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The enterprise implications of Google Wave May 31, 2009

Posted by gonzalezloumiet in Google Wave.
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http://blogs.zdnet.com/Hinchcliffe/?p=400

Health IT commission postpones certifications May 31, 2009

Posted by gonzalezloumiet in CCHIT.
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* By Alice Lipowicz
* May 29, 2009

The federally-recognized Certification Commission for Healthcare Information Technology (CCHIT) is deferring launch of its 2009-2010 certification programs until it reviews the health IT standards being developed by the Health and Human Services Department this summer under the economic stimulus law.

Established in 2004, the certification commission has developed several health IT standards and has certified vendors who meet the standards. It was recognized by the Bush administration in 2006 as the only group federally authorized to certify health IT products and services. Under Bush-era policies, doctors and hospitals were encouraged to convert to digital record systems, but few did.

The Obama administration and Congress included $19 billion in the economic stimulus law in February to promote health IT adoption that includes payments to physicians and hospitals that buy and use certified systems. Under the law, HHS’ Office of the National Coordinator for Health IT will develop standards and a certification process.

The law also set up a policy committee and a standards committee to advise the national coordinator. The law did not specify a role for the CCHIT, but did not rule one out.

Under a May 18 implementation plan, the national coordinator is required to deliver a draft rule on standards and certification criteria to HHS by Aug. 26, 2009.

Because of that timing, the certification commission said it will not be accepting vendor applications for its 2009-2010 programs until some time after that date.

“We will defer launch of our 2009-2010 inspection programs until we have reviewed that material, in order to ensure conformance of this program to American Recovery and Reinvestment Act incentive requirements,” Mark Leavitt, certification commission chairman, said in a statement on May 19.

About the Author

Alice Lipowicz is a staff writer for Federal Computer Week.

Electronic Patient Records Will Force Consolidation in Health Care May 30, 2009

Posted by gonzalezloumiet in Electronic Patient Records.
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By Steve Lohr
Darren Hauck for The New York Times

The Obama administration’s ambitious plan to accelerate the adoption of electronic patient records will be a “steamroller” that drives the consolidation of the health technology industry and threatens many small physician practices, predicts Leonard M. Fuld, head of a large competitive-intelligence firm.

In an interview on Wednesday, Mr. Fuld summarized the conclusions of a “war game” his firm organized last month, “The Battle for Healthcare Information,” and added some postgame observations of his own.

The 35 participants in the business strategy-and-forecasting exercise were students from four graduate business schools — the Wharton School at the University of Pennsylvania, the Graduate School of Business at Columbia, the Sloan School of Management at the Massachusetts Institute of Technology and the Kellogg School of Management at Northwestern.

The government’s $19 billion plan to hasten the use of electronic health records in hospitals and doctors’ offices is intended to improve care and curb costs. But the government pump-priming will also set off an acquisition spree as large technology companies buy health information-technology specialists to grab market share, the war-game participants concluded. Allscripts, Epic and Cerner, they said, could well be targets for larger companies like I.B.M., Microsoft, Oracle and McKesson.

Hundreds of thousands of doctors in small practices, Mr. Fuld said, will be forced to join larger groups in part because of the expense and complexity of adopting computerized health records. “It’s an unintended consequence, I think, of the administration’s policy,” Mr. Fuld said. “Many doctors don’t like computerized health records, but they know they have to adopt them over the next several years.”

The computerized record technology, Mr. Fuld predicts, will be “a steamroller” that changes the organization of American health care.

SOURCE: NY TIMES

Prescription For E-Health Care May 25, 2009

Posted by gonzalezloumiet in CIO, Healthcare IT, Integration.
1 comment so far

CIO Chat

Ed Sperling, 05.25.09, 6:00 AM ET

Shifting health care from paper to electronic records could be one of the most important efficiency gains in our lifetimes, affecting everything from how quickly we can check into a clinic or hospital to how many specialists are available to monitor patients.

Yet this presents some complex questions: What exactly is involved in making this system more efficient; how do we measure that efficiency; and what are the unexpected effects of this digitization effort? To help shed light on what is likely to be the biggest change in health care in decades, Forbes caught up with Denni McColm, chief information officer at Citizens Memorial Hospital in Bolivar, Mo.

Forbes: What is changing in your world?

Denni McColm: In the past, we had pretty antiquated IT systems. We hadn’t invested in much beyond a lab system, a pharmacy system and a billing system.

So, everything was in silos?

Yes, but then in 1999 we started upgrading. We made a huge project out of revamping our entire structure. We had 76 beds, five long-term care facilities, a home-care agency and 16 physician practices. We wanted to provide seamless care for our patients. We had been getting complaints that if patients moved from one facility to another, they had to answer all the same questions over again.

But more important, the lab reports, radiology and physician visits were not available. We wanted to have paperless medical records.

How do you measure the efficiency of those systems?

We did an [return on investment] study initially. A lot of analysis showed that over five to seven years we would see increased revenue by better coding and documentation. Physicians would be freed up to admit more patients, and clerical costs would go down. The reality is that over five to seven years it’s hard to measure that. We have seen a reduction in clerical staff even though we’ve grown. We’ve also increased revenue, but how much of that is due to the system, we don’t know.

How does the federal government’s push for electronic medical records affect you?

There’s a lot of uncertainty with the stimulus package funding. It’s not grant money. It’s money that hospitals will get for proving meaningful use. Right now we’re making sure that all of our products are certified at the level they need to be and [that we are] going to be able to meet whatever that definition of “meaningful use” turns out to be. It’s still very vague. …

We think we will only have to do a few small things, while a hospital starting from scratch will have to do a lot of things. But if they had done it in the traditional grant-funding approach, we would have been penalized. The way this works is that you have to make the investment and become a meaningful user before you get the money. As far as we can tell, we’re almost there.

What’s the ultimate goal for your IT system?

Making sure every patient gets care that is evidence-based, across the continuum. There are certain things we have to publicly report, but beyond that there are things every patient should get. If they are at risk for blood clots, they should get treatment to prevent that. We also try to make the record a byproduct of the care process so nurses and physicians spend as little time as possible documenting the care and the record. The data is secondary to providing the care. When they take blood pressure or vital signs, the only thing they have to do is accept it into the record.

