News

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.

Major German research project chooses openEHR

I just returned from Heidelberg, where another very successful ‘openEHR day’ was held, this time by the HiGHmed research consortium, with 100 attendees. HiGHmed is funded with 20m€ by the German Federal Ministry of Education and Research (BMBF) under the “Medical Informatics” funding scheme, and has as its goal..... to develop and use innovative information infrastructures to increase the efficiency of clinical research and to swiftly translate research results into validated improvements of patient care...

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Towards a Fortnite Healthcare System or how Gen X and Millenials will demand Gamification in Medicine

The World Health Organization (WHO) just included "gaming disorder" as a new mental health condition, listing it is its 11th edition of the International Classification of Diseases. My first reaction was, oh, good, now I have a good excuse to write about Fortnite. A year ago I hadn't even heard of Fortnite. That's no surprise, because few had; it wasn't officially released until July 2017, and even then the free, most popular version -- Fortnite Battle Royale -- wasn't released until last September. It was an immediate sensation, with over a million players within the first month. It has been smashing numbers ever since.

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HLN Submits Comments to the CMS Quality Payment Program

On June 14, 2018 HLN submitted the following comments on the Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program based on our earlier comments...We are quite concerned by both the overall direction and the specific recommendations regarding public health objectives and measures in the NRPM. Regarding the changes to the proposed measures, CMS has not provided any explanation for why Syndromic Surveillance reporting was selected as the required measure. Other public health measures (e.g., Immunization reporting, Electronic Laboratory Reporting, Electronic Case Reporting) continue to require incentives for implementation.

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We Are Going to Need Bigger Post-ITs if We Want Design Thinking in Healthcare

When it comes to healthcare, we certainly have a lot of things that are big, and probably the only reason more aren't red has to do with that color-of-blood/code red thing. But when it comes to design that one would really call good...not so much. In NEJM Catalyst, Amy Compton-Phillips and Namita Seth Mohta reported on their Care Redesign Survey, which surveyed the NEJM Catalyst Insights Council. The survey found that there was strong support for design thinking (90%+), and was seen as valuable for a wide range of health care issues. Yet less than a quarter use design thinking regularly. When asked to list the top three barriers to applying design thinking to healthcare problems, respondents said:

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Been there, Done that, Doesn’t Work: Veterans Health Administration IT goes back in time

If you have an interest in the worlds of economics, healthcare or technology, here’s a story that’s emerged this month that is worth noting for the record books. In the US, amidst the chaos of the Trump administration, yet another mistake has been made this month. For the record, it is worth noting that the US Department of Veterans Affairs (VA) Veterans Health Administration (VHA) ended up with a contract for a large IT solution for the next 10 years worth about $10 billion as of May 2018. On the face of it that may appear to be unremarkable news: just another big expensive contract for an IT system. Yet there is a part sad/part silly dimension to it that is well worth flagging up at this point.

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The Utopia of Unique Patient Identifiers

The subject of Unique Patient Identifiers pops up with clockwork regularity in the healthcare discourse. A recent article in the New England Journal of Medicine (NEJM) titled Has the Time Come for a Unique Patient Identifier for the U.S.? points out that HIPAA initially mandated patient identifiers. Reason prevailed and the requirement was abandoned. The article goes on to list, correctly, all the issues related to duplicates and split records and their dire consequence from financial costs to potential loss of life. Just a few short years ago the American Health Information Management Association (AHIMA) issued a petition calling for unique patient identifiers citing much of the same issues and making a proposal for a voluntary solution. That effort also failed to get much traction either. While the problems cited are very real, it is not at all clear how a unique identifier would solve the problem, in spite of the very bold claims.

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Healthcare: Cheater's Edition

If you grew up in the pre-video games era, you have probably played Monopoly. If you have, chances are you've probably cheated too; Hasbro's own research indicates half of players do. So they did what, in hindsight, seems like the obvious solution: they created a version of the game that explicitly builds in cheating. Monopoly Cheater's Edition launched June 1. My first thought was, gosh, what kind of game builds in cheating? Then it struck me: healthcare. Of course, healthcare is not a game, but there certainly are plenty of rules (some of which make sense, some of which don't), and plenty of, well, if not outright cheating, then at least gaming. And let's not minimize the outright cheating.

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A Public Health Perspective on the CMS Quality Payment Program

I have seen several pretty good summaries of the recently 0release Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program (one from AMIA, one from CDC). Here are just a few additional tidbits I picked out of the NPRM. Of course, this document is written like stereo instructions so I welcome any corrections or comments to my interpretation of what’s in the rule. I put page numbers (from final FBO version referenced above which has just been released) where relevant in parenthesis. And I apologize in advance as much of what’s here is cryptic to anyone who has not been exposed to this before and I don’t make much of an attempt to explain the context (or even the acronyms)...

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A Tale of Two Health Systems

We need a different health system for the majority of us, if only so that we can devote the necessary resources to the people who need to use our health care -- aka medical care -- system the most. My vote is for a public health system. You know, public health. Like clean water. Like vaccinations. Like safer food. Like reducing smoking. It includes a variety of efforts that, intentionally, do not usually look much like medical care but which have drastic impacts on health and longevity. In a recent article in The Upshot, Aaron E. Carroll and Austin Frakt make the case for why we should spend more money on public health. As they detail, we spend very little -- depending on what you count, as low as $10 billion and as high as $100 billion or so, either of which is basically a rounding error in our overall health spending -- but which often have dramatic paybacks.

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