Ignacio Valdes thread from the American Medical Informatics Association Open Source Working Group Listserv on Healthcare under the Obama Framework

<ed.note>Ignacio edits LinuxMedNews.com, where he is also posting on this meme.</ed.note>

'Rockefeller Amendment' for Studying Open Source in Stimulus Bill

About page 701 of the
http://finance.senate.gov/sitepages/leg/LEG%202009/020209%20complete%20legislative%20text%20of%20American%20Recovery%20and%20Reinvestment%20Act.pdf
stimulus bill  is a provision for studying Open Source: "…(A) the
current availability of open source
6 health information technology systems to Fed
7 eral safety net providers (including small, rural
8 providers);
9 (B) the total cost of ownership of such sys
10 tems in comparison to the cost of proprietary
11 commercial products available;
12 (C) the ability of such systems to respond
13 to the needs of, and be applied to, various pop
14 ulations (including children and disabled indi
15 viduals); and
16 (D) the capacity of such systems to facili
17 tate interoperability…'

# # # #

Brief Analysis: American Recovery and Reinvestment Act of 2009

After reading the parts of the American Recovery and Reinvestment Act
of 2009 that relate to health IT, here are my conclusions: 1) More of
the same. The current plans and all the same players for Health IT as
before only now there is a lot more money involved and a brief time to
accomplish all of this in terms of health care time: 2014. 2) A
chicken in every pot approach, everyone gets money: education, Health
IT schools, some physicians get money for implementation on a
descending rate. Some talk of free/open source but the usual political
favorites AHIC, etc. are all still there as well only they get a lot
more money now. 3) No clear plan as to how to do all this. No clear
plan for dealing with issues such as 20 year veteran clinicians and
nurses with no computer experience. No plan for enabling the
proliferation of innovative software with existing systems. No penalty
or plans for dealing with proprietary software stonewalling.

Complete brief article: http://linuxmednews.com/1234372142/index_html

# # # #

Brief Analysis: American Recovery and Reinvestment Act of2009

Well, I didn't want to say some of the things that are in the HIMSS
analysis, especially given the near silence of AMIA on any of this. I
cannot argue with its conclusions. The ARRA of 2009 appears designed
to remove competition, unfortunately all competition, even healthy
competition except for a select few who will form a cartel or a
monopoly. It looks as though legalized robbery and absolute control of
medical data at great expense by a few wealthy corporations may be at
hand. I will not be surprised when doctor and personnel scapegoating
will begin when much of this doesn't work very well and billions have
been spent. Then comes the criminal penalties for non-use of CCHIT
certified systems. If all this occurs, then goodbye privacy, goodbye
rapid innovation, and the traditional role of physicians as custodians
of medical data. That nearly everyone except a select few were shut
out of the debate on this in Congress and how quickly it has been done
so that organizations like AMIA can only stand by in stunned silence
speaks volumes.

>From the HIMSS analysis:
"e)    The shrinking number of vendors that are capable of meeting CCHIT
certification exposes a fundamental flaw in its current organizational
structure – CCHIT is funded by the very vendors it certifies. In order
for it to maintain revenue, it needs to provide a reason for vendors
to continue to either:
i)    re-certify on a regular basis
ii)    apply for new certifications
The problem with this model is that, in order to justify ongoing
re-certification, CCHIT must continue to add new certification
requirements year-to-year. The driver for more requirements is not
necessarily the needs of customers or the best interest of the
healthcare system, but the need to have new requirements against which
to certify vendors. This is illustrated by the fact that CCHIT has
recently reduced the length of the certification from three to two
years, and is adding numerous supplemental certifications in areas
like child health, cardiovascular, etc. There is no end to the number
of requirements to which this could lead, but there is no evidence it
will serve anyone well in the long run, other than the few large
vendors with the resources to keep up with this process, and CCHIT
itself.
f)    Although in theory vendors can apply jointly for CCHIT
certification, in practice the monolithic certification process will
limit the ability for vendors to provide component solutions from
which customers can choose to create best-of-breed, low cost solutions
that best fit their needs. For instance, in the ambulatory arena, this
might typically be a combination of Practice Management, EMR and
e-Prescribing solutions.
g)    Certification of Practice Management systems in other markets
(e.g., UK) has arguably reduced innovation and investment, increased
the total cost of ownership and consolidated the market to such a
point that there is limited choice and the barrier to entry for new
entrants into the marketplace is unaffordable."