Now that Citizens has made this investment, does it require constant new funding?

The IT budget, annually, is a lot bigger than it used to be and it is a constant investment. If it’s not the desktop, it’s the servers and the backup. There is a lot of care and feeding of the system. We did anticipate some of that. It has been more than we anticipated.

Where do you go for more money?

We have a subset of the capital budget now that is just for IT. It’s a little blurry, because some medical equipment these days is almost IT equipment. But we have a separate budget that is analyzed and prioritized.

Are you on standardized systems so you can connect with other hospitals?

Our system, MEDITECH, is in use by about 25% of the hospitals in the United States. We could interact with other hospitals in the state, but there aren’t any at the level we are. One of our first moves might be to connect with Google Health or Microsoft HealthVault unless something else comes across in the state. We’re surprised by how slowly everyone else has moved. We started implementing our system in 2002.

What was the triggering factor for Citizens?

The revelation that if we were the end-all for health care in the community we needed to step up and make investments.

Are there metrics for patient care, as well?

We look at all the publicly reported quality measures, and we have seen big improvement. We’ve also seen some decline in our admission rates for home health patients. They take vital signs, weight and blood pressure every day, and it’s automatically fed into our system.

They can do that at home?

Yes. About 40 of them have this technology at any time, and it’s submitted to electronic medical records through phone lines. It can also remind them to take their medication. They get a reminder to step on the scale, take their blood pressure and put this on your finger. And sometime in the next hour, when their phone isn’t busy, it dials in the information. The sky’s the limit about how much care can be provided at home. One nurse can sit in a room and monitor 40 patients and be alerted to any anomalies, which you can’t do if you have to go through their home or see them one at a time.

What do you have for infrastructure?

MEDITECH is proprietary. It runs on Windows. We have an IBM SAN [storage area network] and blade setup. We are doing a lot of virtualization. We have one data center that serves the entire network. We have an alternate data center too, with an alternate emergency medical record version. When we were down for a few hours recently, we could enable an alternate system within a few hours. What was most important was being able to view patients’ medicines.

All your records are centrally managed?

Yes, and one reason we haven’t had to do interoperability sharing is that patients have one record that can be trended and shared across the clinics, hospital, long-term care and home care. You can view just one encounter or move them all together. There’s a lot of discussion now about systems for physician practices. It’s not just about buying a system. It has to be integrated into the network to get the full benefits. If a patient walks into one of our clinics, a physician can review a patient’s whole record and order a CAT scan. The nurse schedules the CAT scan before the patient even leaves the clinic; they’re pre-registered when they arrive at the hospital, and the second it’s done the image is on the doctor’s desktop.

SOURCE: FORBES

Crisis under check May 25, 2009

Posted by gonzalezloumiet in Data Integration, Informatica, Public Health.
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Collecting and sharing vital health information underpins the successful containment of virus outbreaks and is one of the key requirements to ensure that public health is protected,” says Suganthi Shivkumar, Managing Director, South Asia, for Informatica, working in the space of data integration solutions. In a chat with eWorld, Suganthi shares insights into how governments can make technology serve more effectively as a public healthcare manager.

What are the various ways the government can technically ramp up healthcare?

With healthcare becoming increasingly patient-centric and information-rich, huge volumes of data are being generated by healthcare providers, patients, payers, facilities supplying specialised care on an outsourced basis, and other third-party organisations.

With a data integration platform in place, healthcare organisations will be able to unlock the value of the information residing in their systems by bringing together patient information from disparate systems securely and reliably.

This will increase confidence in the accuracy of patient records and decrease regulatory non-compliance risks by ensuring precise, consistent data delivery with reliable audit trails.

Proper data integration can also link clinicians, personalise patient care and enable access to external patient data.

By doing so, medical staff will be able to improve the overall quality of patient healthcare not just during the outbreaks of epidemics but normal day-to-day operations as well.

Please tell us more about the Hong Kong Hospital Authority data integration platform. Does India have anything like that?

The Hong Kong Hospital Authority, a statutory body that manages all public hospitals and clinics in Hong Kong, has standardised on Informatica’s data integration software to consolidate medical reporting, research, auditing and front-line clinical care data.

In the past, it was extremely difficult to get a complete and up-to-date patient view across hospitals and clinics, but Hong Kong doctors are now able to engage in more comprehensive medical investigations for improved care, and have in place a platform for sharing critical information in near real time to aid in controlling the spread of diseases including SARS (severe acute respiratory syndrome).

The Hospital Authority has used the data integration platform to consolidate data from 30 clinical systems implemented across 43 hospitals and 121 general and specialised outpatient clinics.

The integrated data fuels a data warehouse containing historical data on six million patients, or 90 per cent of the municipality’s population. The data enables holistic views of the organisation’s business and medical performance, as well as clinical research in support of evidence-based medicine.

During the recent SARS crisis, data integration was leveraged to create an external reporting system for sharing SARS-related data with the government’s Department of Health to help support contact tracing and quarantine control.

Replacing a fax-based information-sharing process, the system was set up in just five days, with the data integration portion taking less than two days to implement.

The Hospital Authority is presently working on an expanded communicable disease information system.

Be it swine flu or other threats, hospitals in India need a platform that can bring together data from clinical systems across hospitals and outpatient centres in record time. The aim should be to co-ordinate medical, audit and performance reporting across the system.

What is required to make it cost-effective and efficient is the inclusion of the identity resolution feature, which could help to identify patients as they move around the system and trace people who have been in contact with infectious carriers

Other examples where governments have used technology to combat such outbreaks..

Here are some other instances:

The Cancer Council of New South Wales, Australia: It relies on data integration platforms to help in the fight against cervical cancer.

This organisation created an award-winning register with the aim, quite simply, of saving lives.

It uses technology to provide an accurate way of matching a new test against the existing database which is important because pathology laboratories rely upon a patient’s previous test history when screening their current test.

It is also critical in ensuring that each patient on the register is reminded to attend the subsequent cancer tests.

Clalit Health Services Group: This group provides health insurance, medical care and services to the majority of Israel’s population centres. It encompasses 16 hospitals and more than 1,300 primary and specialised clinics that serve more than 3.7 million patients.

