Feature Articles

"Local" Healthcare Isn't What It Used To Be

We live in a world where bigger is better.  Our phones are getting bigger.  Our televisions are getting bigger.  Our biggest companies are getting bigger (at least if they are in tech).  Our cars, especially SUVs, are getting bigger.  Our houses are getting bigger. And, in healthcare, our hospitals are getting bigger, our physician practices are getting bigger, our health insurers, pharmaceutical companies, and medical device manufacturers are all getting bigger. It's time to question whether any of this is good.

We Have Seen the Future, and It Is...Estonia?

Like me, you may not have been paying close attention to what has been going on in Estonia.  That's probably something many of us should change, at least anyone interested in our digital future(s). OK, I have to admit: I had to look Estonia up on a map.  I knew it was in northern Europe, and that it had been involved in the whole U.S.S.R. debacle.  As it turns out, Estonia sits just across the Gulf of Finland from -- that's right -- Finland, and across the Baltic Sea from Sweden.  Skype was invented there, if you're keeping score. More to the point, over the last twenty years it has evolved into arguable the most advanced digital society in the world.

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Update on Patient Matching Activities

I have written several times about patient matching in the US, both in a blog entry and a published article. On December 11, 2017 the Office of the National Coordinator for Health Information Technology (ONC) sponsored a half-day “Interoperability in Action” webinar focused on Patient Matching Milestones at ONC (see slides). The webinar focused on four ONC projects from the past year. Here’s a quick run-down on what they covered. Read More »

Why We Need Trauma Trained Educators for National and Regional Disaster Response Teams

Lately, I have been dealing on a number of fronts with natural disasters, and how to help schools and their educators can best deal with their aftermath. At the same time, I have been listening to and learning about disaster team efforts across our nation (from across state and federal government), teams that are dealing with the treacherous aftermath of person-made calamities (floods, fires, shootings, hurricanes, tornados, bombs and car/truck intentional crashes). When Veteran hospitals and facilities are at risk, the Department of Veterans Affairs offers their added expertise too.

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Addressing Open Source's Free Rider Problem

Nadia Eghbal, in her major report on the state of our digital infrastructure, and Jonathan Lister, in his response describing our digital ecosystem, both point to a tragedy of the commons in open source software. While some projects are sustainable, many still struggle with "a free rider problem." As Nadia puts it: "Resources are offered for free, and everybody (whether individual developer or large software company) uses them, so nobody is incentivized to contribute back, figuring that somebody else will step in"...

Making Transparency Work for Harvard's Dataverse Project

A culture of transparency permeates the Dataverse project, contributing to its adoption in dozens of research institutions around the world. Headquartered at Harvard University, the Dataverse development team has more than a decade of experience operating as an open source project within an organization that values transparency: the Institute of Quantitative Social Science (IQSS). Working transparently helps the Dataverse team communicate changes to current development efforts, provides opportunities for the community to support each other, and facilitates contribution to the project...

3 Open Source Alternatives to MATLAB

For many students in mathematics, physical sciences, engineering, economics, and other fields with a heavy numeric component, MATLAB is their first introduction to programming or scientific computing in general. It can be a good tool for learning, although (in my experience) many of the things that students and researchers use MATLAB for are not particularly demanding calculations; rather they could easily be conducted with any number of basic scripting tools, with or without statistical or math-oriented packages. However, it does have a near ubiquity in many academic settings, bringing with it a large community of users familiar with the language, plugins, and capabilities in general...

How Open Government Is Helping With Hurricane Relief in Puerto Rico

Just weeks after Hurricane Harvey hit Texas, two more "unprecedented" hurricanes made their way to the southeastern United States. Although changes in Hurricane Irma's path spared Florida from the bulk of the damage, both Irma and Maria directly hit Puerto Rico and the U.S. Virgin Islands. Hurricane Maria was particularly devastating for the more than 3.5 million American citizens living in these U.S. Caribbean territories. The CEO of Puerto Rico's sole electric company indicated that the grid had been "basically destroyed." Without electricity, communications were severely limited. In the aftermath of a natural disaster, embracing open government principles—such as open data, collaboration between citizens and government, and transparency—can save lives.

