Data Interchange and Interoperability in Healthcare

I recently had to go for x-rays on my hip. The imaging company called saying they’d received the “order” from my chiropractor for a knee arthrogram without contrast.

Apparently, this was both wrong and confusing. It’s wrong, because the “order” said hip, but they couldn’t read it; also it’s confusing because, well something to do with x-ray and contrast.

After a short discussion, it turned out the imaging company received the order by fax. Yes, real actual paper fax. The US medical profession still seems to run on faxes. My prior cardiology hospital sent my medical records to my new cardiology Dr via, yes, paper fax. Hospital-1 printed the records to a fax based printer driver, which sent them uing a fax protocol to Hospital-2. Apparently Hospital-2 receives as images in a variation of the TIFF file format.

In the case of my PT, no such luck. Handwritten, manually faxed, received by paper. Even if there had been no problem this created a HIPPA privacy and security cost. In this instance, the cost to clear up the confusion likely cost almost as much as the actual hip x-ray, as that was all that was needed.

While I know there are data interchange standards in the USA for medical records, or as they are called PHRs, it seems there still nothing that is universally adopted. When I contacted my new cardiology hospital and offered my PHR in (Epic Systems) Lucy format, they declined and asked for them to be faxed.

There are a growing number of apps for both ios and android that support EHRs (electronic health records) however, for the most part these are tied to a specific hospital and/or medical group. A good example is the Epic Systems MyChart app. It can read the data from my former cardiology provider, including details of my ER/and cardio surgery and the prescriptions I was given. I can export the data using the Hospital groups website, and that’s it.

Unless you choose your medical providers not on their medical excellence, but their ability to import your lucy records, this is no use at all.

The Big Boys are doing data interchange

My interest was sparked by the recent announcement from Google, Microsoft, Twitter and Facebook introducing the open-source Data Transfer Project (DTP). For the more technically interested, you can read the DTP Overview here.

Ultimately it doesn’t look that different from the Enterprise Service Bus implementations we were working on 15-18 years ago. Same core concept, n-n interchange and interoperability. Same basic extensability through adapters and shared protocols.

I have to say, the use cases given for DTP are pretty weak. Conceptually, though there is much potential for this architected “Share…” facility. One of the key failings of DTP is that there is no ability to delete data, sure you can share your data to more sites/services but the DTP as specified doesn’t allow you to leave.

However, the most disappointing thing about this announcement is it’s aimed at allowing you to move your videos/photo’s, social media posts, and hopefully subscription platforms among the services supported.

To become a supported platform there are a few fairly simple architecture docs and then you have to build plugins or adapters to interface to the service to be able to send/receive data.

Ho hum. Boring. There is definitely space for big tech co’s to innovate around data interchange, but who cares about social media. I want to be able to pay for a PHR service, where I can store and control my medical record. Where I can grant access rights and authorise medical providers to retrieve my data, where I can see my medical records from across the providers etc.

I’m hoping that someone will point out this already exists, or that Nigel or Tom, who both now work in Helathcare will tell me why this isn’t a good idea. The USA is in desperate need for data interchange but it isn’t for social media.

FURTHER READING:

  1. Paper on moving from paper to electronic records and the associated problems.
  2. Review of numerous leading healthcare records mobile apps.

 

Maternity medical crisis

As we approach this year’s open enrollment period for health insurance, I continue to be shocked and disappointed about almost everything I learn about the US Healthcare system. Before I return to notes about my own experiences and my own health, maternity care is another healthcare topic that doesn’t often get discussed, as the average American prepares to pay more than $10,348, per person, per year on healthcare.

While many argue about the definition of single payer, and if it would lead to socialism (and what that is?), the inefficiency, mistakes, cost and just outright expense of what should be routine treatment, continues to make me despair.

America has healthcare snobs, millions of them, they just don’t realize that while they might have great access to medical facilities and Doctors, that doesn’t mean it’s always good, or that the system acts in their best interest. However, any suggested change is met with claims of death panels, socialism and more. Oft heard is also they ‘don’t want the Government in the healthcare.’

Even I was left speechless as I watched a recent CBS Sunday Morning segment on maternal healthcare. Among the points made were:

  • U.S. “most dangerous” place to give birth in developed world
  • The United States is ranked 46th when it comes to maternal mortality. That’s behind countries like Saudi Arabia and Kazakhstan.
  • “Sixty percent of the deaths in the United States are preventable,”
  • At least two women are dying every day

And it’s not about access to healthcare; it’s not about the poor without insurance; yes, there is a racial element, but it’s not what you’d think. Here is the entire segment, well worth watching before you enroll this year.

| Edit: The embedded video doesn’t apparently load in some browsers, so here is a direct link to the CBS This Morning web page. https://www.cbsnews.com/news/maternal-mortality-an-american-crisis/

Can it be true that women giving birth in America are more at risk than women in dozens of other countries?