— IV

# # # #

Brief Analysis: American Recovery and Reinvestment Act of2009

Item 3 pretty much says it all: "CCHIT works to the benefit of a small
number of large EMR vendors that can command a high price from the
relatively small segment of the market able to currently afford their
products. It is essentially anti-competitive, and establishes a major
barrier to entry by new vendors and open source projects (where the
majority of innovation will take place)."

— IV

# # # #

For the record, I am not anti-corporation, anti-big corporation,
anti-business or anti-government. I am for real solutions that will
solve these problems with fairness, and without needless, massive
expense, disenfranchisement, or loss of rights. I agree that there are
massive opportunities, but it looks like the federal government has
already essentially picked who gets the massive opportunities, who
gets crumbs and who gets nothing. That specifically appears to be the
incumbents who get the massive opportunities. That there is little
public rhetoric or any meaningful public vote or say at all on such
massive unfocused Health IT spending bill, good or bad on this is
concerning to me. Three to five billion dollars were floated around in
very recent years for doing this and it was considered a
insurmountably large sum of money to spend by the government. It is
now a fait accompli that we will quadruple that and this is being done
with little or no public discussion vote or consent on a crash basis
with little in the way of guaranteed or even reasonably researched
results. The bill is very vague or things not addressed at all for
solving difficult, crucial problems that I see on a daily basis in the
trenches. Who is driving the language in the bill? I do not know. I
can only conclude that large health IT corporations with lobbyists or
'board members' are driving it by its language. Physicians, patients
and small innovative companies like Webreach that have done wonderful
things for interoperability without any federal money appear to be
utterly disenfranchised in all of this.  The historic propensity of
the US to form expensive corporate cartels whether they are needed or
not and that become government favorites is of great concern as well
as this being HMO's all over again? I can easily see a massive
bureaucracy accomplish very little, then throw this into the hands of
the 'savior' larg
e corporations. It has happened many times before.

Someone else said that this is a "Hurry up and pass this before things
get better on their own" bill.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Original Link: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bi…
TinyURL: http://tinyurl.com/h1as2-pdf

I'm not sure that this will be the final. I am told that the final
will be out possibly Friday.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

The health IT stuff begins about page 230.

Page 249:

''(iii) The utilization of a certified electronic health record for
each person in the United States by 2014."

This is a extraordinarily provocative clause with very large
ramifications. That means that essentially the US government has just
taken over Health IT and is now in complete control. As I understand
it, it means that if an entity cannot pony up $70K every 2 years to be
re-certified until everyone that cannot do this is driven out of
business. That means the only ones that can survive this are the
Epic's and the Cerner's. Along with the reporting requirements, your
privacy and your records especially in a proprietary system is now in
the hands of both a large corporation and subject to what a large
government bureaucracy thinks is the definition of your medical
privacy. Joy.

Comfortable? I am VERY uncomfortable with this. This appears to be a
very invasive action by the federal government that, by the way, you
must have permission to sue.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Page 252:

''(x) Any other technology that the HIT Policy Committee finds to be
among the technologies with the greatest potential to improve the
quality and efficiency of health care."

Hmmm, how is that going to work?

Next, check out Page 253 on what the Policy Committee is composed of.
I will describe it only in one word: vast.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

I will close with apologies to Arthur C. Clark when I say:

I for one welcome our multi-billion dollar spending, bureaucratic,
vast policy committee, cartel favoring, certification-wielding
overlords.

— IV

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

That is: Original Link:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h1as2.txt.pdf

# # # #

Links to: American Recovery and Reinvestment Act of 2009 text.

Others have pointed out that the certification is now no longer CCHIT
that it is in flux with NIST and somewhat unclear if that will be son
of CCHIT or what? The Free Medical Software Foundation (501c3 pending)
director Fred Trotter has discussed with me the possibility of it
having its own certification for F/OSS systems.

A Canadian friend has said: "…we are setting up some group therapy
clinics for American socialism-dodgers in Niagara Falls…probably one
of the casinos… we will accept American dollars and any rounding
errors from your multi-billion dollar socialist makeover." I replied
that I'm in as long as it uses standards-based slot machines that pay
double whenever government committee meetings run overtime.

— IV

# # # #

How is the US Experience Going to be Different than the UK?

A little food for thought on how the British are doing with their
multi-billion effort:

http://www.computerweekly.com/Articles/2009/01/27/234448/public-accounts-committee-criticises-npfit.htm

OASIS Launches SAML XML.org Online Community

The OASIS international standards consortium today introduced a new XML.org online community web site dedicated to supporting the Security Assertion Markup Language (SAML). The site (http://saml.xml.org) will serve as the official information resource for the SAML OASIS Standard, which provides an XML-based framework for online partners to exchange user authentication, entitlement, and attribute information.