Clalit implemented Microsoft BizTalk Server in conjunction with Informatica ContentMaster.

This combination enabled hundreds of legacy systems using Health Level 7 (HL7) data and a variety of document formats-including Adobe PDF and Microsoft Word to interact to display updated patient records.

Complex data transformations can now be accomplished within minutes rather than weeks.

Paromita.pain@gmail.com

SOURCE: http://www.thehindubusinessline.com/ew/2009/05/25/stories/2009052550050200.htm

May 24, 2009

Posted by gonzalezloumiet in Uncategorized.
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As some of you may know, I (Eduardo Gonzalez Loumiet) have been eyeing a netbook…probably go with a DELL or Asus in the next few weeks….i found this article which talks about Netbooks in health care. Quite cool: http://www.mobilehealthcomputing.com/2009/05/what-role-will-netbooks-play-in.html

BANKABLE HEALTH CARE REFORM May 24, 2009

Posted by gonzalezloumiet in HealthCare.
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Over the past year, it has become evident that the U.S. bank and financial sector has a huge influence over both parties in Congress and the top financial advisers in the Obama Administration. The same has held true even longer for large manufacturers involved in weapons and defense spending. We will soon see the same heavy influence over Congress by the insurance companies, the AMA, pharmaceutical companies, and various healthcare providers.

For those who dream of comprehensive healthcare reform and some sort of universal coverage – you should live so long. 2009 Reality Check: “It’s not gonna happen.” The out-of-pocket costs for businesses and families have to be much higher, the number of uninsured and underinsured must be much larger, and the governmental deficits to maintain the current system must be simply untenable. Essentially things have to be much worse in order for Congress to pass any meaningful changes.

The wealthiest Americans and largest corporations control the business of this country. The U.S. has been, is, and will be an oligarchy or plutocracy (essentially the same), and our “meritocracy” simply exists to buttress this near complete control of the U.S. economic and political system. All members of Congress are so dependent upon campaign contributions for their continuing existences, that only those with enough money or the ability to raise significant amounts of money have access and effective control over the actions of Congress.

It is naive and simplistic for many advocates of various policies and programs to waste years, valuable time, too many brain cells, and far too much paper, internet storage space, and air time on the various Media, making laudable arguments that explain the “fairness, rationality, reasonableness, rightness, merits, efficiencies, ethics, cost-savings, and long-term benefits” for the majority of citizens of their proposals. These compelling arguments may be effective in some other country or political system but they have been completely useless and unpersuasive within our particular system of government.

No policy or program has been, or will be enacted or pursued if it does not benefit the wealthiest of Americans and large corporate interests that essentially control Congress and the U.S. political process. It would be better for advocates of any particular policy or program (regardless of the actual merits) to spend their time and efforts exclusively convincing this small group of people that it is in their best financial, economic, social and political interests to support a particular program or policy that happens to benefit the rest of the country. The simple reason why so many admirable programs and policies have languished in Congressional committees year after year has been that they do not resonate whatsoever with that elite group of people and their particular interests and needs.

Once 95% of Americans realize the fact that they exist principally to please and faun over that group of the wealthiest 5% of Americans (to which most members of Congress belong and upon whom they depend for re-election), then life will become much clearer and easier, and some of the things we secretly wish for might actually come true.

The American healthcare system does not exist to provide the best and most efficient healthcare to all Americans. It exists – as most everything else in the U.S. – to make money generally for the wealthiest of Americans and their controlled enterprises. The huge per capital costs of our healthcare system that far exceed the costs found in other developed countries are principally devoted to ensuring the system’s overall profitability to hospitals, physicians, healthcare providers, medical equipment manufacturers, medical technology providers, pharmaceutical companies, and health insurance companies. To ensure the maximum profitability for most of these participants, (1) we have to accept a large number of uninsured, (2) the reality that many claims and procedures are denied even if the sick people have insurance, and (3) higher infant mortality and lower life expectancies than all other advanced countries. Those other nations view healthcare as a right and a public good so profitability is not the central purpose of their national healthcare systems.

There are many other major wealthy players in the country that might be in favor of serious healthcare reform. They consist of many small, medium and large businesses not part of the financial services and banking sectors, and not part of the healthcare field. However, these stake-holders are historically not well financed, they are often inundated with many other pressing issues, and they are not well organized for effective Congressional lobbying. Therefore, healthcare reform advocates must look elsewhere for secondary support.

Advocates for serious and comprehensive healthcare reform designed to benefit the vast majority of Americans, must come up with arguments for their favorite policies and programs that will improve the wealth and influence of the richest Americans and those entities that control the healthcare industry. Of course, for the past 50 years, those winning arguments have not made and thus most healthcare reforms that have been suggested have been routinely killed Administration after Administration. Medicare/Medicaid and the recent Prescription Drug Program succeeded because they did not challenge the basic system – only provided another payer (the Government) for healthcare costs for those who were previously unable to pay directly and therefore ultimately enrich the many providers of healthcare services within the existing for-profit system.

Sadly, this author has no immediate ideas on how to convince those in power to give a damn about the other 95% of Americans on many areas of public policy, healthcare being just one of many issues. It may be likely that the current system will remain in place and our only hope is to increase the number of employers providing some sort of healthcare benefits to their employees, instead of hiring part-time independent contractors domestically or sending the work overseas. However, hope springs eternal. Now that everyone knows the real playing field, these winning arguments might be found and tailored to those who have the actual final say on any healthcare reforms.

One possible line of arguments should center on the benefits of greater investments in our transportation, energy and educational infrastructures. In fact, they now hold the most immediate and long-term promise for our country. It is very likely that most of the funds spend in these programs will ultimately trickle up to the wealthiest Americans and corporations, particularly those with heavy construction investments. It is well documented that most jobs in transportation, energy and education pay well and come with many extra benefits, including healthcare.

For example, new spending on Amtrak, rail mass transit, and high speed rail has garnered broad bi-partisan support in Congress, simply because the wealthiest Americans and many large corporations now see a direct future benefit to their own bank accounts by way of ostensibly doing something good for the American public. (It also helps that the housing bubble and other investment options are pretty well discredited.) If they did not see these public investments ultimately benefitting themselves, they would not now be playing such a large role in the current and future budget plans of this Congress and this Administration.

