Volume 10, Issue 8 March 4, 2011
GAO: Redundant Federal IT Systems Waste Money The GAO identified four key areas for IT process improvement -- Department of Defense business systems, enterprise architecture, data centers, and e-health records -- and gave recommendations for how the government could eliminate overlap in these efforts.
By Elizabeth Montalbano, InformationWeek
The federal government could save billions of tax dollars annually by addressing duplications in programs, agencies, offices, and initiatives that are adversely affecting the government's financial and operational effectiveness, according to a federal watchdog agency.
Some of the areas of overlap identified in a new 345-page report (PDF) from the Government Accountability Office (GAO) -- the first it's delivered after Congress directed it to report on this area -- are within single departments or agencies, while others span multiple organizations.
The agency identified 81 areas of duplication in hundreds of federal programs that are diverse in their scope and missions, ranging from agriculture to homeland security to social services to international affairs. Not surprisingly, several key aspects of the government's implementation of IT were identified in the report as areas where overlap could be eliminated to help the government provide more efficient and effective services. Figure of the week The GAO in particular identified four key areas for IT process improvement -- Department of Defense (DoD) business systems, enterprise architecture, data centers, and e-health records -- and gave recommendations for how the government could eliminate overlap in these efforts. 15.7 billion At the DoD, 2,300 investments in its business-system environment are fraught with The market for EMR hit in 2010, overlap, including lack of standardization; multiple systems performing the same according to a recent report from tasks; and instances where the same data is stored in multiple systems and in which market researcher Kalorama the same data is entered manually into multiple systems. Information. According to the report, the growth rate of 10 percent in 2009 Among the recommendations the GAO made to improve these areas include defining and 13.6 percent in 2010 was slower DoD business-system investments that can be implemented within the context of its than anticipated. Kalorama cited some federated business enterprise architecture. hesitation in the market due to confusion about meaningful use More at http://bit.ly/g9VwOf guidelines. Volume 10, Issue 8 March 4, 2011 Page 2
Privacy and Security
Microsoft 'Do Not Track' Plan Accepted by W3C noted that while the technology behind "do not track" Web Standards Group W3C options is relatively simple, defining the real meaning of "track" for a global Internet is a complex issue. By Chloe Albanesius, PC World "The privacy concerns from consumers and academics and governments world-wide have both technical and non- Microsoft's "do not track" browser proposal got a boost technical aspects. Addressing these concerns will involve Thursday when the World Wide Web Consortium (W3C), a technology," Dean Hachamovitch, corporate vice president for Web standards body, gave Microsoft's plan its stamp of IE, wrote in a blog post. approval. "The W3C's involvement provides the best forum possible for The W3C has accepted and published Microsoft's submission, that technology discussion. Just as the community has worked which W3C called "timely and well-aligned with the together at the W3C on interoperable HTML5, we can now consortium's objectives and priorities." An official work together on an interoperable (or universal, to use the FTC announcement is expected in early March, and W3C will hold a privacy report's term) way to help protect consumers' privacy." workshop at Princeton University on April 28 and 29 to assess whether W3C should proceed with more work in this area. The feature is in response to the FTC's call for a Web equivalent to the Do Not Call list that addresses telemarketer Microsoft Tracking Protection was included in the release harassment. In the wake of the FTC's report, Google and candidate of Internet Explorer 9, which was announced earlier Mozilla have also introduced varying "do not track" options for this month. At the launch event for the RC, Microsoft also their respective browsers. announced four partners for Tracking Protection: Abine, TRUSTe, PrivacyChoice, and AdBlock Plus. These firms will Earlier this month, Rep. Jackie Speier introduced the Do Not provide lists of sites that plant small tracking code on many Track Me Online Act of 2011, which would give the FTC 18 other Web sites to profile users' site history and habits. months to come up with standards for companies to follow when it comes to online tracking. The Tracking Protection feature in IE9, which was first introduced in December, will allow users to block this More at http://www.pcmag.com/article2/ 0,2817, snooping by either using one of these lists or automatically 2380888,00.asp determining the offending Web domains.
Facebook vs. FTC Round 2: Facebook "Advocates of democracy used Twitter to make their voices Responds heard following the contested 2009 Iranian election of and Oscar Morales in Colombia famously employed Facebook to By Gregory Ferenstein, Fast Company organize massive street demonstrations against the FARC terrorist group in 2008. Facebook just released a 26-page retort to the Federal Trade Commission’s preliminary report on privacy regulation--a Most recently, people in Tunisia and Egypt used social media report that social media firms see as an ominous approaching to spread up-to-the-minute news, share videos of local events storm of chaotic bureaucracy. In summary, Facebook fears that with the broader population, and mobilize online communities government meddling could stifle both its ability to profit and of thousands (and sometimes millions) behind a common smother the industry’s progress on yet-unknown technological cause." advancements. On business Facebook responded in mirror-image to the FTC; first, (respectively) reminding the FTC how much social media has "Finally, the social web is a crucial engine for economic growth done for the government itself, the advancement of democracy, and job creation. Hundreds of thousands of application and the growing cottage industry of social software: developers have built businesses on Facebook Platform.
On government To take just one example, games developer Zynga, creator of the popular Farmville game, has more than 1,300 employees "In government, leaders use social media services to promote and has been valued at about $5.8 billion." Second, it pleaded transparency, as evidenced by the nearly 140,000 followers of for the FTC to be optimistic about how ostensibly intrusive the White House Press Secretary's Twitter feed and the fact technologies end up benefiting the public. that more than 70 federal agencies have Facebook pages." More at http://bit.ly/dUY4BR On democracy Volume 10, Issue 8 March 4, 2011 Page 3
Privacy and Security - (cont.)
Massachusetts Hospital to Pay $1 million in Massachusetts General also agreed to a corrective action plan, HIPAA Settlement which requires the hospital to develop and implement a set of policies and procedures that ensure protected health Massachusetts General Hospital has agreed to information is protected when it's removed from the facility; train workforce members on these policies and procedures; pay the federal government $1 million to settle and designate the director of internal audit services of Partners potential violations of the Health Insurance HealthCare System to serve as an internal monitor to conduct assessments of the hospital's compliance with the plan, and Portability and Accountability Act's privacy rule, also issue semi-annual reports to HHS for a three-year period. HHS said today. Deborah Adair, privacy officer at Massachusetts General, By Jessica Zigmond , ModernHealthcare.com issued a statement Thursday saying the hospital will be issuing new or revised policies with respect to physician removal and At issue was the loss of protected health information of 192 transport of protected health information from the hospital's patients of the Boston-based provider's Infectious Disease premises, laptop encryption and USB drive encryption. Associates outpatient practice. HHS' Office for Civil Rights "After these policies and procedures are issued, we will be began an investigation after receiving a complaint from a providing mandatory training on them," Adair's statement patient whose protected health information was lost on March continued. 9, 2009. "All members of our workforce must participate in the training According to the agency, documents consisting of a patient and certify that they have completed it." schedule that contained the names and medical record numbers for a group of 192 patients, as well as billing This week, HHS announced its first fine for a HIPAA violation, encounter forms that contained the name, date of birth, totaling $4.3 million, to Maryland-based insurer Cignet medical record number, health insurer and policy number, Health. diagnosis, and name of providers for 66 of those patients, were lost that day when a Massachusetts General employee left the documents—which were never recovered—on a subway car. More at http://bit.ly/fscnTu
Pentagon Looks to Militarize the Cloud to send or receive large data packets, like video from drones overhead. Some companies are combating the problem by By Spencer Ackerman , Wired mounting cell towers under the bellies of drones, beaming connectivity below. Store tactical military data on distributed servers, accessible through networked computers or mobile devices? Ask most Mobile Hot Spots is Darpa’s way to even out what it calls the officers about cloud computing and they’ll look at you ―100-1000x mismatch of data needs and available network patronizingly and say: Yes, Google Docs is nice, but it’s not capacity.‖ Starting out with a $10 million request to Congress, secure enough for our secrets. (I write from experience.) it looks to ―create high-capacity and secure wireless technologies by exploiting advances in high-frequency and new But Darpa’s new budget shows that it wants the military all the security paradigms using RF, millimeter wave (MMW) and/or way up into the cloud, and plans to set up mobile wireless optical transmission.‖ hotspots so troops can reach the cloud from the most connectivity-forsaken places. If approved, it’ll spend its first year of life developing hardware and network architecture for the mission. Appropriately, the goal of getting big data files to troops on the move in the middle of nowhere is, well, distributed between And it’s considering going the under-drone route, proposing to two new programs from the Pentagon’s blue-sky researchers. ―explore hardware, software, and waveform options to include Cloud to the Edge looks to essentially ape Google’s tools (other unmanned aerial systems, soldiers, and mobile platforms than search) to create a military cloud. And Mobile Hot Spots connected into network topologies.‖ wants to carry connectivity anywhere troops need to share those big data files. Then there’s the place where the data carried over those networks will reside. Cloud to the Edge has no problem Wherever the military goes, it brings bandwidth with it. But it’s distributing that around through the ether. easier to set up networks around big bases than it is to have them follow troops in the field, especially if those troops have More at http://bit.ly/fWoIJB Volume 10, Issue 8 March 4, 2011 Page 4
Privacy and Security - (cont.)
