Feature Articles

U.S. Healthcare Is a Cadillac...Unfortunately

The good news: the U.S. healthcare is a Cadillac. The bad news: it's not an Escalade or even an XTS, it's a Cimarron, which is on most experts' list not only of the worst Cadillacs ever but also the worst cars ever -- expensive and poor quality. It was literally a Chevy Cavalier dressed up and trying to pretend to be a luxury car. You probably get the metaphor. There was a time when "Cadillac" was essentially a synonym for quality. Products aspired to be "the Cadillac of ____." It was a compliment of the highest order, understood worldwide. Foreign auto manufacturers tried to match its quality and make a dent into its market share. There was a time with U.S. healthcare had that kind of status too.

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Why Cloud for Health IT? Sharing our Experience at careMESH

If you want true, robust security, it is increasingly difficult to argue against cloud, given the advancements and growth in major service providers such as Google, Amazon, or Microsoft. No matter how many security staff members or how much cybersecurity experience you have, the major service providers have more. It's no surprise that across industries, investment in cloud computing, storage and infrastructure are predicted to grow at a rate of 17% annually over the next 3 years.[i]

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Mystery Consent Forms and the Scourge of Surprise Medical Bills

We are, it appears, shocked -- shocked! -- that there are "surprise" bills in healthcare. That is, bills from out-of-network healthcare professionals, even when patients thought they were going to in-network professionals/facilities. The problem is bad enough that even our deeply divided Congress has bipartisan agreement that it should act (although whether it will, of course, remains to be seen). Of course, surprise billing shouldn't come as a surprise to anyone who knows much about healthcare; it is more of a symptom of problems with our healthcare system than a problem itself. Kaiser Health News/NPR deserve much credit for getting more attention for the issue, with their Bill of the Month crowdsourced investigation.

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Clinical Decision Support Strategies for Electronic Case Reporting and its Open Source Connection

A key element of public health surveillance is the reporting of infectious and certain non-infectious conditions to state, local, and tribal public health agencies (PHA) around the United States. Historically, there have been a number of key challenges with the process of case reporting that is pervasive in the United States today. To help overcome some of these barriers, an effort has been underway to move the process of case reporting to electronic. A key component of the emerging electronic care reporting (eCR) strategy is the use of clinical decision support (CDS) to help clinical care organizations determine if a reportable condition is present in a patient's record. Multiple approaches have been identified for this CDS service, including a centralized model being implemented today, and several distributed options which will likely become equally viable. Given the size, diversity, and decentralized nature of healthcare enterprises, it is likely that all three approaches for CDS discussed in this article will be deployed simultaneously.

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The State of Open Source in South Korea

Open source software is growing exponentially all around the world, and South Korea is a vital part of that trend. While most South Korean open source projects don't get the international attention that projects from the Apache Foundation, the Linux Foundation, and similar organizations receive, they are making significant contributions to mobility, artificial intelligence, web technologies, and other areas. Samsung may be the best-known South Korean company working in open source, but Naver, Kakao, Coupang, and others are also writing important open source software and maintaining their projects on GitHub.

Ready or Not: New Report on Protecting the Public's Health

The Trust for America's Health (TFAH) released its 2019 edition of what it hopes will be an annual report, Ready or Not: Protecting the Public's Health from Diseases, Disasters and Bioterrorism last February. The ground-breaking report warns about key global challenges ahead, like the risk of a flu pandemic; the impact of weather pattern changes due to climate change; the dangers of antimicrobial resistance, and others, and tries to offer advice on how to prepare for them.

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Putting Healthcare on a Platform

People in healthcare have been speculating for years about who or what will be the "Uber of healthcare." Uber shocked the transportation industry with its peer-to-peer business model, slick technologies, and almost blithe disregard for numerous regulations that might have dampened its model. Certainly, many thought, the creaky, inefficient healthcare system was vulnerable to disruption from a similar outsider, perhaps even Uber itself (UberHealth, after all).So I found it amusing that it turns out that Uber has aspirations itself; it wants to Amazon...Healthcare wants to be more like Uber. Uber wants to be more like Amazon. Amazon wants to be part of healthcare. Someone, somewhere, sometime will somehow break that circle and healthcare will have the platform(s) it needs. We're waiting.

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Lost in the Signal...Is Most Healthcare Spending Being Wasted?