This post is meant to focus advocates of various meritorious ideas geared to help the majority of Americans to take the realistic view that for those proposals to ultimately become enacted, they must principally get the approval of the wealthiest Americans, investors and businesses. The author has focused other earlier postings on related topics: Americans must understand the real system of government we have and work within those overall parameters for reasonable change.

We have to make the best of an imperfect system. This is not advocating compromise since “something” is better than nothing. Instead, comprehensive policies and programs can be implemented if they are corrected argued and packaged to favor those who ultimately decide whether they are enacted or not. Comments from TMV Readers are always welcome.

5/24/09 by Marc Pascal in Phoenix, AZ

Article printed from The Moderate Voice: http://themoderatevoice.com

URL to article: http://themoderatevoice.com/33036/bankable-health-care-reform/

Is There a Need for a National Healthcare System May 24, 2009

Posted by gonzalezloumiet in HealthCare, Medicaid, Meidcare.
2 comments

Dennis AuBuchon
May 22, 2009

There is much discussion lately about the need for a national health care system and the cost it would bring to the operations of the federal government. There is definitely a need today even more than before to address the uninsured or under insured individuals in this country. To some extent we already have a national healthcare system. It is called Medicare and Medicaid. In addition to these are the various health insurance companies with their requirements for authorization and payment of various medical necessities. These companies for the most part are available throughout the United States. Granted sometimes there are questions raised when some procedures are not accepted for payment. This can be caused to some extent in the way the procedures and the reason for their use are documented. The cost of healthcare in this country continues to grow and force individuals to make choices between the medicine they need and food. This should not take place in a country such as ours with the resources we have at our disposal.

Today many individuals are without health insurance for various reasons. Some have lost their jobs and with it went their health insurance. Others have lost their benefits as companies can no longer provide this benefit resulting from the increased cost to their business. This I understand and that is why changes in the healthcare system are necessary. It does not imply that any kind of national healthcare system be created but only changes to the present system.

Changes proposed in the healthcare environment must address the rising cost that every individual faces whether it is through personal insurance or their work. This does not imply that I am proposing any type of price controls or caps as to what medicine will cost or what doctors and hospitals may charge. To begin with the cost to develop new medicines is costly to those that do the research to address illnesses which now face our country and will face in the future. These organizations deserve to make a profit but it should be a reasonable one. Another aspect is the potential risk of lawsuits. This is part of the rising healthcare cost. It involves not only the drug companies but also doctors and hospitals. To offset these potential costs insurance is purchased to accommodate address any potential losses resulting from lawsuits. Lawsuits are always going to be a part of conducting business especially in the healthcare industry. This cost is passed on to the patients who use these services.

In relation to the subject of lawsuits I have nothing against those who bring lawsuits when they feel they have been harmed. This is their right to seek restitution. There are some lawsuits in the healthcare industry and others which have no real basis and as such they increase the workload of our courts and the costs of organizations responding to any lawsuit. This increases the cost that businesses must pass on to their customers/clients. In relation to healthcare it is part of the cost included in the prices the various segments of healthcare.

There are instances in the private sector today where the cost of prescription medication is drastically reduced through such places as Wal-Mart, Kroger and many other chain stores. I do not know the details of such activities but the process seems to be working. This is something the federal government should take a look at before deciding what changes are necessary in our healthcare system. The private sector always seems to do a better job of providing for the needs of Americans. Medicare and Medicaid are two government systems which seem to be on the road to funding problems. The funding issues involve the high cost healthcare today and in the foreseeable future. Access to medical records by doctors in various parts of the country is limited if available at all. Many times individuals travel and become sick away from their primary doctor and access to records is primarily limited to family members. This may not be a bad thing but the limit nature of the information can affect the treatment a family member receives.

Part of the cost of healthcare is the amount of government regulations in place. This not only includes drugs but patient information security. Regulations in any industry increase the cost of business and when regulations are in place it creates in part a government system by which all businesses must operate. There are many regulations governing healthcare today and probably will be more regulations and laws in the future as changes in the healthcare industry are addressed. The anticipation of a formal national healthcare industry would require detailed regulations and requirements which must be monitored and enforced by the government. Creating such a system in an age of increasing government operations cost must be carefully examined before actions are taken. Many times when laws or regulations are hastily passed problems develop with regards to details that were not properly examined before a final decision on the content was completed. Laws and regulations which are enacted by our government representatives at any level must be properly examined as to the problem and practical solutions to address them.

There has been discussion to have all medical records kept in electronic form. Many doctors now use this type of record keeping as it is beneficial to have information readily available when seeing their patients. Recently there was a case where a hacker accessed medical records for thousands of people and this is a concern. Any electronic records are subject to being hacked to some extent and there are ways to reduce the possibility of this occurring. While I am not totally secure in using electronic record keeping I do feel it is the wave of the future. Controls can be put in place where electronic records access can be limited. Currently there are moves to make electronic health records a requirement.

The current environment and use of the Internet creates a scenario that doctors would be behind the times if their records were not in electronic form. Use of the Internet or specific sites to provide up-to-date information concerning illnesses would also provide positive benefits to patients seeking care. Today there is a wealth of knowledge and information on the Internet but doctors who use this option must be secure in the accuracy of the information they are viewing. Many sites offer medical information but it is important that any information be reliable and accurate. The life and health of their patients may depend on it.

I have previously mentioned the part of the population that has no insurance or are under insured. This is the key to making changes in the healthcare system we have today. The need for making some changes in the healthcare system we currently have I feel should not involve creating a system or additional requirements managed by the government. The changes which should be created are those affecting the under insured or those without insurance. Healthcare for Americans is an important responsibility which may not necessarily rests entirely with the federal government. The state government and the private sector are also involved in the level of care people receive.

The current cost of medical care from doctors, hospitals and the cost of prescriptions are high. I feel that an electronic system will provide better care and reduce cost for patients seeking medical care. There will be a cost in establishing an electronic medical record system but I feel the cost is worth the benefits patients will receive from their doctors and hospitals. Anytime the cost connected to receiving medical treatment can be reduced is a good thing. Granted as I stated earlier there needs to be adequate controls to prevent unauthorized access to medical records.

