Thursday, December 30, 2010

Making Money Uk

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Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.

But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?

In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.

Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:

Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."

Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.

The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.

If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.

Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".

More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.

How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.

The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.

Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.

Windows Phone Marketplace hits 5000 Apps and is Cracked

There's been good news and bad for Microsoft this week. The good news is that the number of apps available in the new Windows Phone marketplace has been growing steadily since October and has now passed the 5000 mark. ...

Great news: Careerist RINO certified as winner of Alaska Senate ...

Great news: Careerist RINO certified as winner of Alaska Senate race.

Larry Kramer: This Is Why Fox News Continues To Roll

People are getting lazy about forming their own opinions.

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Tuesday, December 28, 2010

Who's Making Money

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/> [style="text-decoration: underline;">Ed. note: This post is authored by Evan Jowers and Robert Kinney of Kinney Recruiting, sponsor of the Asia Chronicles. Kinney has made more placements of U.S. associates and partners in Asia than any other firm in the past four years. You can reach them by email: asia at kinneyrecruiting dot com.]

Evan here. If you are a transactional associate at a top US firm and your name happens to be of Asian origin, especially of Chinese background, then you are probably receiving multiple cold calls per day from recruiters. After all the Asia lateral biglaw markets, especially HK / China are red hot now and it is of course very easy to compile a list of top US firm associates with Asian names.

Keep in mind that there can be very negative consequences in giving control of such an important career move and job search to someone calling you out of the blue (no matter how many times they may call). We often get calls from very well qualified US associates with sad tales of at worst their resume being plastered unauthorized all over China or other Asia markets; or at best only authorized submissions (thankfully) but realizing their recruiter has done little more than emailing their resume to begin with and is unresponsive for weeks.

It is important to note that your resume is a very valuable commodity to recruiters calling you. When you are placed at a law firm, the recruiter who submitted your resume is typically paid (by the law firm) 25 to 30% of your starting base salary. Thus, the recruiters cold-calling you have a big incentive to get a hold of your resume and email it to law firms, with or without your authorization (believe it or not, some biglaw recruiters in Asia are known to be even less ethical than the worst of the lot in the US). Once your resume has been submitted to a law firm, the recruiter who did so “owns” your candidacy there for at least six months. Further, when your resume has been submitted without your authorization, it will take an affidavit from you to the target firm explaining such for the submission to be reversed (and basically that is you explaining to the firm that you did not know you even applied there, which can of course cool off any motivation of that firm to continue to want to interview you, and the unethical recruiter is counting on you to thus not take that route).

We try to think that a lot of recruiters do not take such unethical steps, but please note that even the most well-intentioned recruiters trying to break into the Asia markets are more often than not woefully inexperienced with such lateral placements (and even most of those with some experience have never been more than resume pushers).id="more-49277">

We recommend that you make sure you are represented by a recruiter who is willing and able (has the experience necessary in your target market) to act as your agent, instead of just someone who is only able and / or willing to email your resume to firms. You should be pro-actively looking for an agent (we recommend interviewing prospective agent / recruiters months before you start your search when possible), not simply handing your search over to a headhunter that happens to be calling with the earth shattering news that they know, for example, of firms in China that have openings for Mandarin fluent US associates in cap markets and M&A (almost every top US and UK firm in HK / China has such openings), or that the sky is blue.

The question you should be asking is not whether there are openings and whether you would be very competitive candidate for such spots (yes and yes), but whether the person calling you is best suited for representing you.

At the very least, make sure the recruiter cold-calling you can:

a) Provide at minimum 10 references of US associates they have actually placed in your target market in Asia (I could easily provide 50, as 10 is a very small and unimpressive number, but should be a minimum guideline to figure out if the recruiter actually has a history of successfully placing US associates in your target market); and

b) Is able to discuss in great detail each roles you may consider targeting, including details regarding the relevant partners involved (does the recruiter even have a business relationship with the particular partners making the hire), including their personality, practice area, and plans for growth. I usually refer to this as the “3 hour rule”, in that if you get the impression that the recruiter could not talk non-stop about your target market for about 3 hours, then move on to the next recruiter (does not mean you actually have to listen to them for 3 hours).

It can be a lengthy process to find the right fit lateral spot in Asia, especially if you are moving from the US. It is much more complex than simply moving down the street to another big office. Instead you are moving to a much smaller office, smaller group, a place where you will have a lot more responsibilities with clients and where your personality fit with your primary supervising partner will be key (not only for progression at your new firm, but also for the foundation of your career in your target Asian market).

