Wednesday, June 27, 2012

The Dangers of Too Much Ambition in Health Information Exchange

Tripathi, Micky."The Dangers of Too Much Ambition in Health Information Exchange." iHealthBeat, June 22, 2012


From the article: "For those of us who've been toiling in the trenches of health information exchange for a number of years, we're finally living the dream. According to a 2011 KLAS report and a more recent Chilmark report, the HIE market is poised for spectacular growth over the next couple of years. Most of this growth will be driven more by "private" HIE efforts (enterprise efforts usually driven by a hospital system and/or physician organization) than by "public" ones (cross-organization regional or state collaborations usually seeded with government funds), but, regardless of what is driving it, the reality is that HIE is sprouting all around us.

I'm delighted that we're moving rapidly in this direction, but one concern keeps nagging away at the back of my mind, and that is the propensity to pursue over-architected HIE solutions. … What is an over-architected HIE? Put simply, it's one that tries to do too much for too many with not enough money and time. It tries to establish an all-encompassing infrastructure and service to meet multiple, heterogeneous current and future requirements of multiple, heterogeneous current and future customers. It tries to do all of this with a shoestring budget and staff. And worst of all, it focuses more on long-term potential "big-bang" value at the expense of short-term, realizable, incremental value." Read more

U.S. Healthcare Needs Data Standards, Registries, Study Says

Lewis, Nicole. "U.S. Healthcare Needs Data Standards, Registries, Study Says." InformationWeek, June 21, 2012.

From the article: "Due to the highly complex and fragmented nature of the U.S. healthcare system, developing a value-based healthcare model nationwide remains a daunting challenge, a new study from the Boston Consulting Group concludes.

The study, Progress Toward Value-Based Health Care, examined the progress toward implementing a value-based healthcare system in 12 developed countries: Australia, Austria, Canada, Germany, Hungary, Japan, the Netherlands, New Zealand, Singapore, Sweden, the U.K, and the U.S. The study assessed how these countries collect clinical data for the purpose of identifying best practices to improve the delivery of care while reducing costs.

As the U.S. moves from paper-based patient records to EHRs and looks to establish health information exchanges and accountable care organizations, Simon Kennedy, BCG's senior partner and managing director, says more could be done.

"There are several things the Obama administration and the ONC have not done that would make life a lot easier," Kennedy told InformationWeek Healthcare. Included in this wish list: strong patient identification, provider identification, and data exchange standards."
Read more

See also
"Progress Toward Value-Based Health Care," a report prepared by the Boston Consulting Group, June 6, 2011. 

Thursday, June 21, 2012

Joint Statement on the Negotiation of a EU-U.S. Data Privacy and Protection Agreement by European Commission Vice-President Viviane Reding and U.S. Attorney General Eric Holder

"Joint Statement on the Negotiation of a EU-U.S. Data Privacy and Protection Agreement by European Commission Vice-President Viviane Reding and U.S. Attorney General Eric Holder," press release European Commission, June 21, 2012.

From the press release: "We reiterate our determination to finalize negotiations on a comprehensive EU-U.S. data privacy and protection agreement that provides a high level of privacy protection for all individuals and thereby facilitates the exchange of data needed to fight crime and terrorism, as announced at the November 2011 summit by our Presidents. Such an agreement will allow for even closer transatlantic cooperation in the fight against crime and terrorism, through the mutual recognition of a high level of protection afforded equally to citizens of both the United States and the European Union, and will thus facilitate any subsequent agreements concerning the sharing of a specific set of personal data." Read more

Will the Internet Always Be Run By Unelected Technocrats?

Oremus, Will. "Will the Internet Always Be Run By Unelected Technocrats?" Slate, June 20, 2012.

From the article: "Xenophobes and technocrats have found something they can agree on: The United Nations shouldn’t be in charge of the Internet… So if the United States doesn’t control the Internet in the future, who will? Calls to keep the Internet free sound good, but they tend to overlook the fact that the Web is already not entirely anarchic. Between bodies such as ICANN, IETF, and the WC3, it’s more of a laissez-faire technocracy.

That system has worked gloriously so far, helping the Internet grow in ways no bureaucrat could have imagined, let alone planned. But as appealing as it may be to you and me and Vincent Cerf, it is not a system of government that has proven particularly tenable through the ages. Countries tend to be either authoritarian and repressive or democratic and populist. As the Internet becomes increasingly central to people’s lives around the world, state governments will not be content to entrust its governance to a bunch of benign wonks. This round may go to the engineers, but the political struggle has just begun." Read more

Wednesday, June 20, 2012

Silicon Valley Needs a Foreign Policy

Wilson III,  Ernest J. "Silicon Valley Needs a Foreign Policy." Foreign Affairs, June 20, 2012.
From the article: "As California's high-tech firms grew to become economic powerhouses in the American economy, they punched below their weight politically. For the most part, they not very savvy about the ways of Washington -- they came late to the lobbying game -- and their political strategies were naïve compared with those of old industrial sectors like oil and automobiles.