Web's Hot New Commodity: Privacy
By Julia Angwin and Emily Steel, Wall Street Journal
As the surreptitious tracking of Internet users becomes more aggressive and widespread, tiny start-ups and technology giants alike are pushing a new product: privacy.
Companies including Microsoft Corp., McAfee Inc.—and even some online-tracking companies themselves—are rolling out new ways to protect users from having their movements [Ed. Note: monitored online. Some are going further and starting to pay This chart, provided people a commission every time their personal details are used by the Wall Street by marketing companies. Journal, illustrates the "Data is a new form of currency," says Shane Green, chief various companies executive of a Washington start-up, Personal Inc. , which has offering competing raised $7.6 million for a business that aims to help people privacy services. profit from providing their personal information to Services that collect advertisers. and store users’ data are displayed in green; The Wall Street Journal's year-long What They Know services alerting when investigation into online tracking has exposed a fast-growing a user is being network of hundreds of companies that collect highly personal monitored is displayed details about Internet users—their online activities, political in blue; services views, health worries, shopping habits, financial situations and providing reputation even, in some cases, their real names—to feed the $26 billion U.S. online-advertising industry. management are displayed in yellow.] In the first nine months of last year, spending on Internet advertising rose nearly 14%, while the overall ad industry only "I wouldn't give my car to a stranger" for free, Mr. Sequeira grew about 6%, according to data from says, "So why do I do that with my personal data?" PriceWaterhouseCoopers LLP and WPP PLC's Kantar Media. As people are becoming more aware of the value of their data, Testing the new privacy marketplace are people like Giles some are seeking to protect it, and sometimes sell it. In Sequeira, a London real-estate developer who recently began January at the World Economic Forum in Davos, Switzerland, selling his own personal data. "I'm not paranoid about executives and academics gathered to discuss how to turn privacy," he says. But as he learned more, he says, he became personal data into an "asset class" by giving people the right to concerned about how his data was getting used. manage and sell it on their own behalf. Companies are introducing free and paid products that help "We are trying to shift the focus from purely privacy to what people manage the way companies track their online activities. we call property rights," says Michele Luzi, a director at Some services pay people when their personal details are used. consulting firm Bain & Co. who led the Davos discussion. People "have no idea where it is going to end up," he says. Allow, the company that paid Mr. Sequeira, is just one of So in December, Mr. Sequeira became one of the first nearly a dozen start-ups hoping to profit from the nascent customers of London start-up Allow Ltd. , which offers to sell privacy market. Several promise to pay people a commission people's personal information on their behalf, and give them on the sale of their data. Still others sell paid services, such as 70% of the sale. Mr. Sequeira has already received one removing people's names from marketing databases. payment of £5.56 ($8.95) for letting Allow tell a credit-card company he is shopping for new plastic. More at http://on.wsj.com/gm75tX Volume 10, Issue 8 March 4, 2011 Page 5
Health IT
World Economic Forum Drives Health Data pen and paper. The cost of digital support for information is Initiative getting closer to zero and this immediately makes information easier to store, retrieve, share, and aggregate," Raynaud said. By Nicole Lewis, InformationWeek "There are large-scale programs taking place in the most The World Economic Forum has launched the Global Health challenging areas (such as the monitoring of pregnancies by Data Charter, an initiative to advance global health through BRAC, a large NGO in Bangladesh, where midwifes were the management and collection of data. The charter aims to equipped with PDAs), which have shown that it is perfectly enable individuals and patients, health professionals, and feasible and generates immediate and tangible results. policymakers to make more informed decisions through secure access to comprehensive health data. He also said many nations are at a tipping point as they transition from paper-based systems to capturing health data Officials at the World Economic Forum in Geneva said at the electronically, and the hope is that the charter will help foster charter's unveiling last week that accurate health data is not and enable a data-based, digital health era that will address available across health systems operating in developed and global disparities in health. developing countries, and that gaps in data can be overcome through the use of technology, which will be a main driver in "Disadvantaged populations will gain more from improved the collection, analysis, and application of health information. health data management; similar to what has been seen with mobile communication, digital health information has the In an interview with InformationWeek, Olivier Raynaud, head potential to enable a dramatic change in the pace of progress of global health and healthcare industries at the World towards universal coverage and access to health," Raynaud Economic Forum, said the charter is a foundation document said. that can be used by national and individual organizations and clinicians. Healthcare stakeholders, such as health research Developed by the World Economic Forum, the charter covers organizations, academia, providers, insurers, and both clinical health data that will be used for wellness nongovernmental organizations (NGOs), can play a role in and promotion as well as health management and operational data benefit from the capture, storage, sharing, and use of health used for financial and administrative purposes. data. More at http://www.informationweek.com/story/ "Even though it is 2011, most health data is still captured with showArticle.jhtml?articleID=229219488
EHRs, Health IT will Play Expanding Role in adverse event following an immunization. National Vaccine Plan In terms of better use of vaccines, the report said that By Kathryn Foxhall, Government Health IT ―immunization information systems and electronic health records may become increasingly important components of Electronic health records and other health information immunization programs,‖ reducing the problems created by technology will play a growing and significant role in vaccine people having unknown immunization status and receiving safety surveillance and reporting to registries as part of the unneeded vaccine doses. recently released National Vaccine Plan, according to senior Health and Human Services Department officials. The report recommends increasing data sharing and other forms of collaboration across federal agencies and non-federal One of the top priorities of the vaccine plan is to expand and partners, as well as with programs internationally. improve the use of health IT and electronic health records that Vaccination for both children and adults has long been can exchange health information. The plan lays out strategies considered one of the most effective medical care strategies and goals over the next 10 years to develop vaccines, increase and, in recent years, one of the most dynamic. their safety and assure access to a stable supply. For instance, a child born in 1995 could have been protected The movement toward electronic medical records, vaccine against nine diseases through routine vaccination, but that has registries, and other health IT ―is going to make a huge almost doubled, to 17, today, according to the report. difference,‖ said Dr. Bruce Gellin, director of the HHS National Vaccine Program Office, at a meeting of the National Vaccine The document also outlines strategies for developing new and Advisory Committee following the plan’s announcement. improved vaccines, supporting communications for better vaccine decision-making, ensuring a stable vaccine supply, and The vaccine plan, which was published earlier this month, also increasing global disease prevention with vaccines. calls for developing a robust system for collection of medical histories and biological specimens from people who have an More at http://govhealthit.com/newsitem.aspx?nid=76390 Volume 10, Issue 8 March 4, 2011 Page 6
Health IT - (cont.)
Do-It-Yourself Health Care With Smartphones For more and more people, computers and software are becoming a critical part of their health care.
By Sonia Kolesnikov-Jessop, The New York Times
Thanks to an array of small devices and applications for smartphones that gather vital health information and store it electronically, consumers can take a more active role in managing their own care, often treating chronic illnesses — and preventing acute ones — without the direct aid of a physician.
―Both health care providers and consumers are embracing smartphones as a means to improving health care,‖ said Ralf- Gordon Jahns, head of research at research2guidance, which A nurse among paper records, consults a Smartphone for follows the mobile industry. electronic updates. (Source: Getty Images).