“SAML is recognized as the gold standard for federated identity,” said Eve Maler, director of technology in Business Alliances at Sun Microsystems. “OASIS has created SAML XML.org as a way to enable users, developers, vendors, and other standards efforts from around the world to share information and learn from one another. Sun has taken an active role in SAML’s spec development, product support, interoperability, and education since its earliest days, and we’re delighted to see the launch of this new resource.”

All pages on SAML XML.org are accessible by the public, and users are encouraged to contribute content. The site features a wiki knowledgebase of information on using and understanding SAML. It also includes sections where readers can post related news, event information, listings for products and services, links to white papers, case studies, and other resources. Forums that support interactive discussions and blogs are also featured.

“Ping Identity is a strong advocate of standards that allow more and more companies today to benefit from secure internet single sign-on,” said Ping Identity CTO, Patrick Harding. “We are pleased to help the SAML XML.org effort provide an easy-to-navigate nexus point where people can quickly find the information they need.”

SAML is a flexible and extensible standard designed to be used by other standards. The Liberty Alliance, the Internet2 Shibboleth project, and the WS-Security OASIS Standard have all adopted SAML as a technological underpinning for various purposes.

SAML XML.org is the newest addition to the XML.org family of web sites devoted to supporting communities around open standards; other sites are devoted to BPEL, DITA, ebXML, IDtrust, OpenDocument, and UDDI.

About OASIS:

OASIS (Organization for the Advancement of Structured Information Standards), drives the development, convergence, and adoption of open standards for the global information society. A not-for-profit consortium, OASIS advances standards for SOA, security, Web services, documents, e-commerce, government and law, localisation, supply chains, XML processing, and other areas of need identified by its members. OASIS open standards offer the potential to lower cost, stimulate innovation, grow global markets, and protect the right of free choice of technology. The consortium has more than 5,000 participants representing over 600 organizations and individual members in 100 countries. http://www.oasis-open.org

IBM Opens New 3D Virtual Healthcare Island on Second Life

Interactive environment displays IBM’s vision for consumer-driven healthcare

ORLANDO, FL – 24 Feb 2008: IBM (NYSE: IBM) debuted at HIMSS®08 its newest island in Second Life: IBM Virtual Healthcare Island.  The island is a unique, three-dimensional representation of the challenges facing today’s healthcare industry and the role information technology will play in transforming global healthcare-delivery to meet patient needs. 

The island supports the strategic healthcare vision that IBM released in October 2006, entitled, Healthcare 2015: Win-Win or Lose-Lose, A Portrait and a Path to Successful Transformation.  The paper paints a picture of a Healthcare Industry in crisis – of health systems in the United States and many other countries that will become unsustainable by the year 2015.  To avoid “lose-lose” scenarios in which global healthcare systems “hit the wall” and require immediate and forced restructuring, IBM calls for what it defines as a “win-win” option: new levels of accountability, tough decisions, hard work and focus on the consumer.

The IBM Virtual Healthcare Island is designed with a futuristic atmosphere and provides visitors with an interactive demonstration of IBM’s open-standards-based Health Information Exchange (HIE) architecture.  Working with project leads in the U.S., the island was designed and built by an all-IBM-India team.

Starting from the patient’s home, they create their own Personal Health Records (PHRs) in a secure and private environment and watch as it is incorporated into an array of Electronic Medical Record (EMR) systems that can be used at various medical facilities.  As they move from one island station to the next, they experience how the development of a totally integrated and interoperable longitudinal Electronic Health Record (EHR) is used within a highly secured network that allows access only by patient-authorized providers and family members.

Patient avatars arrive and are welcomed at the Central Park and then visit a Central Information Hub, where IBM’s view of the healthcare industry and the power of information technology to transform it are presented.  An amphitheater on the Hub’s second floor provides an area that can support virtual meetings, complete with a large video screen and accompanying slide presentation on IBM’s HIE architecture and the positive impact that this technology can have in the transformation of the Healthcare Industry.