Kohl’s and Car Oriented Development

Back in July, @_anthonyhahn wrote an article which appeared in both the Daily Camera and the Colorado Hometown Weekly about a potential new Kohl’s store in Lafayette CO, and what that meant for the Louisville CO store.

While pitting the two adjacent cities against each other in a battle for sales tax is valid, it totally misses the point about all the new development around the 287 Corridor, north of Lafayette.

At the time, I wrote a letter to the editor of the Colorado Hometown Weekly and sent it in. I just got to checking, and as far as I can see, it never made publication for either space, or editorial reasons. As always, waste not, want not, here it is. Comments?

FOR PUBLICATION

Re: July 11th Anthony Hahn Kohls move to Lafayette

I’m a Louisville resident, but this isn’t Louisville versus Lafayette, it’s the past vs the future.

How much longer can we continue sleep walking into the future with car oriented development?

The city of Lafayette believes a new Kohl’s on 287 is worth, and will pay off its $2-million subsidy in 2-3 years. Add to that the limited benefit of some extra jobs, and extra sales tax receipts during construction. It still means the Residents will have to shop hard, and drive regularly to make another out of town store pay off.

Louisville development director Dejong says the McCaslin corridor tax receipts are up year on year to $420,000, but that’s from a whole lot of small stores and restaurants that are almost always busier than any of the big box stores. Kohls will need to do much more than it does with it’s Louisville store to make it work. The current store in Louisville often looks like it’s been ransacked by people on a scavenger hunt, and the parking lot is frequently less than 1/4 full.

Kohl’s itself we likely be shielded from a failure, tax write-offs against losses, writing off development and moving expenses. The development company, Hix Snedeker can do the same. It’s not the McCaslin corridor thats in economic crisis, it the whole sector.

It’s always easier to build new development, urban sprawl has funded and driven America for the last 80-years. The real question is, what does this contribute to the community? More driving, more concrete, more parking spaces? The 287 location certainly seems more attractive than the current Louisville location, it has more passing traffic in a superficial way. The question is how many will stop, rather than shop online and have it delivered at home?

Lafayette residents should ask, is this worth the money, the tax breaks, etc. ? What type of development do they want, and is this the right type of development rather than just easy development?

Mark Cathcart

Legislating hacking/data exposure responses

I don’t know enough about the European Union General Data Protection Regulation (GDPR) but at least on basic reading it seems inadequate in meaningful individual action requirements and legislation that benefits the actual user/person whose information has been exposed.

I’ve been signed up for haveibeenpwned an excellent website by Troy Hunt. You enter your email, and it tells you what breaches your personal information has been found in.

I was going to say “if any”. But of course your data will be there, especially after breaches like the River City Media (RCM) “spammer gate” where 1.4 billion peoples’ email accounts, full names, IP addresses, and often physical address, were exposed. Suffice to say, my two primary email addresses have been exposed in more than 20-breaches.

haveibeenpwned was a great start. CapitalOne, at least among my financial providers, has stepped up the game significantly. Their creditwise arm has incorporated Credit & Identity Alerts in to the app and website. Numerous times recently I’ve received alerts, and while initially the alerts didn’t contain enough information to take action, the most recent alerts have had all the detail I needed.

Creditwise Email
Email alert from Creditwise
Creditwise Alert
via website or app

Among the websites my data has been exposed this year include:

  • linkedin.com
  • kickstarter.com
  • ticketfly.com
  • bitly.com
  • myspace.com
  • last.fm
  • zomato.com

Some of these websites did individually send emails disclosing the breach. Of these, only ticketfly had any form of financial data that might have been breached. I have all my emails from them going back to 2012. Not a single word about a data breach or other exposure of my personal data.

The same is true for more sites than not. No notification. When you login to the site to at the very least, change your password to a new unique one, they more often than not also give you no indication. For many of them it’s also nearly impossible to find out how to delete your account. In the case of ticketfly, I submitted a trouble ticket asking how to delete my account but retain tickets for future events, so far nothing but a generic ‘we’ll get back to you’ response.

It’s time for legislation about what websites/businesses are required to do when they find a data breach. They must be held accountable, and not just through financial penalties that mostly just go into government coffers.