He added that the firm’s findings ―indicate that the long- expected mobile revolution in health care is set to happen.‖ service is about to be heavily promoted in Asia. John Hendel, With a rapidly aging population in some parts of the world and chairman of Entra Health Systems, said it would be available curbs on government spending, the use of computer- in Hong Kong on March 29, in partnership with PCCW, and in compatible devices and online tools as part of a program of Singapore, Taiwan, South Korea over the next three months. preventive medicine is a growing industry. ―Asia has a very high number of people with mobile phones A report by Parks Associates in February estimated that in the and with diabetes,‖ Mr. Hendel said. ―It’s a market where there United States alone, revenue from digital health technology is a lot of genetic predisposition to diabetes, the health care and services would exceed $5.7 billion in 2015, compared with system is typically underfunded and paid for by the patients, $1.7 billion in 2010, fueled by devices that monitor chronic and so by coming up with a great cost-effective solution it conditions like hypertension and diabetes and by wellness and allows us to capture a big market piece that is just as important fitness applications and programs. as the U.S. market, if not more important.‖
In January, the French start-up Withings introduced a Wi-Fi- A report in November by research2guidance estimated there enabled cuff that can take your blood pressure and pulse and were more than 17,000 mobile health applications designed for that connects to an iPhone to synchronize the data with smartphones and that many were aimed at and being adopted records kept online. The data can be securely stored on a by health care professionals. It forecast mobile and wireless personal page on the Withings Web site or with other personal health care services would expand significantly to reach 500 health record, or P.H.R., service providers, like Google Health million mobile users, or about 30 percent of an estimated 1.4 and Microsoft’s HealthVault, where it can then be accessed by billion smartphone subscribers worldwide, by 2015. your doctor. Microsoft’s HealthVault and Google Health, introduced in the In February, Entra Health Systems announced a deal with the United States in 2007 and 2008 respectively, offer similar Swedish mobile phone company Doro to make its open platforms that allow people to store and manage their MyGlucoHealth service available on their senior-friendly health information, including immunizations, disease history cellphones. With a small device, blood glucose level readings and prescriptions in one place, with access to the records can be sent by text message to a secure MyGlucoHealth portal, possible via various devices or mobile applications. which provides instant advice to users on what to eat. MyGlucoHealth, which the company introduced in 2008, is The personal information is stored in a secure, encrypted also compatible with Google Health and HealthVault. database and the privacy controls are set entirely by the individual, including what information goes in and who gets to Though MyGlucoHealth is already available around the world see it. using various smartphones and simple mobile phones with Bluetooth, early promotion and partnerships centered on More at http://www.nytimes.com/2011/03/01/ Britain, Australia, Germany, the United States and India. The technology/01iht-srhealth01.html?pagewanted=2&_r=2 Volume 10, Issue 8 March 4, 2011 Page 7
Points of View
Collaborations Are the New Black at which was part of the American Recovery and Reinvestment HIMSS11 Act of 2009. The annual HIMSS Leadership Survey found that 81% of respondents said their facilities will meet Stage 1 meaningful use criteria in 2011 or 2012. Virtually every EHR By Jane Sarasohn-Kahn, Ars Technica vendor promises to incorporate meaningful use Stage 1 While meaningful use was everywhere in exhibit hall of requirements into their EHR offerings. HIMSS11, the annual Healthcare Information and Management Systems Society conference, there's a more subtle The wild card is what Stage 2 might hold for vendors. Earlier and exciting back story going on: Health care is an ecosystem, this week, Chuck Friedman, the Chief Scientific Officer for and providers, plans, suppliers, pharmacies and patients all ONC, told vendors at the HIMSS Usability Symposium that have data that must move, combine and be analyzed in their they should expect Stage 2 to require them to incorporate communities. usability into EHR development, coordinating through the National Institute of Standards and Technology. Sure, there's the nearly one-half million square feet of exhibition space with some 31,000 attendees milling about to This could present an additional work stream challenge for kick tires on electronic health records, data warehouses, vendors, whose approach to usability hasn't had to walk the business analytics systems and mobile communications disciplined line that medical device and other health care networks. But the new-new message of HIMSS is that health technologies have been doing for a decade. care is an ecosystem of many stakeholders, and it's time for the Setting the health-political context for 2011. Former data that each player generates to come together for purposes Secretary of Labor Robert Reich's keynote kicking off HIMSS11 of individual patient health care quality, value-for-money and warned that the Great Recession of 2008 generated anger in public health. Of course, that's a vision, and there's a precursor the bottom 90% of people living in the U.S. That angst comes -journey and miles to go before we get "there." from the erosion of the American Dream: Falling property Meaningful Use, Jobs #1-4. Over the next four years, values threaten the financial security of most Americans who providers will work very hard to get their ducks in a row to look to their homes as their primary asset. meet the HITECH Act's milestones for meaningful use of
EHRs. If they don't, providers will not qualify for their share of More at http://www.ihealthbeat.org/perspectives/2011/ $21 billion worth of incentive funding included in the act, collaborations-are-the-new-black-at-himss11.aspx
HIMSS: Cost, Lack of Data Will Not Prevent there is still reluctance among some physicians on the subject EHR Adoption of adopting EHRs.
By Jeff Byers, CMIO In 2007 and 2008, only 4 percent of physicians had a fully functional EHR, while 13 percent had a basic system, Dentzer Even though there hasn’t been any robust statistically stated. She listed the classic examples of barriers to significant relationship between adoption of EHRs and quality implementation including the lack of capital resources to and efficiency among practicing physicians, it’s a no-brainer to invest in them, concern about physicians inability to input invest in an EHR, stated Susan Dentzer, editor-in-chief Health data, lack of support from a practice’s physicians and concern Affairs during an educational session Feb. 21 at the 2011 about the loss of productivity. Health Information Management & Systems Society (HIMSS) conference. However, Dentzer mentioned another, less considered reason: Lack of familiarity. Dentzer quoted from a January Markle Citing data from the Health Information Exchange of Southern Foundation survey that while 64 percent of respondents said Illinois, Dentzer mentioned that the total estimate for a they were "somewhat or very familiar" with the HITECH practice to upfront the cost of an EHR and finance the system incentives and 36 percent were not very familiar, those itself is $37,000 to $58,000. numbers belie their true implications.
But the total estimated savings in time and money for one year More likely, physicians are not as familiar with HITECH relating to the adoption of an EHR for the average incentives as that survey data suggest, she remarked. And yet independent practice is $14,956. Medical Economics estimated physicians are in the business to improve quality, safety and a $40,000 loss to physicians down-coding one level, she said. efficiency, and want the ability to access charts remotely, e- prescribe, receive health maintenance reminders and get Despite the fact that $44,000 is ―not chicken feed‖ for eligible prescription refill management use. physicians to adopt and meaningfully use EHRs, and Medicaid payment bonuses can equal up to $63,750, Dentzer noted More at http://bit.ly/eubghf Volume 10, Issue 8 March 4, 2011 Page 8
Points of View - (cont.)
It Takes a Network and rally their fighters. They aimed to keep dispersed insurgent cells motivated, strategically wired, and continually The new frontline of modern warfare. informed, all without a rigid -- or targetable -- chain of By Stanley A. McChrystal, Foreign Policy command.
From the outset of my command in Afghanistan, two or three While a deeply flawed insurgent force in many ways, the times each week, accompanied by a few aides and often my Taliban is a uniquely 21st-century threat. Enjoying the Afghan counterparts, I would leave the International Security traditional insurgent advantage of living amid a population Assistance Force headquarters in Kabul and travel across closely tied to them by history and culture, they also leverage Afghanistan -- from critical cities like Kandahar to the most sophisticated technology that connects remote valleys and remote outposts in violent border regions. severe mountains instantaneously -- and allows them to project their message worldwide, unhindered by time or filters. Ideally, we left early, traveling light and small, normally using a combination of helicopters and fixed-wing aircraft, to meet They are both deeply embedded in Afghanistan's complex with Afghans and their leaders and to connect with our troops society and impressively agile. And just like their allies in al on the ground: Brits and Marines rolling back the enemy in Qaeda, this new Taliban is more network than army, more a Helmand, Afghan National Army troops training in Mazar-e- community of interest than a corporate structure. Sharif, French Foreign Legionnaires patrolling in Kapisa. For the U.S. military that I spent my life in, this was not an But I was not alone: There were other combatants circling the easy insight to come by. It was only over the course of years, battlefield. Mirroring our movements, competing with us, were and with considerable frustrations, that we came to insurgent leaders. Connected to, and often directly dispatched understand how the emerging networks of Islamist insurgents by, the Taliban's leadership in Pakistan, they moved through and terrorists are fundamentally different from any enemy the the same areas of Afghanistan. They made shows of public United States has previously known or faced. In bitter, bloody support for Taliban shadow governors, motivated tattered fights in both Afghanistan and Iraq, it became clear to me and ranks, recruited new troops, distributed funds, reviewed to many others that to defeat a networked enemy we had to tactics, and updated strategy. become a network ourselves.
And when the sky above became too thick with our drones, More at http://www.foreignpolicy.com/articles/2011/02/22/ their leaders used cell phones and the Internet to issue orders it_takes_a_network
“We believe in health IT” ―We believe in health IT because it's an investment in a stronger economy‖ and understand its ―huge job-creating HHS Secretary Kathleen Sebelius called on potential,‖ Sebelius said. members of the health information technology community to stay the course with healthcare ―There is no doubt we're in a very tough budget environment,‖ she said, noting the Obama administration has proposed reform and the government's meaningful-use hundreds of billions of dollars in budget cuts. But the health information technology incentive program. administration also realizes ―it's equally important to keep the investments that will keep our economy growing‖ and to By Timothy B. Lee, Ars Technica improve the health of the nation. The Obama budget includes a 25% increase to run the ONC, she said. HHS Secretary Kathleen Sebelius called on members of the health information technology community to stay the course ―Close to a third of our healthcare spending, about $700 billion with healthcare reform and the government's meaningful-use a year, goes to pay for healthcare that doesn't benefit anyone's health information technology incentive program while health,‖ she said. outgoing ONC head Dr. David Blumenthal delivered his swan song as the two delivered back-to-back keynote speeches ―We need you to be a part of the conversation to improve Wednesday at the HIMSS convention in Orlando, Fla. health in the country. Healthcare reform needs IT, but health IT needs healthcare reform,‖ she said. Sebelius said that despite ―lots of disagreement‖ in Congress on budget deficits and other matters, health information ―We need you to be more than advocates for the technology. technology ―is one of those issues where Democrats and We need you to be advocates for the healthcare system that Republicans stand together.‖ makes these systems have the most impact.‖
The Obama administration also remains firmly supportive, she More at http://bit.ly/f3j7Zw said. Volume 10, Issue 8 March 4, 2011 Page 9
Points of View - (cont.)
