About DocumentCloud
Simply put, DocumentCloud allows reporters to upload source documents and make them more usable. Reporters can use it to annotate documents with public and private notes, plot dates in the documents on a timeline, share the documents and more.
It was founded by journalists who work at ProPublica and The New York Times, is funded by a grant from the John S. and James L. Knight Foundation and won a 2009 Knight News Challenge grant. A number of news organizations are using DocumentCloud in their reporting and their presentation of news stories.
Explore how the Las Vegas Sun used DocumentCloud to present hospital inspection reports, and the violations they contained, to its readers.
By Marshall Allen
When health inspectors report that a patient caught fire in the operating room, or was discharged from the hospital naked, it gets media attention.
But there are scores of violations that go unnoticed. While doing a comprehensive investigation of the quality of care in hospitals for the Las Vegas Sun, "Do No Harm: Hospital Care in Las Vegas," I wanted to show the breadth of inspectors' findings, including those that are less sensational but just as important to the public.
If housekeepers don't clean rooms, lethal bacteria can proliferate. If too few nurses are on duty, patients may be neglected.
The information about hospital violations is contained in inspection reports produced by the Nevada State Health Division, which licenses health care facilities.
A similar agency operates in every state, producing such reports. But they're difficult for the public to find and filled with bureaucratic language making it tough to identify and understand the violations.
I had been using DocumentCloud – created by journalists from ProPublica and The New York Times as an online repository of source documents – to house source material for "Do No Harm." The source documents have been a popular part of the project, generating more than 18,000 page views.
I realized DocumentCloud could be a useful tool to increase the public's understanding of hospital inspection reports. To do this we created an interactive graphic that melds the powers of DocumentCloud and Flash to make the reports searchable and more meaningful to readers.
I filed a records request for all the substantiated complaints in Las Vegas hospitals in 2008 and 2009. Most were available electronically on the health division's website, but filing the records request ensured I captured reports that had not been placed online yet.
Then we uploaded the documents – 61 in all – into DocumentCloud. 
We're a small newsroom, so our office manager, Nadine Guy, and librarian, Rebecca Clifford, helped identify the various violations in each document. Then we annotated, identifying about 140 violations, so readers wouldn't have to slog through bureaucratic mumbo jumbo to find the violations.
Next, we had to categorize the violations so they could be translated into a meaningful and searchable graphic. We sorted each violation into one of the following categories: administration, admission/discharge, infection control, patient assessment, patient care and sanitation.
Categorizing complaints highlighted the types of problems that persist at individual hospitals and in the community.
We highlighted 11 violations as "featured complaints" – jaw-dropping violations such as the failed terrorism training drill where an off-duty cop entered an ICU brandishing an unloaded gun, took nurses and doctors hostage in a break room without telling anyone it was a drill.
The final result gave a visual comparison of the total violations and breakdown of each type of violation at each facility, allowing comparisons among hospitals. Readers could mouse over each violation for a description, and click on it to be immediately taken to the original inspection report which we had loaded into DocumentCloud.
Marshall Allen reports on health care for the Las Vegas Sun. As a member of the inaugural class of AHCJ Media Fellowships on Health Performance, he is exploring whether transparency about hospital quality improves the quality of care for patients. He has won Awards for Excellence in Health Care Journalism for his body of work in 2007, in the limited report and medium newspaper categories in 2008 and for his body of work in 2009. He was a member of the 2009 AHCJ-CDC Health Journalism Fellowship Program.
