Today, we are proud to announce that Insights for Search is now available in 39 languages around the world. We're also introducing a <a href="http://googleresearch.blogspot.com/2009/08/on-predictability-of-search-trends.html">forecasting feature</a> for <a href="http://www.google.com/support/insights/bin/topic.py?hl=en&topic=13975">some queries</a> based on an extrapolation of the historical trends and search patterns. And to help you visualize these changes and trends, we've also added an <a href="http://www.google.com/insights/search/#q=Twitter&date=today%2012-m&cmpt=q">animated map</a> so you can watch how search interest changes over time in different locations.<br /><br />You can check out some of these cool features in our video below.<br /><br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/4lq98ulKNgg&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/4lq98ulKNgg&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br />Visit <a href="http://www.google.com/insights/search">Google Insights for Search</a> and see what the world is searching for. You can also keep on top of the latest trends by adding a customizable <a href="http://www.google.com/ig/adde?moduleurl=google_insightsforsearch_relatedsearches.xml&source=imag&up__results_type=RISING&up__property=empty&up__search_term=hybrid&up__location=empty&up__category=0&up__time_range=3-m&up__max_results=10">gadget</a> to your <a href="http://www.google.com/ig">iGoogle</a> page or embedding a gadget directly on your website.<br /><br /><span class="byline-author">Posted by Hal Varian, Chief Economist and Yossi Matias, Head of Israel R&D Center</span>

New features and languages for Google Insights for Search

Since launching Google Insights for Search a year ago, we've been providing daily insight into what the world is searching for. Whether...

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