Carrots, Sticks and Digital Health Records Representative Tom Latham, an Iowa Republican, to reclaim unspent stimulus dollars — and money for accelerating the By Steve Lohr, The New York Times adoption of electronic health records could be a target. The United States is embarking this year on a grand Still, steps to encourage adoption of computerized health experiment in the government-driven adoption of technology records have had bipartisan support over the years, though — ambitious, costly and potentially far-reaching in impact. The only the Obama administration has pushed for big financing. goal is to improve health care and to reduce its long-term Most health policy analysts say it is unlikely that the legislation expense by moving the doctors and hospitals from ink and will be overturned. When well designed and wisely used, paper into the computer age — through a shift to digital patient computerized records have proved valuable in improving care. records. Doctors have more complete information in treating patients, Step back from the details and what emerges is a huge reducing the chances of medical errors and unneeded tests. challenge in innovation design. What role should government But the success stories to date have come mainly from large have? What is the right mix of top-down and bottom-up health care providers, like Kaiser Permanente, the Mayo Clinic efforts? Driving change through the system will involve shifts and a handful of others. Most physicians are in small practices, in technology, economic incentives and the culture of health lacking the financial and technical support the big groups care. provide for their doctors. So it is scarcely surprising that less ―This is a big social project, not just a technical endeavor,‖ says than 30 percent of physicians nationwide now use digital Dr. David Blumenthal, the Obama administration’s national records. coordinator for health information technology. Late last year, the administration, working with health This year is when the project really takes off. In the 2009 professionals and the technology industry, set out a roadmap economic recovery package, the administration and Congress for what digital records should include and how they should be allocated billions — the current estimate is $27 billion — in used, for doctors to qualify for incentive payments, typically up incentives for doctors and hospitals to adopt electronic to $44,000. The program begins this year, and will increase in records. stages through 2015.
Now, a new Congress with Republicans looking for budget cuts More at http://www.nytimes.com/2011/02/27/business/ could take back the money. Legislation has been introduced by 27unboxed.html
Social Networking's Newest Friend: stop it. Traditional methods for analyzing transmission Genomics patterns created only a hazy picture. Molecular analysis of specimens collected from patients suggested everyone was The first large-scale study to combine genome infected with the same strain. "Based on the information we sequencing and social-network analysis solves a had, we couldn't really figure out who was giving it to whom," mysterious TB outbreak. says Patrick Tang, a medical microbiologist at the BCCDC. So Tang and collaborators combined two tools to create a By Emily Singer, technology review much clearer picture of the outbreak: social-network analysis, which has become increasingly common in tracking infectious It was the baby's case that first caught people's attention: an disease over the last decade, and whole-genome sequencing— infant in a medium-sized community in British Columbia that an analysis of the microbe's entire DNA sequence. The latter, was diagnosed with tuberculosis in July 2006. When public which has been applied to outbreaks in only a few cases to health workers took a deeper look at the community's medical date, allows much more precise tracing of infections than records, they found a number of additional cases suggestive of traditional molecular techniques, which look at only a few an outbreak. By December 2008, 41 cases had been identified, spots in the genome. bumping up the region's annual incidence rate by a factor of 10. "For the first time, we can paint a really detailed picture of the relationships between people in the community and a really Officials at the BC Centre for Disease Control (BCCDC) were detailed picture of the relationships between the bacteria faced with the question at the heart of any outbreak: what was themselves," says Jennifer Gardy, head of the BCCDC's the source? Had the bacteria that cause TB mutated to become Genome Research Laboratory and lead author on the study. more infectious? Or was there some change in the community "We can reconstruct the path an organism took throughout a that made the microbes more likely to spread? population." The answer would be crucial in focusing public health efforts to More at http://bit.ly/g33hUI Volume 10, Issue 8 March 4, 2011 Page 10
Points of View - (cont.)
Cyberspace Wars the pieces,‖ but ―the cyber-universe is complex well beyond anyone’s understanding and exhibits behavior that no one By Joseph S. Nye Jr., The New York Times predicted, and sometimes can’t even be explained well.‖ This year, the 47th Munich Security Conference included for Unlike atoms, human adversaries are purposeful and the first time a special session on cybersecurity. ―This may be intelligent. Mountains and oceans are hard to move, but the first time,‖ the president of a small European noted to the portions of cyberspace can be turned on and off at the click of a high-powered assembly, more accustomed to dealing with mouse. It is cheaper and quicker to move electrons across the armies and alliances than with worms and denial-of-service globe than to move large ships long distances through the attacks, ―but it will not be the last.‖ friction of salt water. Until now, the issue of cybersecurity has largely been the The costs of developing multiple carrier taskforces and domain of computer geeks. When the Internet was created 40 submarine fleets create enormous barriers to entry and make it years ago, this small community was like a virtual village of possible to speak of U.S. naval dominance. In contrast, the people who knew each other, and they designed a system with barriers to entry in the cyber-domain are so low that nonstate little attention to security. actors and small states can play significant roles at low levels Even the commercial Web is only two decades old, but as of cost. British Foreign Secretary William Hague reminded the Munich In my book, ―The Future of Power,‖ I describe diffusion of conference: It has exploded from 16 million users in 1995 to power away from governments as one of the great power shifts more than 1.7 billion users today. in this century. Cyberspace is a perfect example of the broader This burgeoning interdependence has created great trend. The largest powers are unlikely to be able to dominate opportunities and great vulnerabilities. Security experts this domain as much as they have others like sea, air or space. wrestling with cyber-issues are at about the same stage in understanding the implications of this new technology as While they have greater resources, they also have greater nuclear experts were in the early years after the first nuclear vulnerabilities, and at this stage, offense dominates defense in explosions. cyberspace.
The cyber-domain is a volatile manmade environment. As an More at http://www.nytimes.com/2011/02/28/opinion/28iht- advisory panel of defense scientists explained, ―people built all ednye28.html?ref=global
Treat the Patient, Not the CT Scan Better still, if Watson could harness data from all the patients By Abraham Verghese, The New York Times in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. The other day as I walked through a wing of my hospital, it occurred to me that Watson, I.B.M.’s supercomputer, would be For example, Watson might recognize that the kidney failure in more at home here than he was on ―Jeopardy!‖ Perhaps it’s our patient is linked to kidney failure in a patient in Buffalo good, I thought, that his next challenge, with the aid of the and another in San Antonio; all three patients, he might Columbia University Medical Center and the University of inform me, were taking a ―natural‖ weight loss supplement Maryland School of Medicine, will be to learn to diagnose that contained a Chinese herb, aristolochia, that has been illnesses and treat patients. associated with more than 100 cases of kidney failure. In short, Watson would be a potent and clever companion as we made On our rounds of the wards, Watson would see lots of other our rounds. computers with humans glued to them like piglets at a sow’s teats. We might visit a patient with a complex illness — one But the complaints I hear from patients, family and friends are whose second liver transplant has failed, who has a fungal never about the dearth of technology but about its excesses. meningitis and now also has kidney failure and bleeding and is My own experience as a patient in an emergency room in on a score of medications. another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, Watson might help me digest the sheer volume of data that is her back to me while she clicked and scrolled away. Over her in the electronic medical record and might see trends in the shoulder she said, ―On a scale of one to five how is your ...?‖ data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my The electronic record of my three-hour stay would have looked attention a case report published the previous night in a perfect, showing close monitoring, even though to me as a Swedish journal describing a new interaction between two of patient it lacked a human dimension. reside in there. the drugs my patient is taking. More at http://nyti.ms/g6NbUj Volume 10, Issue 8 March 4, 2011 Page 11
Points of View - (cont.)
Freedom and Anonymity: Keeping the that some law-enforcement experts have called for a wholesale Internet Open reworking of Internet architecture and protocols, such that every packet of data is engraved with the identity of its source. Fear of cyberattacks should not lead us to The idea is to make punishment, and therefore deterrence, destroy what makes the Internet special possible. Unfortunately, such a reworking would also threaten what makes the Internet special, both technologically and By Jonathan Zittrain, Scientific American socially. It’s starting to get weird out there. When WikiLeaks released classified U.S. government documents in December, it sparked The Internet works thanks to loose but trusted connections several rounds of online conflict. WikiLeaks became the target among its many constituent parts, with easy entry and exit for of denial-of-service attacks and lost the support of its hosting new Internet service providers or new forms of expanding and payment providers, which inspired sympathizers to access. That is not the case with, say, mobile phones, in which counterattack, briefly bringing down the sites of Master•Card the telecom operator can tell which phone placed what call and and a few other companies. to whom the phone is registered. Establishing this level of identity on the Internet is no small Sites related to the hackers were then attacked, and mirror task, as we have seen with authoritarian regimes that have sites sprang up claiming to host copies of the WikiLeaks docu• sought to limit anonymity. It would involve eliminating free ments—although some were said to carry viruses ready to take and open Wi-Fi access points and other ways of sharing over the machines of those who downloaded the copies, for connections. Terminals in libraries and cybercafes would have who knows what end. Months before, an FBI official said to have verified sign-in rosters. Or worse, Internet access disruption of the Internet was the greatest active risk to the would have to be predicated on providing a special ID akin to a U.S. ―other than a weapon of mass destruction or a bomb in government-issued driver’s license—perhaps in the form of a one of our major cities.‖ USB key. No key, no bits. To be sure, this step would not stop criminals and states wanting to act covertly but would force Attacks on Internet sites and infrastructure, and the them to invest much more to achieve the anonymity that compromise of secure information, pose a particularly tricky comes so naturally today. problem because it is usually impossible to trace an attack back to its instigator. This ―attribution problem‖ is so troublesome More at http://www.scientificamerican.com/article.cfm? id=freedom-and-anonymity
Diving into 'Do Not Track' What Is Do Not Track? Four myths you should know about ―Do Not When you visit a typical commercial website, that website is far from the only one that knows what you have been doing on Track‖ technology. that site: third-party companies typically contract with By ABC World News websites for permission to track your behavior across many, many sites. Some websites, such as dictionary.com, contract Internet privacy is the new black (or at least it's the new with hundreds of these data collectors (many of whom are green). A recent eye-opening investigative series in the Wall advertising networks or are associated with advertising Street Journal exposed the complex web of companies that are networks). "tracking" your every move online, and just how much information about you and your online behavior they're The information gleaned from your online wanderings is collecting in the process. valuable and can be sold to data aggregators who will update your digital dossier or to companies in the advertising industry It's been nearly a decade since Congress first tried and failed to that will use it to target ads at you. In other words, what pass a privacy law. That void is a cause of consumer outcry, happens on dictionary.com -- and most popular websites -- and Washington is finally listening. does not stay on dictionary.com.
