Feature Articles

First, We Tear Down All the Hospitals

The problem is that hospitals are big and getting bigger, going from building to buildings to campuses.  They are expensive and getting more expensive.  At some point, we have to ask: is this really how we want to spend our healthcare dollar? Some hospitals are figuring other ways to spend their -- I mean, "our" -- money on our health.  Take Nationwide Children's Hospital.  Located in a somewhat blighted neighborhood of Columbus (OH), its Healthy Neighborhoods Healthy Families (HNHF) program "treats the neighborhood as the patient," as their summary in Pediatrics put it. The hospital is leading a partnership that has built 58 affordable housing units, renovated 71 homes, given out 158 home improvement projects, and helped spur a 58 unit housing/office development.  They've also hired 800 local residents and instituted a jobs training program.

Three Reasons the US is Not Ready for the Next Pandemic

One hundred years after the Great Influenza pandemic of 1918, global health leadership stands at a crossroads. The United States continues to expand its policy of isolationism at a time when international cooperation in health could not be more important. The state of pandemic preparedness and the necessary steps for protecting the people throughout the world was the topic of The Scowcroft Institute for International Affairs' 2nd Annual White Paper. As pandemic policy scholars, with two of us spending the majority of our career in the federal government, we believe that it is essential to prepare the country and the world for the next pandemic. It is not a matter of if, but when, the next disease will sweep the world with deadly and costly consequences.

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Keeping Patient Data Safe with Open Source Tools

Healthcare is experiencing a revolution. In a tightly regulated and ancient industry, the use of free and open source software makes it uniquely positioned to see a great deal of progress. I work at a scrappy healthcare startup where cost savings are a top priority. Our primary challenge is how to safely and efficiently manage personally identifying information (PII), like names, addresses, insurance information, etc., and personal health information (PHI), like the reason for a recent clinical visit, under the regulations of the Health Insurance Portability and Accountability Act of 1996, HIPAA, which became mandatory in the United States in 2003.

AIRA 2018: Is Open Source the Key to Immunization Software Sustainability?

On August 14-16, 2018 the American Immunization Registry Association (AIRA) held its 2018 National Meeting. This meeting brought together more than 350 informatics professionals, public health officials, EHR vendors, and other stakeholders who all care passionately about Immunization Information Systems (IIS) and their role in the healthcare community. IIS projects leverage interoperability with EHRs, PHRs, and other systems to promote clinical practice at the point of care; enable public health surveillance, and reduce cost by assisting in preventing both under and over immunization.

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Best Buy Buys Into Health

Best Buy generated a lot of positive press recently with its acquisition of GreatCall, which focuses on technology services for seniors.  Its move into health may not be a surprise since it seems lots of retailers -- think Walmart or Kroger -- and many big tech companies -- think Apple or Amazon -- want into health, not to mention more tech startups than you can throw $100 million at. It's the why and the how about Best Buy's moves into health that deserve more scrutiny, and that healthcare organizations may learn from.

6 Ways Programmers from Underrepresented Countries Can Get Ahead

Becoming a programmer from an underrepresented community like Cameroon is tough. Many Africans don't even know what computer programming is-and a lot who do think it's only for people from Western or Asian countries. I didn't own a computer until I was 18, and I didn't start programming until I was a 19-year-old high school senior, and had to write a lot of code on paper because I couldn't be carrying my big desktop to school. I have learned a lot over the past five years as I've moved up the ladder to become a successful programmer from an underrepresented community. While these lessons are from my experience in Africa, many apply to other underrepresented communities, including women.

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Preliminary Thoughts on CMS Proposed MIPS IP Rule Changes: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM)...The purpose of this NPRM is to address proposed changes for Year 3 of the Merit-based Incentive Payment System (MIPS), the provider (as opposed to hospital) side of the Quality Payment Program. The part that is most relevant to public health is the Medicaid Promoting Interoperability (IP) Program for Eligible Professionals (EP)” (the EHR Incentive Programs have been renamed). A major goal of this NPRM is to synchronize as much as possible the EP program with the hospital-based program that was addressed in a previous NPRM just a few months ago.

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Eaten Alive: A Patients’ Perspective on De-Identification of Personal Health Information

In 2018, the majority of people do not know that their PHI, like their EHR data, prescription data, insurance claims, and genetic data via direct-to-consumer (DTC) tests, are de-identified and sold for research and commercial purposes at massive profits. Medical health data trading is a multi-billion dollar industry. The process of de-identification supplies data that may be aggregated for a variety of analyses, such as basic scientific discoveries, policy & legal reviews, process refinement, pharmaceutical marketing, and other efforts. Data de-identification isn’t new but it is rampant. I’m gravely concerned about the free-for-all that is de-identification. You should be too.