I’d like to see at a minimum:

  1. Mandatory requirement to notify by email, and if the business has a real mail address, by mail.
  2. A default opt-out and deletion period. At discovery, if data breached includes significant personal and/or financial data, the account must be deactivated. After notification, if the business has not heard from the user whose data is breached within 14-days, and the account is not already deactivated, it should be deactivated.
  3. Recovery of a deactivated account should NOT depend on any data exposed in the breach.
  4. When the user whose data is breached logs-in to their account following notification or during account recovery, they must be presented with clear information on what data was exposed. Two, they must be given a simple option at this point to permanently delete their account.
  5. If the user opts to delete their account, any consequences of the deletion must be made obvious at that time. For example, in the case of ticketfly, where I’ve already paid for tickets to future events, those tickets must still be available to me, even after my account is deleted.

In the era of “big data” and “everything online” the only way these businesses/websites will really put privacy and security first is not fines. It’s the actual loss of the customer/user and their data. These companies are often over valued, and paying government fines is just moving magic money from one bucket to another. It has a short term impact on their profitability, their quarterly results, not much else.

How Funk went Swing

My vinyl to digital conversion effort has taken an involuntary pause as my NuWave Phone Converter and pre-amp has failed. Fortunately the makers, PS Audio, or only up in Boulder, so I drove it up there last Friday to drop it off for repair and will go collect it tomorrow.

While tidying up some of my more recent conversions, it caused made me reflect on a few trends, and at least, as far as I can remember them happening. I wrote over 10-years ago about the Day that disco died(for me). One question has been answered with the discovery, and posting on Youtube of scenes from the Clash, January 1st 1977 gig at The Roxy.

Unlike for most, when disco died at the 12th of July, 1979 burning of disco records at Comiskey Park.

Loads of material written and even some video about the punk period, circa ’76-’77, there are also many books and videos about the pure “Disco” period that ran from say late ’78 through ’84, especially in London. Little though has been written about the period from ’75 to ’78 that didn’t include punk.

Even Simon Reynolds Retromania: Pop Culture’s Addiction to Its Own Past. . Published in 2011, Reynolds looks at Pop Cultures addiction to retro themes based on past success. Reynolds covers extensively Northern Soul in Chapter-7, he misses our generations key retro theme, and jumps straight to the Mod’ revival bands and culture of bands like the Jam and 2-Tone.

Come 1972, the kids of London and the South East were looking for something after and the reggae and ska of the late sixties, Motown, and similar. Over the next 2-years, on the backs of many great one-hit-wonders, like Tom the Peeper by Act One, and also from more perennial bands like the Three Degrees, new acts like George McRae, K.C. and the Sunshine Band, meant that soul/dance music had caught on big time. In September ’74 almost half the actual pop music chart was music of black origin, predominantly soul/dance music.

None of the early jazz oriented funk, driven by bands like the Fatback Band, made the charts. Tracks from their first album, the 1972 Street Dance, and later tracks from their 1974 album Keep On Steppin’, again lead by the title track, combined with the totally dance-able Wicki Wacky had been big club hits but had yet to make a chart breakthrough.

By the summer of ’75, when the Fatback Band had their first UK chart record Yum Yum, title track from their 1975 album. In the UK, by the time your youth cult became mainstream, which it always did, it was time to move on.

What had been bubbling under in 1975 was a pivot to swing. The summer of ’75 had seen the epitome of modern swing dance, The Hustle enter the chart, and by July that year had become #3 in the UK Pop Chart. Van McCoy’s emblematic track “The Hustle” had been a club hit for a while in early 1975, and it would be the start of a movement that would carry through to 1977’s Saturday Night Fever and beyond.

The Hustle was a dance for couples. To this point, soul/dance and Jazz funk dancing had been mainly an individual thing. As you can see if this video

We started looking for a different direction. As Reynolds suggests, we fell back on a retro theme. We briefly flirted with ’65 and dressing like the Beatles, clothes were available cheap in what were then Second Hand shops. What was more readily available, especially in London, was army surplus. There was a large surplus store on the north end of Tottenham Court Rd commercial district, prices were right the direction for the summer was set.

Our home club was Mash on Greek Street in SOHO. I don’t recall the club details, I do remember though it stayed open late as a “Restaurant” and it had a late night drinks license along with it. We paid something like £2.50, and that included chicken in a basket, which qualified as a restaurant. Upstairs was a restaurant, not sure what it’s name was MASH was in the basement.