Congress now has several privacy bills — delivered or promised Many responsible individual advertising networks allow — ready for debate and more are poised for introduction. The consumers to opt out of this third-party data collection. But Federal Trade Commission and the Commerce Department consumers cannot be reasonably expected to hunt down every have both weighed in on how best to approach online ad network out there and tell them, one at a time, "Do not consumer privacy. These efforts have converged to create a track me!" raucous conversation about how technology and policy can work in concert to protect and enhance Internet privacy. More at http://abcnews.go.com/Technology/tracking-online- myths-track/story?id=12984499&page=2 Volume 10, Issue 8 March 4, 2011 Page 12
Points of View - (cont.)
Patient Privacy Rights Extend Beyond U.S. way we respect patients in the United States, why are we even Borders, Ethicists Say going?"
By John Commins, for HealthLeaders Media UF researchers examined the Facebook profile pages of 1,023 medical students and residents, finding no breaches of Most U.S. healthcare providers would never photograph patients' privacy in the United States. However, they found 12 patients and post the pictures on the Internet. Doing so, they photos of patient care in developing countries. understand, would violate patient confidentiality, and would merit substantial fines for breaching the federal Health Every year, students from all health fields work in clinics in Insurance Portability and Accountability Act. medically underserved nations, such as the Dominican Republic, Haiti, and Ecuador. It's a chance to get hands-on Yet, some U.S. physicians, nurses, medical students, and other experience in a patient-care setting and help people who providers who volunteer their medical skills in developing sometimes travel days for care. nations have posted pictures of their patients on Facebook and other social media Web sites. That doesn't violate HIPAA HIPAA doesn't apply to patients outside of the United States, because it's beyond U.S. borders, but it is a breach of ethics, says Lindsay Thompson, MD, an assistant professor of University of College of Medicine researchers write in a pediatrics in the College of Medicine, and a lead author of the Journal of Medical Internet Research study. The researchers report. If a nation has privacy laws in place, doctors must want providers to respect privacy rights for all patients, follow them when practicing there. regardless of where they're treated and where they live. In addition, Thompson says, doctors are ethically bound to "A medical student would not take a picture of a patient in follow the laws of the state or country where they practice. "We clinic here and post it on Facebook," said Erik Black, an in the medical profession have to be held to a different assistant professor of pediatrics with the UF College of standard. Our actions, however altruistic they are, could have Medicine and a lead author of the paper. "But there is a some unintended consequences," Thompson said. disconnect on these trips. We are not respecting these people as individuals. If we are not going to respect them in the same More at http://bit.ly/h3n3zD
Watson is Just a Super Search Engine technology and had an internal ―private‖ engine that was as Commentary: pure algorithmic search is the holy good as anything commercially available. I followed its development closely, and somewhere along the line IBM grail. dropped the idea. By John C. Dvorak, Market Watch But this indicated to me that the company had some interest. If we learned one thing by watching the Watson computer Surely the attention (and money) given to Google must have challenge real humans on the ―Jeopardy!‖ game show, it’s that been noticed by now. International Business Machines Corp. has developed a new kind of search engine. When I think of the possibilities, I wonder if the algorithms That’s what this is all about, a search engine, probably called can be used for more than trivia but to determine the kind of Watson that will obviously take straight English queries and websites that people are looking for. deliver answers. This has been the promise of numerous search engines, beginning with Ask Jeeves. That idea is still being In other words, can these algorithms deliver the same kind of explored by Ask.com, owned by IAC/InterActive Corp. results as Google? I don’t see why not. Pure algorithmic search results without needing to cache the entire Internet every few This Watson device should go online immediately — assuming minutes is a holy grail of these technologies. it actually works and is scalable.
All we know so far is that IBM intends to produce a medical- More at http://www.marketwatch.com/story/watson-is-just-a- expert system using the technology. super-search-engine-2011-02-18
During the heyday of the AltaVista search engine and the early days of Google Inc., IBM had been playing around with search Volume 10, Issue 8 March 4, 2011 Page 13
New Reports and Papers
Treasure Trove or Trouble: Cyber-Enabled Decades of technological advancement notwithstanding, the Intelligence and International Politics U.S. Intelligence Community (IC) is wise to embrace this By Dr. Chris Bronk, Rice University reality, continue to develop the enhanced operating picture produced by Information Technology (IT), and construct Oft-mentioned in the lore of U.S. intelligence is the quip of pragmatic, interdisciplinary mechanisms and practices former Secretary of War and State, Henry Stimson, who designed to protect information resources and at the same offered the belief, ―Gentlemen don’t read each other’s mail,‖ as time maintain the capacity to purloin foreign-held information explanation for closing the State Department’s code-breaking of benefit to national security. What this does not mean is that cryptanalytic office, the Black Chamber, in 1929. Dismissed as there shall be no rules in cyberspace for government or the IC. error by the Chamber’s director, Herbert Yardley, as a naïve On the contrary, cybercrime and malicious acts designed to mistake, intercepting, decrypting, and capturing information subvert critical systems should be thwarted at every possible remains a fundamental component of the intelligence opportunity. In addition, the IC should respect intellectual enterprise. Nearly a century after the closing of Yardley’s property protected by copyright, patent, and trade secret. office, much has changed in communications technology, but Maintaining these positions while accepting the realities of the idea that mass connectivity through cyberspace to contemporary global interactions—a post-Cold War, post-9/11, enormous repositories of information somehow changes the post- Internet world—will not be easy, but it should be larger political and ethical issues surrounding intelligence accepted that doctrine regarding the cyber domain of collection is a red herring. Nation-states can, and will continue intelligence is not written on a blank slate. In cyber to, collect information regarding strategic dispositions and intelligence, the sources and methods are markedly changed, intentions in their quest for security. As Microsoft’s but that does not mean that the macro issues regarding trustworthy computing chief Scott Charney argues, ―It is intelligence collected by the cyber channel cannot be liberally important to recognize that military espionage has been borrowed from other domains. occurring from time immemorial, and that some victims of military espionage may be engaged in such espionage activities More at http://www.bakerinstitute.org/publications/ITP-pub- themselves.‖ BronkTreasureTroveAIJ-022211.pdf
Privacy and Security in Health Care: A industry preparedness. Fresh Look
By Paul H. Keckly, PhD, Sheryl Coughlin, PhD, MHA, & Privacy and security is a significant challenge for every health Shiraz Gupta, PharmD, MPH, Deloitte LLP care organization and a concern for every U.S. citizen.
Foreword On September 20, 2010, a computer flash drive containing the names, addresses, social security numbers (SSNs), and The United States health care industry is data-rich. Every protected health information (PHI) of 280,000 Medicaid encounter with the system results in an electronic footprint. members was stolen from the corporate offices of a health The promises of connectivity – electronic and personal health plan. On May 3, 2006, a laptop and disc containing personal records, clinical warehousing, home monitoring, distance health information (names, SSNs, date of birth, and other medicine, and more – mean exponential increases in data and, information) for 26.5 million veterans was stolen from a in tandem, exponential opportunities for breaches of privacy Veterans Administration (VA) employee’s home. and security of personal health information. Personal health information about Congresswoman Nydia Facebook Co-Founder Mark Zuckerberg is a household name Velasquez, country singer Tammy Wynette,2 and ―octomom‖ because his trade – connectivity, information, data flow – and Nadya Suleman were accessed, resulting in civil fines3 and ―data‖ has ubiquitous impact on daily lives. Health care embarrassment to reputable health systems. information is no less ubiquitous.
More at http://www.deloitte.com/us/ This Issue Brief provides a primer on risks associated with privacyandsecurityinhealthcare privacy and security in health care and guidance about Volume 10, Issue 8 March 4, 2011 Page 14
Reports and Papers - (cont.)