Regardless of what changes take place in our healthcare system they should be done slowly to assure or have the high probability of success for any changes being proposed. In the beginning I stated there is much discussion about creating a national healthcare system. These discussions should not be rushed. There should be adequate discussions pushing toward positive changes that are not going to cause a large increase in the cost of government to run such a system. It has been proven through past history that when government programs are initiated they increase the cost of government to monitor and enforce the requirements. Any changes enacted to our healthcare system should provide the means to monitor and enforce new changes with reasonable costs. One last point to make is that there are two cabinet level secretaries at the federal level that have an impact on the cost of healthcare; they are the Secretary of the Food and Drug Administration and the Secretary of Health and Human Services.

SOURCE: http://www.americanchronicle.com/articles/printFriendly/103529

Wiki Govnt May 23, 2009

Posted by gonzalezloumiet in Government, open source, Wiki.
1 comment so far

George Bernard Shaw once wrote, “All professions are conspiracies against the laity,” and nowhere is this more the case than in a democracy. Although political legitimacy demands accountability to an electoral process, those living in a democracy readily submit to what sociologist Michael Schudson calls the “permanent embarrassment” of expertise. We believe that administrative governance by a professional elite is the best way to organize decision-making in the public interest. Experts decide on acceptable levels of mercury emissions in the air, anti-discrimination rules in education and the workplace, and the standards for cross-ownership of newspapers and broadcasting stations.

The justification for this professional decision-making, articulated by theorists ranging from Max Weber to Walter Lippmann, is that while citizens can express personal opinions based on values, they are incapable of making fact-based decisions on matters of policy. For Weber, the complexities of modern governance call for “the personally detached and strictly objective expert.” Only institutionalized and governmental professionals possess the expertise, resources, discipline, and time to make public-policy decisions. And citizen participation is hard to organize and administer, and even harder to scale. It is one thing for 10 bureaucrats to debate a policy and come to an informed consensus; try getting the same result with 10,000 people–or 10 million.
Now, however, new technology may be changing the relationship between democracy and expertise, affording an opportunity to improve competence by making good information available for better governance. Large-scale knowledge-sharing projects, such as the Wikipedia online encyclopedia, and volunteer software-programming initiatives, such as the Apache Webserver (which runs two-thirds of the websites in the world), demonstrate the inadequacy of our assumptions about expertise in the twenty-first century. Ordinary people, regardless of institutional affiliation or professional status, possess information–serious, expert, fact-based, scientific information–to enhance decision-making, information not otherwise available to isolated bureaucrats. Partly as a result of the simple tools now available for collaboration and partly as a result of a highly mobile labor market of “knowledge workers,” people are ready and willing to share that information across geographic, disciplinary, and institutional boundaries.

Consider how communal pooling of knowledge is already at work. An individual may submit the first “stub” about the history of the Ming Dynasty or the biography of Winston Churchill in Wikipedia, and a wider community of millions collaborates on writing, editing, and refining every article. Wikipedia is open enough to allow expertise to emerge, but it is also structured enough, with outlines and to-do lists, to set the rules for a certain kind of group collaboration–and that collaboration is producing high-quality results.

Or take sites that utilize self-reinforcing “reputation” systems to improve quality and reliability. These so-called social-networking sites–like Dopplr for travelers, LinkedIn for business professionals, or Facebook and MySpace–use community rating and friend-of-a-friend (FOAF) accreditation mechanisms to build the reputation and trust necessary to form knowledge groups and communities. Making expertise relevant for the complex processes of policy-making also requires forming communities that can collaborate, but it goes beyond that. It demands “civic networking,” tools designed for groups to transform data into knowledge useful to decision-makers, as well as the concomitant institutional practices designed to make use of that knowledge.

Political philosophers from Aristotle to Rousseau to Rawls have suggested that when groups engage in the public exchange of reason, they produce better ideas. In practice, however, more talk usually slows decision-making and comes with the attendant problem of groupthink. Increasingly, however, we are discovering how to use computers to enable deliberation without endless talk and without having to be in the same room. And those structures–enforced through software–are what transform the subjective, free-wheeling, dynamic expertise of amateurs into effective communities of experts.

For example, the Omidyar Network, the philanthropy launched by eBay founder Pierre Omidyar, asks the public to participate in awarding its grants. Rather than invite submissions from thousands of individuals–which would have strained resources to review–the Omidyar Network created an online framework for the interested community to deliberate and winnow the proposals first. Or consider New Assignment, which was launched to demonstrate that “open collaboration over the Internet among reporters, editors and large groups of users can produce high-quality work that serves the public interest, holds up under scrutiny, and builds trust.” The site set forth the social practices to elicit collaborative reporting (instead of collaborative gossip-mongering), resulting in the publication of seven original essays and 80 interviews, as well as a series of stories about collaborative journalism for Wired magazine. While this fell short of the number of pieces the organizers had wanted, New Assignment still enabled the “crowd” to produce stories as good as any found in a national magazine and demonstrated how to organize (and how not) the process. Similarly, the Sense.us program at the University of California–Berkeley provides public mechanisms to allow people across disciplinary boundaries to collaborate in making, and thereby making sense of, census data graphs and charts. And the United States Patent and Trademark Office (USPTO) is taking this idea to the next level: connecting experts directly to actual decision-making in the “Peer-to-Patent” project.

In each case, we are beginning to see how, if designed with clear, simple tasks to that help create more open and collaborative yet organized practices, the computer screen can shift power from professional sources of authoritative knowledge to new kinds of knowledge networks. Speaking truth to power is easiest to do–and more accurate–when spoken not as an individual, but as a group. This has particular application to policymaking: Non-governmental participants have something more to offer than voting once a year–namely, good information. In much the same way that we devise legal procedures to ensure fairness in the courtroom or open deliberation in Congress, we can design technology–and the legal and policy framework to support it–that elicits specific, structured, and manageable input, not from individuals, but from collaborative groups. If we can harness the enthusiasm and knowledge of “netizens” to the legal and political processes generally reserved for citizens, we can produce government decision-making that is both more expert and, at the same time, more democratic.