That seems to be changing… SOPA's defeat has been held up as a triumph for Internet freedom. But in combination with a few earlier examples, including Google's 2010 courageous but lonely stance against the People's Republic of China, it represents something more transformational. January's legislative battle marked the first time the major U.S. tech firms and their friends and followers came together and leveraged their political might like the globalized, information-age colossus that they have been for a long time. "Read more

Digital Freedoms in International Law

Brown, Ian and  Douwe Korff. "Digital Freedoms in International Law" (June 14, 2012). Global Network Initiative, 2012. 

From this abstract:  "With around 2.3 billion users, the Internet has become part of the daily lives of a significant percentage of the global population, including for political debate and activism. While states are responsible for protecting human rights online under international law, companies responsible for Internet infrastructure, products and services can play an important supporting role. Companies also have a legal and corporate social responsibility to support legitimate law enforcement agency actions to reduce online criminal activity such as fraud, child exploitation and terrorism. They sometimes face ethical and moral dilemmas when such actions may facilitate violations of human rights.

In this report we suggest practical measures that governments, corporations and other stakeholders can take to protect freedom of expression, privacy, and related rights in globally networked digital technologies. These are built on a detailed analysis of international law (particularly the ICCPR), three workshops in London, Washington DC and Delhi, and extensive interviews with government, civil society and corporate actors."
Read more

NSA: It Would Violate Your Privacy to Say if We Spied on You

Ackerman, Spencer. "NSA: It Would Violate Your Privacy to Say if We Spied on You." Wired, June 18, 2012.
From the article: "The surveillance experts at the National Security Agency won’t tell two powerful United States Senators how many Americans have had their communications picked up by the agency as part of its sweeping new counterterrorism powers. The reason: it would violate your privacy to say so.

That claim comes in a short letter sent Monday to civil libertarian Senators Ron Wyden and Mark Udall. The two members of the Senate’s intelligence oversight committee
asked the NSA a simple question last month: under the broad powers granted in 2008′s expansion of the Foreign Intelligence Surveillance Act, how many persons inside the United States have been spied upon by the NSA?" Read more

Free Speech for Computers?

Wu, Tim. "Free Speech for Computers?" The New York Times, June 19, 2012.

From the article: "DO machines speak? If so, do they have a constitutional right to free speech? This may sound like a fanciful question, a matter of philosophy or science fiction. But it’s become a real issue with important consequences. … This is a bad idea that threatens the government’s ability to oversee companies and protect consumers…. Computers make trillions of invisible decisions each day; the possibility that each decision could be protected speech should give us pause. To Google’s credit, while it has claimed First Amendment rights for its search results, it has never formally asserted that it has the constitutional right to ignore privacy or antitrust laws. As a nation we must hesitate before allowing the higher principles of the Bill of Rights to become little more than lowly tools of commercial advantage. To give computers the rights intended for humans is to elevate our machines above ourselves." Read more

A Note to Congress: The United Nations Isn't a Serious Threat to Internet Freedom—But You Are

Brito, Jerry and Adam Thierer. "Note to Congress: The United Nations Isn't a Serious Threat to Internet Freedom—But You Are." The Atlantic, June 19, 2012.

From the opinion: "Tomorrow, lawmakers in the House of Representatives will vote on a powerfully worded resolution declaring that "it is essential that the Internet remain stable, secure, and free from government control." The target of the bi-partisan resolution? The United Nations. That's a bit rich, coming from a legislative body whose appetite for Internet regulation is rapidly growing.

The House resolution, which has garnered over 50 co-sponsors, proclaims that it is "the consistent and unequivocal policy of the United States to promote a global Internet free from government control and preserve and advance the successful multistakeholder model that governs the Internet today."  Read more

Tuesday, June 19, 2012

Businesses 'Need to Build Trust' in Online Data

Couch, Paul Pearce. "Businesses 'Need to Build Trust' in Online Data." Inspiresme, June 19, 2012.  

