Tell us what you think Contact:  Editor, Momentum 1440 Clifton Rd., Suite 105 Atlanta, GA 30322 mgoldma@emory.edu (404) 727-8793

Emory Lifesavers at Grady On behalf of the department of surgery at Grady Memorial Hospital, I want to congratulate you on your comprehensive and insightful article entitled "The Grady Crunch." Among the remaining large public hospitals in the United States, Grady is unique in the extent of faculty support and in the expertise of the same faculty in all disciplines. Part of your article focused on the multiple-casualty situations that our surgical group has cared for since 1995. While these tragic events have brought long-overdue recognition to Emory faculty, fellows, and residents, it is my hope that your readers will recognize the underlying theme -- namely, that the activities of Emory personnel as "lifesavers" occur every day of the year. David Feliciano Professor and Chief of Surgery Grady Hospital The article you wrote on Grady Hospital for the winter 2000 issue of Momentum is the best explanation of the complex Emory/Grady relationship I've ever seen in my five years at Emory. Congratulations on a fine piece of research and writing! Curtis Carlson Emory Associate Vice President for Public Affairs Congratulations on the excellent Momentum article on Grady. The article was widely read by Grady staff and has been warmly received. It clearly reiterates Emory's commitment to the hospital. Bill Casarella Interim Senior Vice President for Medical Affairs Grady Hospital

Ideas for the Millennium In response to Dr. Johns' invitation for aspirations, I submit the following: Set an example for Atlanta area hospitals and have Emory's hospitals fill all their empty beds with overflow patients from Grady. Set up and staff another ER at one of Emory's affiliated hospitals, such as Northlake, Adventist, or Parkway. Partner in research with several pharmaceutical companies, with drugs donated to Grady as payment. Take over Grady; with our new streamlined management, Columbia/HCA and Grady could both become a public relations comeback story. Apply Six Sigma, GE Corporation's quality improvement program, to health care as an answer to Clinton's call for reporting of hospital errors. Jeff Kauffman Perfusionist Emory, Crawford Long Hospital The most appropriate role may be leadership in the care and treatment of environmentally induced disease. The world shrinks daily. Mankind explores opportunities in hitherto relatively pristine places -- farming in the rain forests of Latin America and Africa, oil-drilling in virgin Arctic tundra, war in remote Rwandan lowlands are examples of such incursions. In addition, the health consequences of earlier environmental practices are becoming evident, such as the effects on today's children of drinking water polluted generations ago. The "hot zone" is relentlessly expanding. Its denizens, which range from the merely annoying to the terrifyingly deadly, are the diseases which will attract the most public and professional interest and concern. As the CDC identifies and investigates new diseases, could the WHSC become the acknowledged resource for diagnosis and treatment? Pharmaceutical research is the third factor in the equation. The WHSC could be the beta site for elective clinical trials of medications under development by leading pharmaceutical houses. The WHSC would complement other institutions' work in environmental medicine and afford a structure within which ideas and information could be shared to the benefit of all -- particularly patients. Maureen Allen Director of Marketing and Public Relations Emory Peachtree Regional Hospital

Share an Idea In the winter issue of Momentum, Executive Vice President for Health Affairs Michael Johns called for ideas as to what the Woodruff Health Sciences Center (WHSC) should aspire to over the next 100 years. Momentum will publish some of those ideas during this and subsequent issues throughout the year. Send your submissions to the Editors.

It Takes a Team Thank you for the very complimentary article about the renal transplant program that just ran in Momentum. While the article highlighted some of our activities, we would like to point out that Emory's transplant program is an interdisciplinary, interdepartmental effort. Our many colleagues in the departments of medicine and surgery have played crucial roles in the success and national recognition of the program. In particular, Dr. John Neylan, the medical director of the renal transplant program, is a national leader in the area of clinical trials in renal transplantation and is the immediate past president of the American Society of Transplantation. In addition, Dr. Fadi Lakkis, also of the division of nephrology, has made several seminal contributions in the field of transplantation immunology over the past several years. He is a co-investigator on the 1998 five-year, $7.5 million NIH grant to establish tolerance in transplantation. It takes a team (continued) Dr. Lakkis' cutting-edge research has played a crucial role in Emory's rise to national prominence in transplantation. As Emory works to foster its interdisciplinary programs, it is important that we recognize the many contributions required for excellence. Christian Larsen Chief, Division of Transplantation Thomas Pearson Chief of Renal Transplantation Your article on the kidney transplantation program on page 24 of the winter 2000 issue failed to mention an additional member of the leadership of the kidney transplant team, Dr. John Neylan, the medical director. Dr. Neylan and other members of the renal division have been instrumental in the tremendous success of Emory's kidney transplantation program. Charles O'Neill Associate Professor of Medicine