Preventing a Data Breach and Protecting Economic and Clinical Health (HITECH) Act was passed, Health Records One Year Later: Are You changing the landscape of the healthcare industry Vulnerable to a Breach? dramatically. Incentives, sanctions and penalties regarding non-compliance with the security and privacy of electronic By Staff Writer, Kaufman, Rossin & Co. protected health information have been implemented for healthcare providers and their business associates. Introduction
It was a typical Wednesday afternoon for Jane Smith, the CEO It’s anticipated that there will be a significant amount of of a large hospital, when she received an alarming phone call electronic health information being exchanged between from her Information Security Officer (ISO). providers and associates so federal regulations were implemented to improve security and reduce vulnerabilities. The ISO informed her that one of their employees had left a There are administrative, physical and technical safeguards laptop case in the open on the back seat of his car. When he that must be in place in every covered entity and business finished lunch and returned to his car he found the back associate. window broken and the laptop case missing. As of September 23, 2010, there were 166 data breach Both the laptop and his flash drive were in the case and incidents involving over 500 individuals reported to the contained patients’ protected health information (PHI). The Department of Health and Human Services (HHS) and posted CEO realized her hospital might be in serious trouble over an on their website. These incidents involved 4,905,768 incident that easily could’ve been prevented. Yet she remained individuals who had their PHI compromised. The largest of calm and ensured that the ISO did the same as she started these incidents exposed 1,220,000 individuals in December plotting their next move. ―What do we do now?‖ she asked 2009 resulting from the theft of an unencrypted laptop. herself. More at http://www.kaufmanrossin.com/whitepapers/ On February 17, 2010 the Health Information Technology for process.asp
National eHealth Collaborative Reveals solutions. Results of Stakeholder Survey ―From the perspective of a collaboration among healthcare Wide range of stakeholders weigh in on priorities, organizations that are facing many of the barriers identified in concerns, and barriers to making effective health this survey, I believe that NeHC is making a substantial information exchange a reality. contribution by bringing these issues to light and encouraging the key sectors in the health IT marketplace to focus on By Meryt McGindley, National eHealth Collaborative producing collaborative solutions. National eHealth Collaborative (NeHC) today announced the This survey is just the beginning of an invaluable dialogue results of its first ever Stakeholder Survey, identifying privacy about what we need to do to achieve a sustainable and robust and security, sustainability and funding as the top three pain nationwide health information exchange,‖ said Holt Anderson, points in health information exchange (HIE). Executive Director of the North Carolina Healthcare Information and Communications Alliance (NCHICA) and NeHC established this survey initiative in December 2010 to member of the NeHC Board of Directors. encourage stakeholders across a wide range of specialties to contribute their suggestions on major concerns in health ―Through this survey, NeHC is playing an important role in information exchange. getting all stakeholders in the health information exchange effort on the same page to focus on common problems and NeHC’s Stakeholder Survey also solicited opinions on the common goals. issues that are in greatest need of information distribution or are best primed for collaborative projects to develop innovative More at http://bit.ly/evj2tS Volume 10, Issue 8 March 4, 2011 Page 15
Reports and Papers - (cont.)
Wikileaks and Cyberspace Cultures in security, but for the very future of cyberspace. Conflict In December 2010, Wikileaks released some 250,000 By Eric Sterner, The George C. Marshall Institute classified diplomatic cables that embarrassed policymakers Introduction around the world, exposed classified government activities, and provided ammunition to one side or the other, in any Every few months, Wikileaks and its founder, Julian Assange, number of public policy debates—debates not limited to the make headlines for publicizing yet more titillating information United States. More dire, the most recent release included passing through the U.S. government’s classified systems. Each information that identified critical infrastructure round of publication does real damage to U.S. national vulnerabilities. interests, compromising relations with other countries and revealing to current and potential adversaries the internal Earlier mass releases of classified information and unfiltered thought processes of the U.S. government. Policymakers tend military reports from Iraq and Afghanistan placed the lives of to approach these problems episodically -- they view Wikileaks U.S. allies and pro-democracy forces at risk by, among other as a specific challenge. things, giving terrorist groups a ―hit list.‖ In short, Wikileaks is successfully waging a concerted disclosure campaign that, It may be that, but it also symbolizes a burgeoning conflict intentionally or not, damages U.S. national security and between two differing views of cyberspace and how it relates to interests via cyberspace. The group’s founder, Julian Assange, society. One perspective generally holds that cyberspace must for example, has primarily described his purpose as enhancing be managed in such a way that conforms it to society’s existing public insight into the operations of large institutions. institutions, particularly in matters related to national security. According to Assange, Wikileaks’ goal is to create ―a world Another philosophy holds that cyberspace is fundamentally where companies and government must keep the public, or reordering society and that, in doing so, it will unleash new their employees, or both, happy with their plans and behavior.‖ possibilities in the story of human liberty. That conflict will run for decades, with consequences not just for U.S. national More at http://www.marshall.org/pdf/materials/931.pdf
Peer-to-peer Healthcare This report is based in part on a national telephone survey of Many people – especially those living with 3,001 adults which captures an estimate of how widespread this activity is in the U.S. chronic or rare diseases – use online connections to supplement professional medical advice. All numerical data included in the report is based on the telephone survey. The other part of the analysis is based on an By Susannah Fox, Pew Research Center’s Internet & American Life Project online survey of 2,156 members of the National Organization for Rare Disorders (NORD) who wrote short essays about their Summary of Findings use of the internet in caring for themselves or for their loved ones. The internet gives patients and caregivers access not only to information, but also to each other. Many Americans turn to One in five internet users have gone online to find others like friends and family for support and advice when they have a them. Eighteen percent of internet users say they have gone health problem. online to find others who might have health concerns similar to theirs. This report shows how people’s networks are expanding to include online peers, particularly in the crucible of rare The most striking finding of the national survey is the extent of disease. peer‐to‐peer help among people living with chronic conditions.
Health professionals remain the central source of information More at http://www.pewinternet.org/~/media//Files/ for most Americans, but ―peer‐to‐peer healthcare‖ is a Reports/2011/Pew_P2PHealthcare_2011.pdf significant supplement. Volume 10, Issue 8 March 4, 2011 Page 16
Reports and Papers - (cont.)
Social Networks, Privacy, and Freedom of cities but many here in the United States share the worries of Association those Egyptian protesters when it comes to privacy, including privacy of their political views but not just political privacy. How individual rights can both encourage and reduce uses of personal information. These deeply held worries about information sharing must be considered given the growing role of social networking in our By Peter Swire, Center for American Progress society—from Barack Obama’s successful online political Introduction campaign that helped propel him into the presidency in 2008 to the Tea Party’s successful social networking activism The ongoing political transformation in Egypt highlights the beginning a year later. crucial role that social networks play in helping individuals organize politically. Facebook was central to the initial sweep This report explores the tension between information sharing, of Egyptians onto the streets of their nation’s main cities, which can promote the freedom of association, and limits on allowing dispersed individuals to organize effectively. information sharing, notably for privacy protection.
And democracy protesters could fear, if the popular movement Although many experts have written about one or the other, to displace President Hosni Mubarak had not been successful, my research has not found any analysis of how the two fit that the regime would be able to track them down individually, together—how freedom of association interacts with privacy in part through their Facebook accounts. protection.4 My analysis here, which I offer as a ―discussion draft‖ because the issues have not been explained previously, At precisely the same time that everyday Egyptians were highlights the profound connection between social networking pouring out of their homes in protest, the U.S. Federal Trade and freedom of association. Commission was receiving comments on how new online technologies, including social networks, affect privacy. The More at http://www.americanprogress.org/issues/2011/02/ FTC request obviously did not spark protests across American social_networks_privacy.html
The Failure of Online Social Network a majority of users cannot or will not fix such errors. We Privacy Settings conclude that the current approach to privacy settings is By Michelle Madejski, Maritza Johnson, & Steven M. Bellovin, fundamentally flawed and cannot be fixed; a fundamentally Columbia University different approach is needed. We present recommendations to ameliorate the current problems, as well as provide Abstract suggestions for future research.
Increasingly, people are sharing sensitive personal information To the best of our knowledge this is the first attempt to via online social networks (OSN). While such networks do measure the correctness of privacy settings by first surveying permit users to control what they share with whom, access user's sharing intentions, to aid the process of identifying control policies are notoriously difficult to configure correctly; potential violations, then confirming the potential violations this raises the question of whether OSN users' privacy settings with the user. match their sharing intentions. We argue that this method produces a more accurate We present the results of an empirical evaluation that evaluation compared to passive data collection. This work measures privacy attitudes and intentions and compares these draws upon many themes including: research on online social against the privacy settings on Facebook. network (OSN) usage, surveys on privacy attitude, and evaluations of users' ability to manage access control policies. Our results indicate a serious mismatch: every one of the 65 participants in our study confirmed that at least one of the More at https://mice.cs.columbia.edu/getTechreport.php? identified violations was in fact a sharing violation. In other techreportID=1459&format=pdf& words, OSN users' privacy settings are incorrect. Furthermore, Volume 10, Issue 8 March 4, 2011 Page 17
Reports and Papers - (cont.)
Protecting Human Rights in the Digital Age and social networking, the characteristics of the ICT industry and its interaction with society are in constant flux. Understand evolving freedom of expression and privacy risks in the Information and Seemingly innocuous changes to the ICT landscape—such as Communications Technology Industry. altering the internet domain name system to allow non-roman characters, or massively increasing the number of IP By Dunstan Allison Hope, BSR addresses—can have significant social implications. Introduction A world in which a car is also a computer and household We live in a world today where vast Information and devices are connected to the internet (the so-called ―internet of Communications Technology (ICT) infrastructures and things‖) will be a very different place. extensive flows of information have become natural and unquestioned features of modern life. This increasingly pervasive, unpredictable, and rapidly changing interaction between ICT and society brings with it a Rapidly growing online services—everything from social media wide range of new human rights risks and ethical dilemmas for to ecommerce and virtual collaboration—have come to define companies in the ICT industry, especially for how to protect our day-to-day lives in ways unimaginable just a decade ago. and advance freedom of expression and privacy online.