We totally continued with funk and rare dance tracks, but a core function of the club was swing aka hustle dancing, increasingly in US Army Style uniforms. Monday evenings we’d head out to Canvey Island to the Goldmine, where Chris Hill took everything one step further and as well as playing Glenn Miller, he also held dance competitions, a full 2-years before any of us saw Saturday Night Fever. By February 1976, Manhattan Transfer had covered Tuxedo Junction, punk was starting to happen. It was time to move on.

David Johnson has some interesting observations about the Goldmine on his Shapers of the 80s website, including pictures.

Later that spring I tore my meniscus/cartilage playing soccer, which restricted severely my ability to dance through the summer. I went to France on the Canal Du Midi, and by the time I got back, the crew I’d been part of moved on. I’m convinced now that a few of us did go to the Roxy for the New Years Day ’77 Clash night.

IMG_20180820_213219Some of us kept in touch over the next few years, we did summer clubs, Great Yarmouth weekenders, the Bournemouth Soul Club, and others but it was never the same again. After I had a serious motorcycle accident in 1978, I did get back together with many of the gang in the summer of ’79, especially one college graduation party in South London, where I re-met Wendy, who’d become my wife a year later.

By then, clubs and disco were mainstream, the kids were younger, the 80’s and New Romantics were happening, it was no longer our time.

Why do some States have more Representatives?

As a quick follow-on from yesterdays post, thanks for the emails and messages on linked-in. I was listening to the USCIS MP3 for the 100 Interview questions last night and found this answer, among others pretty imprecise. This is a single question extract from the actual USCIS MP3.

The question this raises is, which States have more representatives but a smaller population, and why? Obviouly this also hightlights the importance of the U.S. Census which measures the population.

Also, google searching for the questions is a great way to find the confusing litany of websites out there to help immigrants learn and practice for exams, most being for profit. ESLbasics being a good example. Here is the same question.

The delivery isn’t quite as monotone, and the answers are EXACTLY the same, the speaker, Andrea Giordano, even looks down to ensure she is reading it correctly.

Andrea sells a complete pack to prepare for the test for $59.99. She also has most of the questions on youtube for free.

The US Citizenship conundrum

It’s become a constant, “why aren’t they citizens?”

Questions over immigration eventually always end up with a debate, almost always unproductive, sometimes angry about why people who live in the US have not become US Citizens.

It’s my view, that people who pose these questions, do so mostly because they’ve never had to apply themselves. They have no idea how expensive the process is, how long it takes, and for many how difficult it is.

I get a weekly email, it contains a 1-byte GIF, which is used for tracking. When the mail reader loads the .gif file via http, I presume the USCIS keep a record rather than depend on email “read/open receipts”. Other than this the email always says:

USCIS

In my “case” (pun intended), it’s not an application for citizenship, it’s a road block to that application. Turns out sometime late last year while sorting out all my medical billing related issues, I physically lost my green card.

The application for a replacement, cost circa $725. Not a new one, not one that is extended, not a renewal of an expired one, just a replacement/duplicate card. When I applied in the Denver office, and had my bio-metrics done again, I was told to expect a 9 to 11 month delay before I received the card.

I’m waiting for the replacement, so I can legally surrender it during my citizenship process. I wasn’t able to apply until at least May 12th, 2017 as per this very helpful and positive info-graphic. Since I married Kate in October, strictly that would normally mean a 3-year wait, but my 5-year wait was already up.

What does it take to become a US Citizen?

As is often the way, the US Government provides a very helpful and mostly simple set of web pages. The forms can be confusing and intimidating, purely due to the cost of  failed application.

The process is initiated through the completion and submission of form N-400. The filing fee is currently $725 including the bio-metrics fee. After that you have to wait for an appointment, depending on state, this can take up-to a year. You also have to respond as fast as possible to any  requests for information about your application.

Next up you’ll get you interview. At the Interview apparently the process includes

  • you will answer questions about your application
  • take the civics and English tests as required. In a quick vox-pop survey, most of the natural born citizens I’ve asked fail some of the less obvious ones.
  • You also have to prove a level of proficiency with spoken and written English.

You can study up for the questions in many ways. Including this helpful MP3. According to this article in the Boulder Weekly of the 100 questions

Out of the 100 questions the group studies each week, only six are asked at the naturalization interview, at the most 10, as each person is allowed to miss four.

 After which, USCIS issues a written notice of decision. Your application is
  1. Granted—eligible for naturalization.
  2. Continued—you need to provide additional evidence/documentation; or retake the test(s).
  3. Denied—Ineligible for naturalization.

Assuming you are eligible, all you have left is the Oath of Allegiance ceremony.