The Problem with Experts
In his award-winning book On Political Judgment, social psychologist Philip Tetlock analyzed the predictions of those professionals who advise government about political and economic trends. Pitting these professional pundits against minimalist performance benchmarks, he found “few signs that expertise translates into greater ability to make either ‘well-calibrated’ or ‘discriminating’ forecasts.” It turns out that professional status has much less bearing on the quality of information than we might assume, and that professionals–whether in politics or other domains–are notoriously unsuccessful at making informed predictions.
Moreover, the traditional reliance on institutionalized expertise is fraught with political controversy. Sometimes these pre-selected scientists and outside experts are simply lobbyists passing by another name. The current administration, for example, regularly replaces experts on agency advisory panels with ideologues and political allies. In a published statement titled Restoring Scientific Integrity in Policy Making, over 60 preeminent scientists, including Nobel laureates and National Medal of Science recipients, lambasted the Bush Administration for “manipulation of the process through which science enters into its decisions.” But if Bush is among the more egregious violators of the presumed wall between politics and institutionalized expertise, his actions only go to show how easy it is for any executive to abuse his or her power of appointment to disrupt experts’ advisory function.

The problem of relying only on professionals in our bureaucracy has been compounded by institutionalized practices of confidential decision-making, even in areas where public input could have a decisive impact, such as the review of patent applications. Whereas a first- or second-year civil servant at another agency might be drafting memos, a patent examiner with limited supervision is doling out a patent that could impact the fate of an industry or fundamental scientific research. Yet, until 1999, the USPTO, in order to protect the confidential trade secrets of inventors, did not publish applications. Even today, most (but not all) applications are only published after 18 months, and even then the examiner cannot communicate with the public. The USPTO allows third parties to submit publications with no commentary, annotations, or markings, and only for a fee, effectively eliminating participation by all but the most die-hard corporate competitors. As a result, despite a backlog of 700,000 applications last year (by now it is 800,000 and counting), the USPTO received only 40–100 such submissions, none of which were necessarily used in decision-making.
But if excessive reliance on governmental or selected professionals is the problem, direct public participation, as we have typically known it, is no panacea. Public participation in regulatory decision-making has been a part of the federal landscape since the end of World War II, when it was enshrined as a right in the Administrative Procedure Act of 1946. This may sound good in the abstract, but there is such a thing as too much public participation. Whereas democracy is to be practiced at the polling booth, bureaucrats are not supposed to feel the pressures of direct democratic involvement. It can corrupt the rationality of the process with the distortions of private interests. And more participation does not mean better participation. How should administrators deal with individuals who carp but offer little useful information to improve decision-making? Or interest groups that electronically submit tens of thousands of identical “postcard comments”?
Scientific peer review provides an alternative mechanism for oversight and quality control. The practice is widespread in government grant-making: The National Science Foundation relies on a network of more than 50,000 reviewers, while the National Institutes of Health relies on outside review groups and advisory councils from the scientific community to review over 70 percent of its grant applications. And the Environmental Protection Agency’s grant-selection process relies heavily on “science review panels,” peer review groups chosen and managed by an outside scientist.

But peer-review panels, like agency advisory boards and other professional commissions, are empanelled, not self-selected. Membership is closed. Even if their deliberations are posted online or made available after the fact, the public has no say over who participates and no voice in the process. People have no option to self-select on the basis of enthusiasm, rather than being chosen on the basis of profession. Even when not unduly subject to political influence, the decision as to who participates is based on institutional status. Those who may have meaningful contributions to make–graduate students, independent scientists, avid hobbyists, retired executives, and other consultants in the “free agent nation”–fall outside the boundaries of professional institutions and status and will of necessity be excluded, regardless of their intellectual assets.
Peer review is also time-consuming to organize and run. The group has to be selected, vetted, and approved, and because fights can arise over membership, conflicts of interest have to be identified and sorted out. Participants must also be convinced to join. It is, perhaps, in part because of the work that must go into maintaining a peer-review system that review generally happens only in limited contexts, and too late in the process to have the maximum impact on regulatory decision-making.

Nonprofessional Expertise
In contrast to what we see in government, in many other fields there is a move away from the preeminence of institutionalized professionals. Instead, technology aggregates and refines the knowledge of distributed, non-institutional experts. Patients, not doctors, are providing medical information to each other about cancer via the Association of Online Cancer Resources website and its 159 associated electronic mailing lists. Almost 30,000 citizen-journalists report on stories for OhMyNews.com. Amazon’s Mechanical Turk project outsources the work of answering simple questions or doing basic tasks to a distributed network. YouTube depends on amateurs to post video content. The Internet Movie Database (IMDb), which offers information about close to one million movie titles and more than two million entertainment professionals, started as a collection of movie trivia submitted by members of two online newsgroups. In South Korea, the Naver search engine, where Korean speakers answer each other’s queries, far outpaces Yahoo and Google as the most popular.
But how might this open, online collaboration improve governmental decision-making? How do we square the expertise and talent we see emerging via Wikipedia or YouTube with the professional standards of science to which we expect governmental decisions to conform? After all, Wikipedia has been known to contain errors and defamation. For every brilliant art film or newsworthy clip, there are thousands of pieces of video junk on YouTube. To put it bluntly, information quality may not be a matter of national security when it comes to a fifth-grade book report, but it is essential to nuclear regulations or environmental safety standards or the quality of issued patents. While we know that excessive reliance on professionals is problematic, we do not want to replace one set of abuses with another by eliminating the professionals and replacing them with direct, popular decision-makers.
Rather, we want to design practices for “collaborative governance,” shared processes of responsibility in information-gathering and decision-making that combine the technical expertise of public experts with the legal standards of professional decision-makers. There are plenty of people with expertise to share if their knowledge can successfully be connected to those decision-makers who need it. It is not necessary to pre-select authenticated and known professionals when structures can be put in place to ensure that informational inputs are discernable, specific, well-labeled, and easy to search, sort, and use. An online system will not be without its own problems and abuses, but the assumption is that greater public participation, not in setting values but in supplying information or making sense of and connections between informational sources supplied by others, can substantively improve decision-making.