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An interoperability update: Do we need more carrots and sticks?

Earlier this year, the ONC released the Trusted Exchange Framework and Common Agreement (TEFCA), which responds to a mandate included in 2016’s 21st Century Cures Act and lays out principles, terms and conditions on which to base an interoperability framework that healthcare organizations can embrace. “This means patients who have received care from multiple doctors and hospitals should have their medical history electronically accessible on demand by any other treating provider in a network that signed the Common Agreement,” said National Coordinator for Health IT Donald Rucker in a recent blog post. To achieve that goal, TEFCA is divided into parts A, the principles, and B, the terms and conditions, which is also where the rubber meets the road for many who live in the healthcare IT world...

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CMS Goes Live with Blue Button - With Life and Cost Saving Applications for 53 Million Americans to Use

On August 13 at the White House in Washington, D.C., the Office of American Innovation and the Center for Medicare and Medicaid Services (CMS) will host the first Blue Button 2.0 conference. This event will highlight CMS’ strong investment and leadership in Blue Button as a patient driven means for interoperability, cost-effective care and patient safety. Eight years after President Obama’s announcement of the Blue Button initiative to give Veterans, military beneficiaries and Medicare beneficiaries “easy access to their health information” with the use of a “Blue Button”, CMS Administrator Seema Verma took action with “Blue Button 2.0” so that 53 million Medicare beneficiaries can now make use of CMS approved patient facing Blue Button applications, turning a four-year history of claim data into actionable longitudinal health records to prevent costly medical errors, unnecessary redundant care or other harmful and wasteful care.

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Is it Finally Time to Reinvent the Wheel?

When people talk about "reinventing the wheel, " it is often meant to discourage, even disparage. As in, "why reinvent the wheel?" It usually refers to a technology or a process that works well enough and is widely enough distributed that trying to replace it would be a fool's errand. Fortunately, the folks at DARPA aren't afraid of fool's errands -- and they are literally reinventing the wheel. Healthcare could use some fool's errands of its own. We all know what a wheel is. We know a wheel when we see one, we know what one does, we know how they do it. We've all traveled on wheels -- skates, bikes, cars, buses, whatever. It's hard to imagine a world before the wheel, before that beautiful circular shape, and it's hard to imagine improving on it.

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3 Reasons Why the US is Vulnerable to Big Disasters

During the 2017 disaster season, three severe hurricanes devastated large parts of the U.S. The quick succession of major disasters made it obvious that such large-scale emergencies can be a strain, even in one of the world’s richest countries. As a complex emergency researcher, I investigate why some countries can better withstand and respond to disasters. The factors are many and diverse, but three major ones stand out because they are within the grasp of the federal and local governments: where and how cities grow; how easily households can access critical services during disaster; and the reliability of the supply chains for critical goods. For all three of these factors, the U.S. is heading in the wrong direction. In many ways, Americans are becoming more vulnerable by the day.

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The Evolution of Blockchain - A Quick Guide and Why Open Source is at the Heart of It

It isn't uncommon, when working on a new version of an open source project, to suffix it with "-ng", for "next generation." Fortunately, in their rapid evolution blockchains have so far avoided this naming pitfall. But in this evolutionary open source ecosystem, changes have been abundant, and good ideas have been picked up, remixed, and evolved between many different projects in a typical open source fashion. In this article, I will look at the different generations of blockchains and what ideas have emerged to address the problems the ecosystem has encountered. Of course, any attempt at classifying an ecosystem will have limits—and objectors—but it should provide a rough guide to the jungle of blockchain projects.

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Holochain – the Perfect Framework for Decentralized Cooperation at Scale

Holochain is a new technology project with huge potential for the cooperative economy. Members of The Open Co-op have been promoting the idea that new software could, potentially, revolutionize both our failing democracies and our predatory capitalist economies, since 2004. Back then we weren’t quite so clear on exactly how the required information architecture should be designed – but we knew what we wanted it to do and how it should work. In 2004, I published a paper entitled Participatory Democracy Networks, which explained how I thought some new information architecture could facilitate participatory democracy worldwide.

OpenStax Provides Cheaper Textbooks and Better Access for Higher Ed Students

OpenStax was founded by Rice University engineering professor Richard Baraniuk in 1999 under the name Connexions. It started like most open source projects: To scratch an itch and address a problem. In this case, Rice University wanted to do something on the web related to education. A grad student suggested that they take the model used to develop Linux and apply it to create textbooks, and Connexions was born. They decided on a license that allowed for reuse with attribution—in essence, this was the first use of the Creative Commons license even before the license existed.