Why am I waiting?

us gov chatIf you read the webpage details, you can in principle apply, and use the receipt given when I applied for my replacement green card, form I-90. However, when I asked at the office I was told you must have your green card. I asked again today (see left, yes the USCIS uses Salesforce for chat) and was told the same thing.

If I was still working, I could refer the whole thing through to an immigration attorney, but as a stay-at-home Dad, right now I’d like to avoid paying an immigration attorney. Equally, I don’t want to complete and submit my form N-400 and have it rejected, at $725 that’s another expense I don’t want to risk.

I’ve completed the application, minus the final section which lists time outside the country in the last 5-years, only because I have to set aside time to be factually accurate. Until I have my green card that can wait.

So, aside from the expense, it takes a year for most people, which assumes they’ve already been in the country for a minimum of 5-years as a legal green card holder. For most people, that means you’ve been in the country on a visa program before that, add another 2-5 years. Unless of course you’ve can apply for fast-path to green card.

I was an O-1 visa recipient, that didn’t qualify me to be fast-pathed.

Next time you meet someone who isn’t a US Citizen, instead of assuming they are lazy, or don’t want to, have some empathy, it’s an intimidating and fraught process.

 

Solar saves water…

Back in 2002, researchers were already warning of the shortage of water, and the possibility that there would be ‘water wars’.

Seriously.

I’ve been going through a set of older notebooks to look up some project design detail, and came across a set of research notes, from 2002, for this slide deck.

Back in 2002, researchers were already warning of the shortage of water, and the possibility that there would be ‘water wars’. This 2016 National Geographic article is a good starter, if you don’t think water wars are a thing.

One of the more well know American “water wars” , are the Tri-State water wars going on between Atlanta, Georgia, and Florida. Lake Laneir, created some 50-years ago by the Army Corps of Engineers when they created the Buford Dam on the Chattahoochee River. It along with Lake Allatoona were created primarily for hydropower. Both lakes feed major river basins that flow from Georgia through to Alabama and Florida. As Atlanta grows, with much higher water needs, the dispute over whose water it is, started

(Clean) Water is becoming a scarce commodity. With the administrations change of how we classify “Clean Water“, the need to conserve water has never been greater. Forget the climate impact and other negative impacts of coal and nuclear power, they are both “water monster” fuels.

The nations thermoeletric power stations use 4x as much water as all US Residencies, and about the same as farms. Nuclear power plants intake water flow rates can range from 13,500 to 52,000 gallons per minute.

Uranium fuel extraction, requires 45-150 gallons of water per megawatt-hour of electricity produced and uranium mining has contaminated surface or ground water sources in at least 14 states (1).

Choices made now  about power sources will be reverberating for decades. Many Americans are still choosing solar, despite the increased cost following the addition of tariffs, Solar installations in the US are remaining stable, year over year.

If you’ve been thinking about installing a residential solar system, this is another great reason to do it, albeit one that doesn’t have a direct financial benefit. Maybe you will end up selling water by the river?

(1). https://www.ucsusa.org/sites/default/files/legacy/assets/documents/nuclear_power/fact-sheet-water-use.pdf

Privacy: Europe vs the USA

On a day when the likelihood is you’ve been bombarded with GDPR emails from companies you’ve done business with, or just whose websites you’ve registered with, there is no better comparison of the difference between how the European Commision and the USA are dealing with our privacy.

While the new General Data Protection Regulation comes into force tomorrow (May 25th), which isn’t as many think, a reaction to the Facebook privacy scandal, the regulation which took seven years of negotiation, and will force changes in a braod range of industries, including, but not limited to technology, advertising, medicine and banking.

Here in America, we learned this month that a company called LocationSmart is buying the real time cell phone location data obtained from the country’s largest cell giants, including AT&T, Verizon, T-Mobile, and Sprint.

We only learned, because Securus, a prison technology company, who use the data from LocationSmart, had their website tested by a researcher who was able to access the cell phone location of anyone, without consent. Apparently, while the explicit selling of cell phone location data to the Government is banned/illegal, selling it otherwise is not. We don’t even know who they are selling it to, or what it is used for.

Big business is just about making a buck. In the same way as Facebook mostly didn’t care who got your data, and what they did with it, provided facebook got their money, that made it OK. The same has been true for decades for the cable and telephone, cell phone companies.

Europe vs Facebook

The questions that Zuckerberg never answered, including this:

How will you be remembered: As one the three big internet giants along with Steve Jobs and Bill Gates who have enriched our world, or as the genius who created a digital monster that is destroying our democracy and society?

https://gizmodo.com/mark-zuckerberg-played-parliament-for-fools-and-theyre-1826227452