I finally got around to reading Bryan Caplan's The Case Against Education: Why the Education System Is a Waste of Time and Money. In it, Dr. Caplan, an economics professor at George Mason University and self-avowed libertarian, argues that, aside from basic literacy and numeracy, our educational system serves less to educate and more as a way to signal to employers who might make good employees. Oh, boy did this book make me think about our healthcare system.Dr. Caplan's views on economic signaling are by no means out of the mainstream, although his application of it to education may be. Think of it this way:

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ONC Gets It Mostly Right with TEFCA 2.0

On April 17, 2019 the Office of the National Coordinator for Health Information Technology (ONC) released the second draft of its Trusted Exchange Framework and Common Agreement (TEFCA) for comment. The initial version was released more than a year ago in January 2018 (see my original blog). As before, this is in response to a requirement imposed by Congress in the 21 Century Cures Act. After a somewhat lengthy (but well written) introduction, the document contains three parts (compared to just two parts the first time around)...

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Hydroelectricity and Transmission Planning in Chile Use Open Source Geospatial Tools

We were able to leverage a number of open source geospatial tools, such as QGIS, GDAL/OGR, and the PostGIS extension to the PostgreSQL open source relational database, in order to control the quality of the geospatial data at hand. These tools also helped us carry out the types of spatial analysis necessary to determine relationships between the various objects of value and, on the one hand, the potential hydropower projects, and on the other, the possible alternative transmission corridors. The key to hydroelectric capacity planning in Chile is the ability to generate the maximum amount of electricity, given certain restrictions, while assuring a fixed level of interaction with objects of value.

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From Data Silos to Black Holes...the Story of America's Healthcare System?

The scary thing about black holes is that their gravity inexorably drags in everything within its reach. Unless you are very far away or have sufficient escape velocity, you will get pulled in, and, once you are sucked in, you are never getting out. We call it our "healthcare" system, but usually what we mean is medical care. It treats illnesses, it puts us under the care of medical professionals, it turns us into patients. A doctor's visit begats prescriptions, and perhaps some testing. Testing leads to procedures. Procedures lead to hospital stays. Hospital stays lead to....you get the idea. What we might once have thought of as "health" -- or never thought about at all -- becomes "health care," a.k.a. medical care. And once you transform from a person, whose health belongs to you, to a patient, your health is never quite your own again. You've been sucked into the medical care black hole.

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Health Organizations Implore Congress to Fund Public Health Surveillance Systems

HLN Consulting joined more than eighty organizations, institutions, and companies in imploring Congress to fund public health surveillance systems. The appropriations request letters – one to the House and one to the Senate – seek one billion in funding over ten years (and $100 million in FY 2020) for the Centers for Disease Control and Prevention (CDC). This funding would allow CDC, state, local, tribal, and territorial health departments to move from sluggish, manual, paper-based data collection to seamless, automated, interoperable IT systems and to recruit and retain skilled data scientists to use them.

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12 Open Source Tools for Natural Language Processing

Natural language processing (NLP), the technology that powers all the chatbots, voice assistants, predictive text, and other speech/text applications that permeate our lives, has evolved significantly in the last few years. There are a wide variety of open source NLP tools out there, so I decided to survey the landscape to help you plan your next voice- or text-based application. For this review, I focused on tools that use languages I'm familiar with, even though I'm not familiar with all the tools. (I didn't find a great selection of tools in the languages I'm not familiar with anyway.) That said, I excluded tools in three languages I am familiar with, for various reasons.

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Is WeWork's Ecosystems Approach a Model for Healthcare Platforms?

Maybe you don't work in a WeWork office setting. Maybe you haven't ever visited one. Maybe you haven't even heard of WeWork. In that case, then you'll probably be surprised that this audacious real estate start-up now has a valuation close to $50b, with over 400,000 "members" in 100 cities across 27 countries (and they claim to "touch" 5 million people worldwide). Or that their plans go well beyond their unique twist towards office sharing. Who in healthcare is thinking about them, and who should be worried...or intrigued?...WeWork was never just about finding people and companies office space: it wanted to "help people work to make a life, not just a living." It focused on building a culture in its spaces, complete with amenities and events to help build a community among its members.

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9 Resources for Data Science Projects

Data science, machine learning, artificial intelligence, and deep neural nets are all hot topics these days (and key terms that might help this post with some SEO, unless the AI sees through my attempts). Below I've shared several of the resources I use regularly while working on data science projects over the last few years. I don't read many books, so that I've shared even one is evidence of how important it is. There are enough resources here to get even the most novice engineer started on a path towards data science mastery in this new age where data science skills will be needed at every level. There is a tool for performing the work, a class taught by a renowned Stanford professor, websites with tutorials to give you real-life experience, and a site dedicated to making the latest research available to all for free so you can learn more if you want.

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