Yet the role of ICT in society continues to evolve at a rapid The way in which private sector corporations respond to these pace, with new developments constantly altering the risks and dilemmas will affect the lives of billions of ICT users interaction between ICT and the way we lead our lives. all around the world.
Whether it is the increasing use of mobile devices to access More at http://www.bsr.org/reports/ internet content, the trend toward remote storage (―cloud BSR_Protecting_Human_Rights_in_the_Digital_Age.pdf computing‖), or the rapid growth of user-generated content
Effect of Internet Health Information on The aim of this paper is to analyze how the health information Health Care Use that people obtain from the Internet affects their health care By Agne Suziedelyte utilization. To capture this effect, I construct a binary variable that indicates whether or not an individual has recently Abstract searched for health information on the Internet. Health care utilization is measured by the number of visits to a health This study estimates the effect of Internet health information professional in the past 12 months. on health care utilization. The causal variable of interest is a binary variable that indicates whether or not an individual has Since the probability of using the Internet to search for health used the Internet to search for health information. information is likely to endogenous, I use instrumental variable estimation methods. Survey data shows that an Health care utilization is measured by an individual's number individual's probability of searching for health information of visits to a health professional. I use the variation in online is related to having high-speed Internet access at home telecommunication laws of U.S. states as a novel instrument to (Fox and Jones, 2009, p.8). As an instrument, therefore, I use identify the causal effect. U.S. state telecommunication policies that are shown to affect the supply of high-speed Internet services. I find that Internet The analysis results show that, on average, using the Internet health information has a positive economically and statistically as health information source increases the utilization of health significant effect on health care utilization. care. The effect is quantitatively large and precisely estimated. An ordinary least squares regression underestimates the effect, More at http://papers.ssrn.com/sol3/papers.cfm? even after controlling for a number of observed individual abstract_id=1764093 characteristics. Volume 10, Issue 8 March 4, 2011 Page 18
Reports and Papers - (cont.)
Many Physicians are Willing to Use physicians. Female physicians were significantly less willing to Patients’ Electronic Personal Health use these tools than their male peers (34 percent versus Records, but Doctors Differ by Location, 46 percent). Gender, and Practice Physicians broadly have concerns about the impact on By Matthew K. Wynia, Director of the Institute for Ethics, patients’ privacy, the accuracy of underlying data, their American Medical Association; Gretchen Williams Torres, potential liability for tracking all of the information that might doctoral student in public policy at the University of Chicago; be entered into a personal health record, and the lack of Josh Lemieux, Director of Personal Health Technology, payment to clinicians for using or reviewing these patient Markle Foundation records. Abstract Policy makers hope that health information technology (IT) Electronic personal health records could become important will help transform health care by facilitating information tools for patients to use in managing and monitoring their exchange, reducing inefficiencies, and improving the quality of health information and communicating with clinicians. care.
With the emergence of new products and federal incentives Better information flow between patients and clinicians can that might indirectly encourage greater use of personal health avoid unnecessary visits and increase patients’ engagement in records, policy makers should understand the views of their care, perhaps producing better outcomes at lower cost. physicians on using these records. Hence, physicians are being urged to do more than merely adopt electronic record keeping. Policy makers want to see In a national survey of physicians in 2008–09, we found that health IT tools used in meaningful ways to engage patients although 64 percent have never used a patient’s electronic better and improve quality. personal health record, 42 percent would be willing to try. Strikingly, rural physicians expressed much more willingness More at http://content.healthaffairs.org/content/30/2/266.full to use such records compared to urban or suburban
Putting Patients into "Meaningful Use" time frame. By 2015, health systems that have not achieved Stages 1, 2, and 3 will see a decrease in their Medicare By the Health Research Institute, PwC reimbursements. In January 2011, the U.S. Dept. of Health and Human Services But according to the HRI survey, only 82% of respondents said issued the draft set of criteria for Stage 2, which sets higher they will achieve ―meaningful use‖ before the penalties kick standards for communicating health information to patients. in—compared with 90% last spring. As health systems finalize Stage 2, which begins October 2012, requires hospitals to have work flows to meet the data requirements for ―meaningful use‖ at least 20% of their patient populations using PHRs. This with plans for delivering more-patient-centered-care—the long represents a big leap from what hospitals have been preparing -term goal—they might not be first in line to collect on for over the past year. incentives. Meaningful-use Stages 1 and 2 are leading to interoperability. 2. Patient awareness of and access to available health IT tools The hope is that this will enable providers to exchange is low; social, expectation, and education hurdles also exist. information, better coordinate care, improve treatment outcomes, and move into emerging delivery models like the Only 14% of patients access their medical records electronically patient-centered medical home, health information exchanges through their doctor’s office or a hospital, according to an HRI (HIEs), and accountable care organizations (ACOs). survey. Prescriptions re the most common piece of health information accessed electronically, but over 55% of Key Findings from PwC Research consumers can’t access such information as lab results or 1. Engaging external constituents may postpone achievement physician visit notes. And of the few who do access their of “meaningful use.” health data electronically, only one-third share their EMRs with primary care physicians and specialists. Even though more and more health systems have begun to involve physicians, health insurers, and patients in their More at http://www.pwc.com/us/en/health-industries/ ―meaningful use‖ initiatives, they appear less confident about publications/putting-patients-into-meaningful-use.jhtml achieving ―meaningful use‖ within the government-specified Volume 10, Issue 8 March 4, 2011 Page 19
Internet Governance
Cyber Cops and Domain Name Registrars movies and child pornography. Meet to Tackle Net Crooks Tackling criminal activity on a borderless The controversial Combating Online Infringement and Counterfeits Act (COICA), currently being discussed in the US, internet. would codify the government's domain seizure powers. In the UK, the Serious Organised Crime Agency is pushing for a By Kevin Murphy, The Register Nominet policy that would make it easier for police to shut down sites selling bogus goods. Cyber cops from both sides of the Atlantic are meeting with domain name registrars in Brussels today to try to figure out ways to crack down on internet crime. But the last two days of meetings in Brussels have focused on discussing ways to help law enforcement crack down on all types on cybercrime, and on ways the domain name industry This second meeting of the "EU-US working group on cyber can self-regulate through policies overseen by ICANN, security and cybercrime" is dedicated to increasing according to Go Daddy general counsel Christine Jones and cooperation between law enforcement agencies and the other attendees. companies that unwittingly sell web addresses to online crooks, according to attendees. Specifically, registrars are responding to recommendations made in October 2009 by the FBI, the Mounties, SOCA, and "We're trying to get both sides to communicate, so that we on law enforcement agencies from Australia and New Zealand. our side have some idea what they're trying to achieve, and The recommendations call on ICANN to conduct more they on their side understand what we're able to do rigorous due diligence before accrediting registrars, and to technically," said Michele Neylon, managing director of the more aggressively police their conduct thereafter. Law Irish registrar Blacknight Solutions. enforcement is particularly interested in the Whois services that registrars have to provide, which enables anyone to The two-day consultation comes as police in the US and UK quickly uncover the name, address and phone number of any are increasingly turning their attention to domain names as an domain name registrant. internet choke-point that can be used to shut down web sites selling counterfeit goods and enabling the trading of pirated More at http://bit.ly/hdmwn4
Administration has 'Great Trepidation' The remarks follow the Obama administration's biggest push About the U.N. Governing the Internet yet to support Internet freedom, which featured a speech this week by Secretary Of State Hillary Clinton pledging $25 By Sara Jerome, The Hill million to support circumvention technologies. Such inventions help Internet users get around online censorship by The Obama administration is working to keep Internet their governments. freedom and governance outside the control of the United Nations, according to a State Department official. Along with communications crackdowns in countries across the Middle East, the WikiLeaks controversy has provoked new Michael Posner, an assistant Secretary of State, said on Friday calls for the U.N. to play an active role in Internet governance. that the State Department does not think the United Nations is The U.N. has opened a working group of member nations to the best body for governing Internet freedom, the principle consider changes to its current body for online issues, the that governments should not block Internet content and Internet Governance Forum. access. More at http://bit.ly/gkbcdY "We have a range of anxieties about throwing this issue into the United Nations," Posner said. "We have great trepidation that if this becomes a U.N.-sponsored initiative, all the governments that have the greatest interest in regulating and controlling content and protecting against dissident speech in their own countries would be very loud voices."
He said the State Department is looking for "alternatives that provide some form of governance without ... a race to the bottom." Posner added that the U.N. has a lot of important roles to play in other domains. Volume 10, Issue 8 March 4, 2011 Page 20
Internet Governance - (cont.)