5 Ways to Invigorate Education with Raspberry Pi

Recently I was invited to talk to a group of eighth grade students about the Raspberry Pi. Of the 15 students and three teachers there, only a few had heard of the Raspberry Pi. None had ever held one in their hand, nor did they know how to set one up or even where to look for information to do so. I spent 40 minutes talking to them and inviting them to explore the Raspberry Pi and the wealth of high-quality, open source software that comes with it. They were energized and eager to learn more...I think something needs to be done, so I am inviting fellow open source advocates to join me in making minor investments in their communities to move the ball forward.

Scientist at Work: Measuring Public Health Impacts after a Disaster

More than two months after Hurricane Harvey submerged much of metropolitan Houston, recovery is under way across the city. Residents and volunteers are gutting and restoring flooded homes. Government agencies and nonprofit organizations are announcing cleanup programs and developing plans to distribute relief funds. But many questions remain about impacts on public health. What contaminants did floodwaters leave behind? How many people are being exposed to mold – which can grow rapidly in damp, humid conditions – as they repair their homes? Will there be an increase in Zika, West Nile or other vector-borne diseases as mosquito populations recover? Or an uptick in reported cases of other illnesses?...

Elon, Do We Have a Disaster for You!

One of the most interesting twists resulting from Hurricane Maria striking Puerto Rico was Elon Musk's offer that Tesla could help Puerto Rico solve its energy crisis, with a long-term, 21st century fix. After all, its electrical grid was devastated, with almost all the power wiped out. It didn't help that even prior to this disaster its system was antiquated and badly in need of repairs. It is telling that we don't have similar offers to rebuild the Puerto Rico's health care system, which is similarly devastated. Or, for that matter, our system, which is its own kind of disaster. Mr. Musk was asked on Twitter if Tesla could help Puerto Rico using solar and battery power, and he responded in the affirmative, saying it had done so on smaller islands but faced no scalablity issues...

Europe Pledges Support for Open Source Government Solutions

Estonia has long been the digital envy of many European Union member states. An effective and open policy approach to digital government has yielded extraordinary results—from 90%+ uptake of electronic identification (E-ID) solutions to an open source e-government platform (X-Road) to meet the ever-growing expectations of IT-savvy citizens as well as other countries wanting to pool IT across borders. Perhaps the most significant development for open source supporters is the explicit recognition of open source software (OSS) as a key driver towards achieving ambitious governmental digitisation goals by 2020. Under the declaration, European goverments will...

Let's Hope This Bores You

I think I know what is wrong with health care: not enough people are bored. These are stressful times for health care. There's a never-ending stream of innovation, constant pressures about costs, concerns about the quality of care, conflicting research findings, ongoing uncertainty about how we should finance what coverage for which people, and new business models and organizational structures. There's too much to take in, and everyone in health care is working too hard, too long.  Honestly, who has time to be bored? But that's a problem. We usually think of being bored as a bad thing. You don't often find people saying they're looking to be bored. You don't find many activities that bill themselves as being boring...

How a University's 3D-Printed Prosthetics Club Provides Devices for Amputees

Last fall, one of the co-founders of Duke University eNable published an article describing our club’s beginnings and visions for the future. In the spring of 2016, we started out as six engineering students with a passion for innovation and design, supported by a small stipend from the Innovation Co-Lab and a grant from OSPRI (Open Source Pedagogy, Research and Innovation), a project supported by Red Hat. Since then we have established ourselves as a presence on campus, grown into a large interdisciplinary team, and connected with multiple recipients—including a young boy in Milot, Haiti. The resources offered through Duke and the sponsorship we've received allow us to continuously transform our ideas into things we can share with open source enthusiasts, makers, and dreamers alike...

Patients Are Not Consumers...But Who Is?

It has become an article of faith in some health policy circles over the past 20 years that the "solution" for our health care system's woes is to make us better health care consumers -- the so-called consumer-driven movement. After all, we've known for at least forty years that increased cost-sharing does influence how much health care we consume, so, in theory, higher deductibles and coinsurance, plus better cost/quality information, should give us the right incentives to shop. Most health care professionals are equally convinced patients aren't, and are never going to be, "consumers" in any meaningful sense.  Health care is too scary, relies on too much specialized information, and is too often "consumed" at times when we are least able to make thoughtful decisions...