Software Wars

Q2JB

The Unsung Heroes Who Move Products Forward | NYT | 9.30.07

AT first blush, the iPhone from Apple, the new microprocessor family from Intel and the ubiquitous Google search engine have nothing in common. One is a gadget, one is an electronic part and one is a service.

Yet all of these products — much acclaimed for their creativity — depend on obscure process innovations that, while highly complex and lacking glamour, are an essential part of establishing a winning edge in commercial electronics.

Eric E. Schmidt, Google’s chief executive, appears to agree. Last year he declared, “We believe we get tremendous competitive advantage by essentially building our own infrastructures.”

Intel treats its process innovations as a competitive weapon, striving to create a “new generation” every two years. That enables the company’s chips, even if there were no changes in their design, to perform better and cost less to make.

As a result, process gurus are resigned to playing in the shadows, leaving fame, if not fortune, to others … [the] job is to make our customers look like heroes[.] … like Q to James Bond.”

OIG On-Call

Concerning the Physicians’ On-Call Coverage and Uncompensated Inpatient Care Arrangement Employed by a Medical Center (PDF) | HHS OIG | 9.27.07

We are aware that hospitals increasingly are compensating physicians for on-call coverage for hospital emergency rooms. We are mindful that legitimate reasons exist for such arrangements in many circumstances, including: compliance with EMTALA obligations; scarcity of certain physicians within a hospital’s service area; or access to sufficient and proximate trauma services for local patients. Simply put, depending on market conditions, it may be difficult for hospitals to sustain necessary on-call physician services without providing compensation for on-call coverage.

Notwithstanding the legitimate reasons for such arrangements, on-call coverage compensation potentially creates considerable risk that physicians may demand such compensation as a condition of doing business at a hospital, even when neither the services provided nor any external market factor (e.g., a physician shortage) support such compensation. Similarly, payments by hospitals for on-call coverage could be misused to entice physicians to join or remain on the hospital’s staff or to generate additional business for the hospital.

The opinion carries the appropriate disclaimers regarding applicability of the opinion beyond the specifics used to render the opinion; however, it is a good analysis of the complexities of the on-call problem.

Hospitalists Boost Outcomes

Hospitals’ Primary Care Docs Boost Outcomes | WP | 9.25.07

Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease,” the researchers wrote. “The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge, because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens.

Hospitalist Care and Length of Stay in Patients Requiring Complex Discharge Planning and Close Clinical Monitoring | Arch Internal Med | 9.24.07

Teaching hospitalist care was associated with shorter LOS in patients requiring close clinical monitoring and complex discharge planning, without adversely affecting readmission or mortality rates.

Sloppy Analysis

Most Science Studies Appear to be Tainted by Sloppy Analysis | WSJ | 9.14.07

[I]f you believe medical scholar John Ioannidis…most published research findings are wrong.

Dr. Ioannidis is an epidemiologist who studies research methods at the University of Ioannina School of Medicine in Greece and Tufts University in Medford, Mass. In a series of influential analytical reports, he has documented how, in thousands of peer-reviewed research papers published every year, there may be so much less than meets the eye.

These flawed findings, for the most part, stem not from fraud or formal misconduct, but from more mundane misbehavior: miscalculation, poor study design or self-serving data analysis. “There is an increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims,” Dr. Ioannidis said. “A new claim about a research finding is more likely to be false than true.”

We are the Hospitalists…resistance is futile

The Hospitalist Is In… | WP | 9.11.07

In the past 10 years, despite resistance from primary care physicians and fears that the development could erode continuity of care, the ranks of hospitalists have exploded from a few hundred physicians in 1997 to 20,000 today—about as many as there are gastroenterologists or neurologists. That’s the fastest growth for any medical specialty in the country, according to the nonprofit Society of Hospital Medicine (SHM), the professional society for hospitalists.

Most hospitalists are internists; 11 percent are pediatricians. By 2010, SHM projects 30,000 hospitalists will be practicing. Medical students may soon choose which side of the hospital divide they want to work on: inpatient or outpatient. For now, it’s your physician’s choice whether to refer you to a hospitalist or to follow your inpatient care. If you have no primary care physician, a hospitalist will probably manage your hospital stay.