From the article: "For businesses to succeed in a digital economy where data is currency they need to build trust to encourage consumers to share their personal information, a new report concludes. New research into consumer attitudes towards data privacy has revealed that one in three people now regard their personal information as a tradable commodity and that trust in a brand is the main factor in determining whether or not a person is prepared to share their details for marketing purposes.The findings of the research have significant ramifications for brands and digital platform owners that rely on niche and mass marketing for their revenues. The independent study conducted by Future Foundation and published by the Direct Marketing Association (DMA) comprises findings of a survey of 1,020 UK adults. Titled Data privacy: What the consumer really thinks the report reveals that the public holds a finely nuanced range of perspectives and a sophisticated level of understanding of the commercial value of their personal information and how it is used by companies." Read more

The Era of Big Data Is Here

Silva, Tom. "The Era of Big Data Is Here." Huffington Post, June 18, 2012.

From the blog: "As we see the recovery sputtering because of the European debt crisis, we await the next big thing. What will power this economy the way returning servicemen, the housing boom, urbanization and the Keynesianism of presidents from Eisenhower to Nixon powered the U.S. from the 1950s to the early 1970s? Or the way liberalization, low oil prices and the tech boom created 21 million jobs in the 1990s? A clue may lie in my industry. As our economy has moved from manufacturing to service-based over the last century, commercial real estate has traced the same arc, mutating from a sector focused largely around industrial buildings to one that's about the high-rise and suburban offices that dot our commutes home. But recently, a new sector and catchphrase has emerged that indicates a major new spur in our country's growth: Big Data." Read more 

ONC Looks to Grow the Power of Health Gaming

Miliard, Mike. "ONC Looks to Grow the Power of Health Gaming." Healthcare IT News, June 15, 2012

From the article: "At Games for Health 2012 on Thursday – amid talk of virtual worlds, avatars, Kinect sensors, biomechanics, social media crowdsourcing and exergaming – a policymaker from the Office of the National Coordinator for Health IT said that gaming is "on the radar of the federal government."… Games offer a whole lot more value beyond mere entertainment, Poetter pointed out. They can motivate people to overcome challenges; enable them to visualize change and progress; improve self-efficacy through knowledge and goal sharing and facilitate patient/provider communication and interaction.

And they can do even more than that. At Games for Health, one session explored how Xbox's Kinect could be be used not just burn calories with its virtual tennis, but be applied to gauging biomechanics and assisting with telesurgery and helping with catatonic schizophrenia." Read more 

See also
The Eighth Annual Games for Health Conference. Games for Health website, February 8, 2012.

Chinese Operators Hope to Standardize a Segmented Internet

Ricknäs, Mikael. "Chinese Operators Hope to Standardize a Segmented Internet." Computerworld, June 18, 2012.

From the article: "A technology draft written by employees at China Mobile and China Telecom and submitted to the Internet Engineering Task Force describes how the Internet could be split into several parts using the Domain Name System and in the process give countries more control over their own segment of the network.

The DNS is one of the key building blocks of the Internet. Its most important task is translating IP (Internet Protocol) addresses to host names, which is done by a distributed system based on one unique root that is used all over the world…

Today, China blocks Internet access to some foreign websites. The goal outlined by the new document is to make it easier and cheaper for countries to create independent root DNS servers and realize Internet autonomy. Today, that is both costly and technically difficult, according to the draft." Read more

See also
Diao, Yuping, et al. "DNS Extension for Autonomous Internet(AIP)," commissioned by the Internet Engineering Task Force, June 13, 2012.


Fast Access to Records Helps Fight Epidemics

Freudenheim, Milt. "Access to Records Helps Fight Epidemics." The New York Times, June 18, 2012.

From the article: "Public health departments around the country have long scrutinized data from local hospitals for indications that diseases like
influenza, tuberculosis, AIDS, syphilis and asthma might be on the rise, and to monitor the health consequences of heat waves, frigid weather or other natural phenomena. In the years since 9/11, this scrutiny has come to include signs of possible bioterrorism.

When medical records were maintained mainly on paper, it could take weeks to find out that an infection was becoming more common or that tainted greens had appeared on grocery shelves. But the growing prevalence of electronic medical records has had an unexpected benefit: By combing through the data now received almost continuously from hospitals and other medical facilities, some health departments are spotting and combating outbreaks with unprecedented speed." Read more

Google Reports 'Alarming' Rise in Censorship by Governments

Rushe, Dominic. "Google Reports 'Alarming' Rise in Censorship by Governments." The Guardian, June 17, 2012.

From the article: "There has been an alarming rise in the number of times governments attempted to censor the internet in last six months, according to a report from Google.