Peer-to-Patent
On June 15, 2007, the USPTO launched an experiment, the “Peer-to-Patent: Community Patent Review,” which could become a model for precisely this sort of collaborative governance. The program solicits public participation in the patent examination process via the Web. This system (the design and implementation of which I direct in cooperation with the USPTO) allows the public to research and upload publications–known in patent law as “prior art”–that will inform the patent examiner about the novelty and obviousness of the invention and enable her to decide whether it deserves a patent. This is truly revolutionary: In the 200 years since Thomas Jefferson founded the patent office, there has been no direct communication between the patent examiner and the public.
“For the first time in history,” David J. Kappos, vice president and assistant general counsel at IBM, says in the Washington Post, patent-office examiners will be able “to open up their cubicles and get access to a whole world of technical experts.” With the consent of participating inventors, this USPTO pilot allows the self-selecting public to review 250 software-patent applications from such companies as CA, Hewlett-Packard, General Electric, IBM, Intel, Microsoft, Oracle, Red Hat, Yahoo, and several smaller firms. The community not only submits information, but it also annotates and comments on the publications, explaining how the prior art is relevant to the claims of the patent application. The community rates the submitted prior art and decides whether or not it deserves to be shared with the USPTO. Only the 10 best submitted prior-art references, as judged on the basis of their relevance to the claims of the patent applications by the online review community, will be forwarded to the patent examiner.

The USPTO pilot program is neither a blog nor a wiki. It is not a free-for-all for “software patents SUCK!” comments. Rather, the software is designed to provide a structured environment that solicits specific information targeted to the decision-making process. Eligible applications are posted online for review for up to four months. There is a shared discussion space, but it requires registration and joining the group committed to reviewing that application. The group can deliberate about the application’s quality, decide what research needs to be done, discuss where prior art may be found, and even divvy up the work of finding it. At the same time, the group has tools to “filter” comments in the discussion, identifying those that are most important, contain a request for follow-up research, or are low-quality “noise,” thus mitigating the influence of the person who simply talks the loudest or the most. Private-sector websites–from the book reviews on Amazon to the movie reviews on IMDb to the news postings on Slashdot, the technology news site–have shown that these community ratings can be aggregated with surprisingly accurate results to sort and filter discussion.

While the discussion is designed to foster belonging and community and offer a space where ideas can be refined collaboratively, none of the discussion is forwarded to the agency, limiting the opportunity for undue influence. Instead, only the work that will be most helpful to the decision-making process, namely the community’s research and the prior art, are forwarded. Those who join an application community research the background to the application and share that research, helping to guide the governmental professional in her work. The research may help the examiner identify fruitful avenues for her search, decreasing the work done in that limited 20-hour window or, at the very least, shortening wild goose chases.
To be sure, the patent examiner still conducts a search. She has all the same information available to her as before. But now she also has the results of this “human database.” By structuring the request for feedback, the agency avoids inviting participation it cannot use. And the public has an opportunity to participate in a way that is directly relevant to and will shape decision-making.
What’s more, through the software administrators can measure the level of expertise of public reviewers and thus better understand how this online participation process shapes that expertise. They can also measure the impact of public participation on examiner decision-making and on the resulting quality of the issued patent. Over time, with the benefit of greater experience and more data, it may become possible to introduce more refined algorithms for assessing the quality of information on the basis of the past performance of citizen-participants. We can also better understand and anticipate the ways in which those with an interest to do so will attempt to “game the system” (an unavoidable part of the process) and improve the practice accordingly.
Driving this pilot program is a combination of public attention to patent reform and the availability of the technology to do open peer review online. Patent reform has become the subject of intense, recent legislative debate in the United States and in Europe. The problem is not so much with the patent office itself as it is with the explosion in the number of applications, which has put enormous strain on an old system, resulting in the issuance of low-quality patents that subsequently become the subject of expensive and wasteful litigation. Given the doubling of the number of patent applications in the last decade, examiners currently have less than 20 hours to review an application about the most cutting-edge nanotechnology, the latest genetic bio-science, or the most controversial financial business method. In that time, they have to search the USPTO’s limited databases to determine if there is a prior publication that would reveal that the application lacks the requisite novelty or significance required. Yet publications–which go beyond traditional scientific journal articles and include websites, software code, and products–are not all to be found in this closed database. Examiners must also contend with poorly drafted applications. There is no legal duty incumbent upon inventors to do a thorough search of the prior art and submit it to the agency.

The problem is as obvious as it is intractable: It is hard to find information that is not there. In other words, the patent examiner has to scour the scientific literature to figure out if a particular chemical compound has already been invented by someone else, lest she award the patent to the wrong person who turns it into the next billion-dollar pharmaceutical blockbuster. And she can’t delay her research, as it would risk exacerbating a backlog that will soon approach one million applications.
Rather than going to the experts, the USPTO realized that it is easier to let the experts find it–and that is precisely what the new program does. The process is open to anyone. At the same time, just as Wikipedia’s two million entries are actually maintained by a few thousand knowledgeable and dedicated die-hards, this patent public participation program does not need to attract everyone, just everyone enthusiastic enough to do the hard work of sharing in the burdens of decision-making. Of course, for those who work or study in a particular area of innovation, participation should be anything but hard.
It is assumed that competitive self-interest will be one of the drivers causing people to get involved. Far from distorting the process, when someone from IBM or Microsoft (both of which have publicly announced that employees may participate in the program while on the job) has relevant information to contribute, ultimately the public benefits. Graduate students and those with deep knowledge but little status may also be inclined to participate, whether out of moral indignation that a patent is being applied for in an area of research that they know or out of the desire to gain status in, and professional recognition from, their community of interest. Incentives could eventually be created through prizes and rewards, such as a monetary bounty from an inventor for those who find the best prior art, or public recognition (an “Oscar” for public participation) to the reviewer and the team who contribute the most useful information. It is also an opportunity to generate interest in and a market for the invention.

The UK patent office has announced plans to do its own, much-wider pilot for 10,000 to 15,000 patent applications, adapted to its legal regime and cultural practices. This will make it possible to begin to build a global community with expertise and interest and, at the same time, to test different practices, gather real data about how expertise can best be obtained in response to this complex subject matter, and refine the process for patents. It will also provide valuable learning about how such practices could be adapted for other areas of governance.