China Co-Opts Social Media to Head Off protests, as police detained or confined to their homes dozens Unrest of activists across China and Internet censors blocked searches for the word "Jasmine" on Twitter-like microblogging sites and Government allows networking sites—if they other websites. block or remove controversial material. Communist Party leaders have issued a flurry of statements in By Jeremy Page, The Wall Street Journal the past few days reflecting their concern that social issues such as rising food prices, combined with the unbridled flow of China's domestic security chief, Zhou Yongkang, added his information over the Internet, could trigger the kind of voice to calls for tighter Internet controls as censors ratcheted protests that have challenged authoritarian governments in the up temporary online restrictions, a day after a failed attempt to Mideast and North Africa. use social-networking sites to start a "Jasmine Revolution" in China. At the same time, the government has demonstrated many of the tools at its disposal to prevent such a protest movement Mr. Zhou, one of the nine members of the Communist Party's from gaining traction—from thuggery and physical Politburo Standing Committee, the country's top decision- intimidation to media manipulation and a sophisticated making body, was quoted in official media Monday as saying Internet censorship system, known as the "Great Firewall." Chinese officials needed to find new ways to defuse social unrest. He made the remarks at a meeting of Chinese officials Despite the role of Twitter and Facebook Inc. in mobilizing on Sunday, when police and Internet censors easily thwarted protests in Egypt, Tunisia and elsewhere, China is, for the an anonymous online appeal for people to stage simultaneous moment, allowing Chinese social-networking sites to flourish— antigovernment protests in Beijing, Shanghai and 11 other provided they cooperate with censors by removing or blocking Chinese cities. controversial material. One social-networking site, Renren.com—a Chinese equivalent of Facebook that focuses on "Strive to defuse conflicts and disputes while they are still entertainment and is rarely used for political discussion—said embryonic," Mr. Zhou was quoted as saying. On Saturday, Monday that it planned a $500 million initial public offering in President and party chief Hu Jintao also called in a speech for New York. tighter Internet supervision to help prevent social unrest. More at http://online.wsj.com/article/ Only a handful of people turned up Sunday for the planned SB10001424052748703610604576158290935677316.html
Obama Administration Joins Critics of U.S. that the United States finds unsavory. Nonprofit Group that Oversees Internet "There's a deeper question of how the world is reacting to a By Ian Shapira, The Washington Post small company - even a nonprofit - completely in charge of a The California nonprofit organization that operates the key part of the Internet. Is that acceptable? There's no 100 Internet's levers has always been a target for such global percent comfortable solution here," said Steve Crocker, heavies as Russia and China that prefer the United Nations to ICANN's vice chairman, who lives in Bethesda and is the chief be in charge of the Web. But these days, the Internet executive of Shinkuro, a technology company. Corporation for Assigned Names and Numbers is fending off With some Middle East countries shutting down the Internet attacks from a seemingly unlikely source: the Obama within their borders to curb uprisings, the question of who administration. runs the Web is increasingly figuring into global foreign policy Concerned about the growing movement to cede oversight to debates. Some fear that governments such as those of Libya or the U.N., the U.S. government, which helped create ICANN in Iran could more easily crush rebellions if they gained more 1998, has been reprimanding the nonprofit group to give control over the Internet's inner workings. foreign nations more say over the Web's operations. ICANN quietly wields vast influence over the Web, a power unfamiliar to many Americans and elected officials. Based in The battle has come at a sensitive time for ICANN, which this an off-campus University of Southern California building, the month is meeting with foreign governments as it pulls off the company has more than 100 employees and is led by a chief biggest expansion ever of Web suffixes - including .gay, executive and a board of directors comprised of private sector .muslim and .nazi. Also this fall, the nonprofit organization is executives and technology experts. ICANN's core function: seeking to hold on to its federal contract to oversee the Web's Decide which Web addresses get seen on the Internet. master database of addresses - a sweeping power that governments fear could be used to shut down foreign domains More at http://wapo.st/gAPnQh Volume 10, Issue 8 March 4, 2011 Page 21
March Calendar Sun Mon Tue Wed Thu Fri Sat MARCH 7, 2011 27 28 01 02 03 04 05 1:30 - 5:30 PM. The Public Knowledge (PK) will host a half day conference titled "Toward a Copyright Office for the 21st Century." Keynote by Maria Pallante 06 07 08 09 10 11 12 (acting Register of Copyright) and Aneesh Chopra (EOP's Office of Science and Technology Policy). 13 14 15 16 17 18 19 Location: Mandarin Oriental, 1330 Maryland Ave., SW. Washington DC. 20 21 22 23 24 25 26 More at http://www.publicknowledge.org/node/3627
27 28 29 30 31 01 02 MARCH 8, 2011 03 04 05 06 07 08 09 10:00 AM - 5:00 PM. The Executive Office of the President's (EOP) Office of Science and Technology Policy's (OSTP) President's Council of Advisors on Science and Technology (PCAST) will hold a partially closed meeting. . Location: Marriott Metro Center, Junior Ballroom, 775 12th St., NW. Featured Conference More at http://edocket.access.gpo.gov/2011/2011-3039.htm of the Week MARCH 9, 2011 U.S. Competitiveness: A New 8:30 AM – 11:30 AM. The Obama Administration's Innovation Policy. ITIF Conversation with New will host key Obama Administration officials charged with developing and overseeing the Administration's innovation policy and top private sector leaders for a discussion Opportunities of the ―Strategy for American Innovation." The forum will focus on key elements of the Administration’s strategy: 1) Investing in the Building Blocks of American March 10, 2011. Washington DC Innovation; 2) Promoting Competitive Markets that Spur Productive Entrepreneurship; and 3) Catalyzing Breakthroughs for National Priorities. Presenter There is a growing sense of urgency for include, Aneesh Chopra, Chief Technology Officer of the United States. bipartisan commitment to restoring America's competitive edge through Location: Hamilton Crowne Plaza, Washington, DC. innovation. More at http://www.itif.org/events/obama-administrations-innovation-policy
In that spirit, ITIF is hosting a seminal 11:30 AM – 1:00 PM. Innovation Through Social Media – A case study. half-day conference on how the United Technology and IP Event: Innovation Through Social Media - A case study Please States can revitalize economic growth join us for a lunch event where we will hear how one company put social media to by boosting innovation and productivity work for them and what results they were able to achieve in doing so. in existing industries while also Location: RadiSys Corporation, Hillsboro, OR. advancing emerging growth sectors such as nanotechnology, biotechnology More at http://www.techamerica.org/social_media_cs and mobile broadband. How can we find the right mix of private 12:00 – 1:30 PM ET. Webinar. Health care reform for CFOs: Impact on sector dynamism and government technology companies. support, as well as the political More at http://www.itaa.org/Events/eventDetail.cfm?eventid=a0E4000000CQIDPEA5 consensus required, to stay ahead of global competition and boost long-term 1:00 - 5:00 PM. The Department of Homeland Security's (DHS) Data Privacy and prosperity? Integrity Advisory Committee will meet. The agenda includes discussion of implementation of privacy protections in DHS operations, cybersecurity efforts, The speakers will be Paul Jacobs USCIS implementation of DHS privacy policy, and privacy protections for DHS use of (Qualcomm), John Leibovitz (FCC), social media. Bryan Mistele, Cameron Powell, Jon Taplin, and Robert Atkinson (ITIF). Location: Carl Hayden Room, 8th floor, U.S. Government Printing Office, 732 North Capitol St., NW. Location: 50 Massachusetts Ave NE. Columbus Room, Union Station. More at http://edocket.access.gpo.gov/2011/2011-3447.htm5 MARCH 10, 2011 3.00 PM. Senate Homeland Security and Governmental Affairs Committee (Chairman Lieberman, I-Conn.) will hold a hearing titled "Information Sharing in the More at http://www.itif.org/events/ Era of WikiLeaks: Balancing Security and Collaboration." us-competitiveness-new-conversation- new-opportunities More at http://hsgac.senate.gov/public/index.cfm?FuseAction=Home.Home Volume 10, Issue 8 March 4, 2011 Page 22
Sites Compendium Book Review www.abcnews.com The Art of Immersion: www.americanprogress.org www.amazon.com How the Digital Generation Is Remaking Hollywood, Madison Avenue, and the Way We www.bakerinstitute.org Tell Stories www.cmio.net By Frank Rose www.deloitte.com www.fastcompany.com A field guide to the visionaries—and the fans— www.foreignpolicy.com who are reinventing the art of storytelling. www.govhealthit.com Not long ago we were www.healthleadersmedia.com spectators, passive consumers of mass www.thehill.com media. Now, on www.ihealthbeat.org YouTube and blogs www.informationweek.com and Facebook and Twitter, we are www.kaufmanrossin.com media. www.marketwatch.com www.marshall.org And while we watch more television than www.modernhealthcare.com ever before, how we www.nationalehealth.org watch it is changing www.nytimes.com in ways we have barely slowed down www.pewinternet.org to register. www.pcmag.com www.pwc.com No longer content in our traditional role as www.theregister.co.uk couch potatoes, we www.scientificamerican.com approach television www.technologyreview.com shows, movies, even advertising as invitations to participate— as experiences to immerse ourselves in at will. www.washingtonpost.com www.wired.com Wired contributing editor Frank Rose introduces us to the people who are reshaping media for a two-way world—people www.wsj.com like Will Wright (The Sims), James Cameron (Avatar), Damon Lindelof (Lost), and dozens of others whose ideas are changing
how we play, how we chill, and even how we think. The Art of Immersion is an eye-opening look at the shifting shape of entertainment today.
Research and Selection: Stefaan Verhulst About the Author As a contributing editor at Wired, Frank Production: Kathryn Carissimi & Lauren Hunt Rose has covered everything from Sony's gamble on Please send your questions, observations and suggestions to PlayStation 3 to the posthumous career of Philip K. Dick in Hollywood. His books include the bestselling West of Eden, [email protected] about the ouster of Steve Jobs from Apple. The views expressed in the Weekly Digest do not necessarily reflect those of the Markle Foundation. More at http://amzn.to/fHdJQD