The Big Picture I am writing to congratulate the editors of Momentum for producing an informative and attractive publication. Emory is a large and growing institution, and I have found the articles in Momentum very useful in helping me to see the "big picture" of present and future issues facing the university, particularly the medical school. The writing, design, and photography are lively and interesting. In the winter issue, the history and analysis of the "The Grady Crunch" and the photographs that accompanied "The Healing Fields" were outstanding. I look forward to future issues. Joanne Green Associate Professor Department of Neurology As a member of the Emory Board of Trustees and the Woodruff Health Sciences Center Board, I want to congratulate you for such a fantastic job that you achieved when you produced Momentum for the winter edition 2000. The articles on "The "Grady Crunch," "The Healing Fields," "Getting into the Act," and "On Point: Grady's Crisis in America" were sterling. You have produced a wonderful piece that your readers must be thoroughly enjoying, and I congratulate you and encourage you to keep up the good work. David Allen Trustee, Emory University and the Woodruff Health Sciences Center

Security, Accuracy on Web? I enjoyed reading your article (fall 1999 issue) on the soon-to-be web presence of Emory Healthcare. However, two issues mentioned - accuracy and security - are more problematic than they may at first seem. I have no doubt that HealthWeb's developers see accuracy as critical, but the failures of other health websites suggest that ordinary attention to this issue may not be enough. Some months ago, an article in the New York Times noted that all the medical websites surveyed (including the most highly regarded) provided some seriously inaccurate information -- in one case, citing a 95% mortality rate for a condition with a 5% rate. Needless to say, such errors cannot be permitted in information that may well be life or death. Printed information undergoes careful content editing and proofreading before being delivered to the public. Time saved by publishing on the web rather than in print encourages an emphasis on up-to-the-minute information, with a de-emphasis on the careful writing, editing, and proofreading that are the hallmarks of literate, informative non-fiction. After all, we can always fix the web page later, right? But those who read incorrect information are unlikely to return to see the corrected version, and even if the client escapes harm, Emory's hard-won reputation may not. Department personnel updating their own areas is also cause for concern. Certainly, department staff can edit and proofread for content, but how many departments are prepared to not only provide content and take additional patients, but also frequently update web-based material and take care that old or inaccurate information doesn't get mixed in by mistake. The ability to make changes to web pages cuts both ways: mistakes can make previously accurate information misleading or wrong. The prospect of individual medical information, such as history, prescriptions, and state of health being kept in any database which is designed to be accessed worldwide is very unsettling. No computer security is foolproof, and thousands of patient records would be a tempting target indeed to a big employer or insurance company, for that matter. Even if encryption is in effect at all times (that is, the data is never stored or backed up in unencrypted form), the password security for user access has well-known vulnerabilities -- the average user can rarely come up with an unguessable password. Your article mentions that lab test results are being considered for delivery by web. A recent study by the California HealthCare Foundation found that none of 21 top health care websites had privacy guidelines in line with Federal Trade Commission recommendations on the collection and use of personal data. The majority did not even follow their own, less strict, privacy policies. "Cookies" and on-line advertising were cited as vulnerabilities allowing privacy restrictions to be bypassed. Imagine the devastating results of mishandling a pregnancy or HIV test result. Do protocols permit leaving the information out where other family members could get to it? There are undoubtedly many benefits to be gained from using the web in this novel way. There are also many traps for the uninitiated (as we all are) and the unwary (as we need not be). I urge HealthWeb's planners to give additional consideration to accuracy and security. Jaime Henriquez Web designer Institutional Advancement

Editor's note: Your concerns are pertinent to all health care users today, and we are doing our technical and ethical best to address them, says Una Newman, senior director of marketing for Emory Healthcare: "Emory Healthcare understands its responsibility to insure technical security, and we are working with our new vender, Interactive Planet (IPI), to insure that we have the tools to provide that security. We are basing those security parameters on expected guidelines from the US Department of Health and Human Services, which have been reviewed by such organizations as the Coalition on Patient's Rights. As of April, those rules had not been finalized." "We plan to provide access only to authorized individuals through appropriate identification and passwords. We will allow access only to as much data required to perform a current function, and we are designing the system so we can document all access to a patient's record. All data will be stored on an Emory Healthcare server located behind a firewall. Data transmitted across Internet connections will be encrypted. IPI says that all databases and content that they deliver to our servers will be encrypted. Not all data will be accessible to everyone, and we will not share personal health data with any outside agency or vender. Besides technical safeguards, Emory Healthcare will encourage patient users to protect their passwords and change them on a regular basis." "Providing accurate, up-to-date information is always a challenge, whatever the media. Nothing will go live on the web until it has gone through a staged approval process that we are currently establishing. Ultimately, however, the responsibility for the accuracy of the data must remain with the 'owner' in each department." Newman now expects Emory HealthWeb to go live by the end of the summer. It will feature a physician directory, general information on Emory Healthcare (hospitals, clinics, maps, personnel, and jobs), continuing medical education, clinical trials, news, and publications. Clinical content will include information about the Emory Heart Center, radiation oncology, orthopaedics, reproductive medicine, bone marrow transplant, ENT, and the Fuqua Center for Late Life Depression.

From the Director  /  Letters Through Thicket and Thin Traveling Well Wanted: More Good Nurses Moving Forward  /  Noteworthy Nurses' Prescriptive Authority Trash or Treasure?