Visitors can then walk, fly or use transporters to visit the various island stations:

  • The Patient’s Home:  In the secure environment of a private home, patient avatars can initiate a PHR and populate it with their personal health characteristics and clinical history, accessed and downloaded from physician EMR data.  They can also establish privacy and security preferences as well as health directives.  The ground floor demonstrates secure messaging with providers and activates the initial PHR.  Using a transporter to move upstairs, patients use home health devices to take weight, blood pressure and blood sugar readings in the privacy of a bedroom, further incorporating this information into the PHR, which is shown on presentation screens. 
  • The Laboratory: This stop offers laboratory and radiology suites to help avatars extend their understanding of the benefits of  HIE.  Here, patients can check in at a Patient Kiosk and have blood work and radiology tests performed. The use of EHRs – revealing only appropriate portions of the PHRs — shows how consumers can also benefit through cost and time savings.
  • The Clinic: Patient avatars transport or walk from the Lab to the Clinic, where a welcome from their primary-care physician awaits.  A combination of scripting and information screens supports simulation of a patient exam, after which an electronic prescription is generated, and the continued development of the EHR is explained on nearby screens. 
  • The Pharmacy: Here, avatars can check in at a Patient Kiosk that simulates the verifying of drug information.  They then receive their prescriptions and update their PHRs/EHRs with new medication data.  The HIE architecture demonstrates how use of PHR/EHR technology can prevent consumers from purchasing medications that are contra-indicated given the medicines they presently require, as well as alerting them about potential drug-to-drug interactions.  The PHR/EHR is again updated.
  • The Hospital: In this futuristic, three story structure, avatars arrive for a scheduled visit with a specialist.  Physicians’ offices, patient rooms and exam rooms are all simulated here. 
  • The Emergency Room: Avatars can chose to experience a virtual emergency by “touching” a specially scripted control.  This engages a medical episode and a ride on a fast gurney directly into the private and secure emergency treatment area, where a special screen is programmed to reveal the full incorporation of the PHR to ensure proper treatment.

“We are pleased to offer our IBM Virtual Health Island as a tool for our healthcare customers and our worldwide sales force.  The island allows each healthcare stakeholder to envision how the total system can be affected by intercession at each juncture of the healthcare delivery process,” said Dan Pelino, General Manager, IBM Global Healthcare & Life Sciences Industry.  “We believe that the use of our new virtual world provides an important, next-generation Internet-based resource to show how standards; business planning; the use of a secured, extensible and expandable architecture; HIE interoperability; and data use for healthcare analytics, quality, wellness and disease management are all helping to transform our industry. “

IBM’s Healthcare & Life Sciences (HCLS) Industry will continue to develop the new island in months to come.  The island can perform as a virtually “always on” demonstration tool for IBM’s sales personnel.  A video version of the island is also under production.

IBM believes in the significant promise of virtual-worlds technologies far beyond today’s usage: the next evolutionary phase of the Internet. IBM is helping clients and partners to conduct business inside virtual worlds and to connect the virtual world with the real world through a richer, more immersive Web environment. 

Second Life is a 3D online world created by Linden Lab, a company founded in 1999 by Philip Rosedale, to create a revolutionary new form of shared 3D experience.  Last October, IBM and Linden Lab announced their intent to jointly develop new technologies and methodologies based on open standards that will help advance the future of 3D virtual worlds.

Voice: The New Fingerprint?

Jun 1, 2007 By David Jastrow, speechtechmag.onlineinc.com

Prevailing security methods used to protect against identity theft are losing ground to fraudsters. In fact, the total cost of identity fraud in the United States in 2006 reached $56.6 billion, up 6.4 percent from $53.2 billion three years earlier, according to the 2006 Identity Fraud Survey Report from Javelin Strategy and the Better Business Bureau. What’s more, mean resolution time for these cases has risen to 40 hours and costs $6,383 per person, up from 33 hours and $5,249 per person three years ago, according to the same report.
 
The overwhelming damage to organizations forced the government to step in. New laws designed to protect people from identify theft, such as the Bank Secrecy Act, are requiring higher levels of user authentication for financial transactions.

Private medical records of Colorado residents exposed on Internet

As medical records are created and transmitted electronically more and more, the chance of private information falling into the wrong hands is growing. Sometimes records are stolen by hackers, other times just improperly secured. Compromised records can lead to a range of problems, from loss of employment to identity theft to plain old embarrassment.

Future Tense has discovered that detailed, personally identifiable medical records of thousands of Colorado residents were viewable on a publicly accessible Internet site for an uncertain period of time through at least last Friday, May 18. The data included patient records from at least 10 Colorado clinics and hospitals, and one hospital in Peoria, Illinois. It’s unclear how many people may have seen the records.