It is also a very exciting move and you deserve to be working with an agent / recruiter (rather than headhunter / recruiter) who is excited about helping you and the firms / partners he is recruiting for in Asia; who is excited to be invested in your career for the long-term; not focused on a recruiting fee (is willing to give advice not corresponding with recruiter being paid if that is the best advice); and who is capable (actual long-term experience with the market and similar lateral moves) of giving you the best advice and guidance.

Our team at Kinney can of course do a great job for you on an Asia job search. We know a handful of recruiters outside our recruiting firm as well whom we can recommend and are happy to do so. If unfortunately you have gone down the road already of being represented by a headhunter (instead of an agent) and you need advice, feel free to get in touch with us as well. While we can’t represent you at your target firms in such situations (remember, your headhunter already “owns” your candidacy at any firm contacted for at least 6 months), we are happy to give you advice and guidance regarding job search strategy and which offer to take (we have helped numerous US associates in such situations, including helping them negotiate their comp packages).

energy, Entrepreneurship, startups

How SunRun Applies Financial and Software Muscle to Home Solar Installation

Wade Roush 12/21/10

Sometimes we tech reporters get so wrapped up in writing about cool new technologies that we overlook other, equally important forms of innovation. Recently I visited SunRun, a San Francisco startup that installs photovoltaic panels on residential buildings and charges homeowners for the electricity they generate. I was expecting to hear a lot about the latest ways to engineer solar panels to produce more power—but I came away with a notebook full of thoughts about power purchase agreements, tax equity financing, and pricing engines. So while there are certainly people at SunRun who spend their time figuring out how to optimize the power output of the company’s 3,500 installed systems, this is largely a story about how three-year-old SunRun is spreading solar to more homes through clever financial engineering.

Despite the rapid growth of the Bay Area’s three leading residential solar companies—SunRun, Solar City, and Sungevity—there’s still a big puzzle about solar homes. It’s why there aren’t a lot more of them. California Governor Arnold Schwarzenegger signed the California Solar Initiative into law in 2006, making more than $2 billion in cash rebates and tax credits available to utility customers who put solar panels on their roofs. The goal was to get a million residential rooftop systems installed in the state, but all that free money hasn’t translated into the envisioned acres of solar panels. “We’ve soared past a million Priuses shipped, but in terms of solar homes in California, we are only at 100,000 since the beginning of the solar initiative,” notes Steve Vassallo, a Foundation Capital general partner who oversees several of the firm’s energy investments.

It’s partly an awareness issue: the state’s Public Utility Commission has issued dozens of news releases since 2006, and has designated August as “Solar Energy Awareness Month,” but it hasn’t done much else to publicize the rebates or explain how consumers can get them. But it’s also an economic issue: homeowners hammered by the recession don’t have a lot of extra money to shell out for home improvements these days, and they aren’t sure how much money they can save on their utility bills by installing solar.

And that’s the first thing that’s so ingenious about SunRun’s business model. It’s designed to take most of the risk out of solar installation, by asking homeowners for a tiny down payment (averaging $500), lining up equipment and installers, handling all maintenance and repairs for 20 years, and finally guaranteeing that homeowners’ post-installation electricity payments to SunRun will be lower than their existing utility bills.

That simple pitch has won SunRun 7,000 customers in seven states—Arizona, California, Colorado, Hawaii, Massachusetts, New Jersey, and Pennsylvania—and made it the fastest growing residential solar company in the country. But it has taken a lot of careful planning, and quite a bit of creativity on the financial and administrative sides, to make it all work.

“It’s a simple concept to take away the hassle and up-front costs of solar,” says Vassallo, who’s been working with SunRun since Foundation made its first investment in the company in mid-2008. “But to make it happen behind the scenes, a lot of fascinating challenges had to be overcome.”

The story starts back in 2007, when Edward Fenster and Lynn Jurich, who would eventually become SunRun’s CEO and president, respectively, were students at Stanford’s Graduate School of Business. Fenster had M&A experience from …Next Page »

Wade Roush is Xconomy's chief correspondent and editor of Xconomy San Francisco. You can e-mail him at wroush@xconomy.com, call him at 415-796-3024, or follow him on Twitter at twitter.com/wroush. You can subscribe to his Google Group and you can follow all Xconomy San Francisco stories at twitter.com/xconomysf.

Thursday, December 30, 2010

Tuesday, December 28, 2010

energy, Entrepreneurship, startups

How SunRun Applies Financial and Software Muscle to Home Solar Installation

Wade Roush 12/21/10

Thursday, December 23, 2010

WikiLeaks and Newspaper Profits

WikiLeaks and Journalistic Ethics

Wednesday, December 22, 2010

Sunday, December 19, 2010