Since the search engine last published its bi-annual transparency report, it said it had seen a troubling increase in requests to remove political content. Many of these requests came from western democracies not typically associated with censorship…. In a blog post, Dorothy Chou, Google's senior policy analyst, wrote: "Unfortunately, what we've seen over the past couple years has been troubling, and today is no different. When we started releasing this data, in 2010, we noticed that government agencies from different countries would sometimes ask us to remove political content that our users had posted on our services. We hoped this was an aberration. But now we know it's not." Read more

See also
Chou, Dorothy. "More Transparency Into Government Requests." Google Public Policy Blog, June 17, 2012.

 Google Transparency Report. Google.

Crovitz: The U.N.'s Internet Power Grab

Crovitz, Gordon. "Crovitz: The U.N.'s Internet Power Grab." The Wall Street Journal, June 17, 2012.

From the article: "It's easy to understand why countries like Russia, China and Iran would want to rewire the Internet, cutting off access to their citizens and undermining the idea of a World Wide Web. What's more surprising is that U.S. diplomats are letting authoritarian regimes hijack an obscure U.N. agency to undermine how the Internet works, including for Americans. Someone leaked the 212-page planning document being used by governments to prepare for the December conference. George Mason University researcher Eli Dourado summarized: "These proposals show that many ITU member states want to use international agreements to regulate the Internet by crowding out bottom-up institutions, imposing charges for international communication, and controlling the content that consumers can access online." The broadest proposal in the draft materials is an initiative by China to give countries authority over "the information and communication infrastructure within their state" and require that online companies "operating in their territory" use the Internet "in a rational way"—in short, to legitimize full government control. The Internet Society, which represents the engineers around the world who keep the Internet functioning, says this proposal "would require member states to take on a very active and inappropriate role in patrolling" the Internet. Several proposals would give the UN power to regulate online content for the first time, under the guise of protecting against computer malware or spam. Another proposal would give the U.N. authority over allocating Internet addresses." Read more

You for Sale: Mapping, and Sharing, the Consumer Genome

Singer, Natasha. "You for Sale: Mapping, and Sharing, the Consumer Genome." The New York Times, June 16, 2012.

From the article: "IT knows who you are. It knows where you live. It knows what you do.
It peers deeper into American life than the F.B.I. or the I.R.S., or those prying digital eyes at Facebook and Google. If you are an American adult, the odds are that it knows things like your age, race, sex, weight, height, marital status, education level, politics, buying habits, household health worries, vacation dreams — and on and on.

Right now in Conway, Ark., north of Little Rock, more than 23,000 computer servers are collecting, collating and analyzing consumer data for a company that, unlike Silicon Valley’s marquee names, rarely makes headlines. It’s called the Acxiom Corporation, and it’s the quiet giant of a multibillion-dollar industry known as database marketing.

Few consumers have ever heard of Acxiom. But analysts say it has amassed the world’s largest commercial database on consumers — and that it wants to know much, much more. Its servers process more than 50 trillion data “transactions” a year. Company executives have said its database contains information about 500 million active consumers worldwide, with about 1,500 data points per person. That includes a majority of adults in the United States.

Such large-scale data mining and analytics — based on information available in public records, consumer surveys and the like — are perfectly legal. Acxiom’s customers have included big banks like Wells Fargo and HSBC, investment services like E*Trade, automakers like Toyota and Ford, department stores like Macy’s — just about any major." Read more

Network Non-Discrimination and Quality of Service

van Schewick, Barbara. "Network Non-Discrimination and Quality of Service." Internet Architecture and Innovation website, June 13, 2012.
From the blog: "Over the past ten years, the debate over “network neutrality” has remained one of the central debates in Internet policy. Governments all over the world have been investigating whether legislative or regulatory action is needed to limit the ability of providers of Internet access services to interfere with the applications, content and services on their networks… The precise contours of a non-discrimination rule have important implications: Non-discrimination rules affect how the core of the network can evolve, how network providers can manage their networks, and whether they can offer Quality of Service.[1]

On Monday, I published a white paper titled Network Neutrality and Quality of Service: What a Non-Discrimination Rule Should Look Like. It discusses the relationship between network neutrality, non-discrimination rules and Quality of Service in more detail. The paper:

* Provides the first detailed analysis of the Federal Communications Commissions’ non-discrimination rule and of its implications for network providers’ ability to manage their networks and offer Quality of Service;

* Offers the first in-depth analysis of the relationship between network neutrality and Quality of Service; and

* Proposes a non-discrimination rule that policy makers should adopt around the world – a rule that the FCC adopted at least in part." Read more

See also
van Schewick, Barbara. Network Neutrality and Quality of Service: What a Non-Discrimination Rule Should Look Like. The Center for Internet and Society, June 11, 2012.