Evolving Institutions
Our institutions of governance are characterized by a longstanding culture of professionalism in which bureaucrats–not citizens–are the experts. Until recently, we have viewed this arrangement as legitimate because we have not practically been able to argue otherwise. Now we have a chance to do government differently. We have the know-how to create “civic software” that will help us form groups and communities who, working together, can be more effective at informing decision-making than individuals working alone. We know from James Surowiecki’s book, The Wisdom of Crowds, as well as Simon and Schuster’s new MediaPredict project (which encourages readers to guess which manuscripts will become best-sellers), that technology can be used to aggregate predictions. But Peer-to-Patent is teaching us that we can go beyond the tallying of votes. While the general public has good instincts about value-based decisions and could be engaged better to identify “big mistakes” (such as egregiously unfair media ownership rules), there are specific people out there who possess specific information about patents or trucks or chemicals whom we can now incorporate into our decision-making.

Nor does it have to stop at patents. Scientists who currently give their time to review grant applications might be just as willing to contribute their knowledge to decision-making about the environment, transportation, nuclear power, and agriculture. Frequent travelers have useful information to share with homeland security officials about how to best organize security at airports. Economists, businesspeople, and lawyers know a great deal about financial markets, securities, and consumer protection. State Department officials do not possess better information than select graduate students in computer science about RFID chips for passports. Immigrants and welfare recipients have information based on lived as well as learned experience to contribute.
In order to make it possible for ordinary, busy people to participate, and for government to make use of their knowledge, government must design the practices of public participation to enable groups, not just individuals, to participate. Agencies must crystallize the questions they ask of the public and embed those targeted practices into software. Of course, not even the best-designed civic software is going to stop government from making bad decisions or ignoring–willfully or otherwise–good information dropped in its lap. And there will be manipulation and gaming, to be sure. But these are not reasons to shy away from opening up the practices of governance, especially when those practices can evolve over time to respond to problems that may arise.
Opening up closed decision-making also introduces a greater degree of transparency and accountability than we have had before. For example, even if Peer-to-Patent does not yield good research or prior art every time, many eyeballs on the application still encourage the inventor to do a better job of writing it and produce public debate and discussion about the application. It drives more information into the open and encourages the “liberation” of government data, not for its own sake, but as an enabler for engagement. And public involvement reminds the agency official that he is working for (and being watched by) the public.
To bring about the new revolution in governance, the next president ought to issue an executive order requiring that every government agency begin to pilot new strategies for improved decision-making. For example, he or she could require that each agency, as part of their Semi-Annual Regulatory Agenda delivered to Congress and as part of a new collaborative governance report to the Office of Management and Budget (OMB), set forth at least one “Peer-to-Policy” experiment to see how it could make its decision-making practices more collaborative.
Experimentation with community feedback would provide the impetus for independent rulemaking agencies, such as the Environmental Protection Agency, to post questions to the scientific community before enacting regulations. It would encourage the Department of Labor to create an online network to solicit the expertise of those with disabilities. These new opportunities for participation are not limited to rulemaking activity. The FCC can seek targeted but open advice on the economics of spectrum policymaking as part of its efforts to decide which rules to draft. The National Oceanic and Atmospheric Administration might create an online marketplace for the collaborative creation of weather maps. The National Institute for Standards and Technology could award venture funding for scientific innovation and research, which would benefit from public collaboration and input. With public collaboration, decisions about everything from health care initiatives to housing programs to efforts to attract foreign direct investment could be improved by collaboration with public experts.
And imagine if this executive order were backed by an industry “X-Prize,” a large monetary reward for the private or public sector entity that designs the best new civic software tools to support more open decision-making. This X-Prize–or Peer-to-X-Prize –would provide a matching grant to support agency pilot programs and allow OMB to give this software to agencies. It might also go to support the development of tools to be disbursed on a state and local level. The aim would be to create turn-key technologies that can be deployed by any government decision-maker to enlist the help of her “public staff” and give her the tools she needs to send out a short questionnaire, enable collaborative drafting on a document, invite proposals and suggestions, or perform any number of useful activities to engage the interested and expert community. By enabling agencies to try different practices–while bringing down the costs of procuring technology–we can learn a great deal about how to construct new and better practices of public participation.

By being explicitly experimental with new forms of digital institution-building, we have an opportunity to increase the legitimacy of governmental decisions. The tools–increasingly cheap, sometimes free–will not replace the professionals. Technology will not, by itself, make complex regulatory problems any more tractable, or eliminate partisan disputes about values. What this next generation of civic software can do, however, is introduce better information by enabling the expert public to contribute targeted information. In doing so, it can make possible practices of governance that are, at once, more expert and more democratic.

SOURCE: http://www.democracyjournal.org/article.php?ID=6570

Data.gov Launched by Federal Government May 23, 2009

Posted by gonzalezloumiet in Data, Vivek Kundra.
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May 21, 2009, By Matt Williams, Assistant Editor

Federal CIO Vivek Kundra made good Thursday on his promise to launch Data.gov, which will make data generated by the federal government publicly available.

It’s apparent that Data.gov is only in the initial state of development. Day one featured an eclectic assortment of data sets, such as the locations of the world’s copper smelters, National Weather Service advisories and weekly reports of earthquakes. Web site widgets for the FBI’s 10 Most Wanted and the H1N1 swine flu virus are also featured.

Kundra championed a similar Web site in his former position as the CIO of Washington, D.C.: The District of Columbia Data Catalog contains more than 275 data sets — everything from the locations of road kill pick-ups to crime incident reports. Like the D.C. Data Catalog, datasets available on Data.gov are retrievable in different formats like XML and ESRI Shapefile.

Kundra has said that the aim of Data.gov will be to improve government transparency by releasing these data sets so that citizens are able to analyze them and build mash-up applications.

Not all government data will be released on Data.gov, though. According to a policy statement posted on the Web site, all information must comply with privacy regulations. National security information will be unavailable.

President Barack Obama has made transparency and open government one of his central themes. Shortly after taking office, Obama ordered a 120-day review that will set the recommended parameters of an open government directive for the entire federal government. But that hasn’t been released yet, in part because national CTO Aneesh Chopra is awaiting confirmation by the Senate.

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