Online Tracking Ramps Up

Angwin, Julia."Online Tracking Ramps Up." The Wall Street Journal, June 17, 2012.

From the article: "Online tracking on 50 of the most-visited websites has risen sharply since 2010, driven in part by the rise of online-advertising auctions, according to a new study by data-management company Krux Digital Inc.

The average visit to a Web page triggered 56 instances of data collection, up from just 10 instances when Krux conducted its initial study, in November 2010. The latest study was conducted last December.

The rapid rise in the number of companies collecting data about individuals' Web-surfing behavior is testament to the power of the $31 billion online-advertising business, which increasingly relies on data about users' Web surfing behavior to target advertisements."
Read more

Friday, June 15, 2012

Internet Access Services: Status as of June 30, 2011

From the report: "This report summarizes information about Internet access connections over 200 kilobits per second (kbps) in at least one direction in service in the United States on June 30, 2012… Notable developments between June 2010 and June 2011 include:
• Internet connections overall are growing. The number of connections over 200 kbps in at least one direction increased by 31% year-over-year to 206 million.
• Growth is particularly high in mobile Internet subscriptions, but fixed-location connections also continue to increase. The number of mobile subscriptions grew to nearly 120 million – up 59% from June 2010. The number of fixed-location connections increased by 6% year-over-year, to nearly 87 million.
• Both fixed and mobile services are shifting to higher speeds. The share of fixed connections with speeds at or above the availability benchmark adopted in the Sixth Broadband Deployment Report increased from 51% to 56% of total fixed connections. Among mobile wireless subscriptions, the share increased from 6% to 14%." Read more

Internet Governance: The Way It Works Now

Carrie Ellen Sager. "Internet Governance: The Way It Works Now." Public Knowledge, June 14, 2012.

From the article: "There has been a lot of talk recently about the ITU getting involved with regulating aspects of the Internet. But some of you may be wondering how the Internet is governed now. If you don’t have multiple hours to devote to the rabbit warren of Wikipedia articles on the subject, read on for a brief explanation of the current organizations involved in Internet governance. 

These organizations can be roughly divided into two major categories: international technical standards organizations and governance organizations. The technical standards organizations tend to deal with standards on a physical level: how to make a computer chip, for example. The governance organizations deal more with permissions and protocols: what are appropriate identifiers for computers on a network, or how to write a webpage that all computers will understand. But this is not a perfect rule, and there is significant overlap between the two groups." Read more

Thursday, June 14, 2012

Former Governors Douglas, Geringer: States to Transform Care Through HIT

Douglas, Jim and Jim Geringer. "Former Governors Douglas, Geringer: States to Transform Care Through HIT." Government Health IT, June 11, 2012.

From the blog: "During this week’s opening of the HIMSS Government Health IT Conference and Exhibition in Washington D.C., Governor Jim Douglas released the Roundtable’s first report States Will Transform Healthcare through Health IT and HIE Organizations. Our report opens with a historical snapshot of health IT legislation and an overview of innovative and collaborative state initiatives. Critical challenges faced by states are recognized and supported with recommendations for meeting them.
  1. States should continue to leverage their state-level HIE and state level health IT infrastructure in new and innovative ways. Close working partnerships between State governmental entities, federally supported RECs, Beacon Communities, Medicaid Offices, Professional Trade Associations and HIMSS National and local Chapters will expedite the implementation of health IT in the States.
  2. Health IT transcends political lines and should be on the federal and state agendas over the next several years in order to continue the current momentum and improvement of care quality and healthcare spending.
  3. Encourage states to facilitate, engage and educate patients and consumers with the delivery of their healthcare services and promote overall increase in health literacy. The delivery of high quality healthcare requires patient participation and shared decision making in which the patient, families and providers use the most effective steps to improve healthcare outcomes. Population Health Literacy is the essential first step in maximizing improvements in healthcare.
  4. Health IT is a necessary and vital precursor to a lot of the other healthcare reform actions that are contemplated by both private payers and public payers both at the state and federal level.
  5. State-level HIEs need to be prepared to shift their business models as Federal and State health reform policies continue to shift from fee-for-service to pay-for-quality models in order to develop and maintain sustainability. “Health Information Exchange” will likely need to shift to “Health Care Coordination Facilitation.”
  6. Better coordination between and among federal agencies and state health agencies to ensure the value of state-level HIEs and funding sources are aligned to ensure success." Read more
See also
Healthcare Information and Management Systems Society, 2012.