Archive | April, 2010

“Free” Internet Service

26 Apr

How much should each one of us pay to have access to the internet?

I think it should be something like the annual pass fee for the National Parks.

(This is taken from the National Parks Service FAQ )

How many employees are in the National Park Service?

Permanent, Temporary, and Seasonal – Approximately 20,500 diverse professionals

Volunteers in Parks – 145,000

How many people visit the National Parks?

Total recreation visitors to the National Parks in 2009: 285,579,941

Visit the Public Use Statistics for more detailed information.

What is the National Park Service Budget?

FY 2010 Enacted – $3.16 billion

FY 2011 Request – $3.14 billion

How do I obtain a park pass?

Visitors can obtain park passes by visiting their nearest park site. Most sites have passes available, however it is recommended to call a      park prior to your visit. Learn more about the America the Beautiful – National Parks and Federal Recreation Lands Pass.

(note: based on the annual 2009 visitors and the 2010 budget that is like $11.00 per person)

And,  if you are older yeah, you get a discount….maybe like 50%

Here is what I think I should pay…

Remember there are 350 Million individuals. Even if two fifths of them paid, that would be 140 Million individuals

@$10/year that would be $1.4Billion dollars per year

@$20/year that would be $2.8 Billion dollars per year

Since the internet charges for both ingress and egress traffic (they charge you and the person you are connecting to) they get paid twice for most traffic.

I vote for “free” being less than $20.00 / year for individual internet access.  Let them get the rest from the companies that we connect to.

Most of the internet facilities I have been to are “lights out” (nobody works there) and their costs are for equipment and electricity.  It doesn’t take a lot of people to run the internet.  The equipment is depreciated so the companies get tax breaks on the equipment and the expenses as the costs of business.

Oh yeah, if we made it easy to get a wireless connection (no password) I doubt we would need many customer service people (no password reset).  Companies don’t need much support after installation and most of it can be done remotely.

The internet by definition is “best efforts” delivery so I am not paying for or getting quality of service.

I can afford $20.00 and that includes access at home and away.  Make sure I have Wi-Fi and I will only use my cell when I can’t get Wi-Fi service.  So I get it “free” on my cell phone plan too.

Everyone needs internet access – Net Neutrality

26 Apr

“The internet is global”

[but the global governance of the internet is not recognized or well known or that functional]

“all media is moving to the internet”

[Government censorship or regulation is only available on regulated communications services.  Currently the internet is not under the jurisdiction of any government agency.]

These comments can be heard in this video from Bill Moyer’s Journal It is short and worth watching.

Everyone needs access to the internet.

It should be “free” <$20.00 /year for individuals but organizations and  Companies will have to pay.

The use of the internet is for access to our information and because “all media is moving to the internet” it will be the way we get our general news and information in the future if not already today.   When all of our personal information is online we will have to have open access to the internet as the means to survive.  It will be just like the air we breath.  We will have to have it.  Take it away and we will be unable to function.  It is very important and a necessary resource for our digital future.

Open letter to Aneesh Chopra

25 Apr

I attended the Connect 2009 conference in Washington D.C.  and felt a strong sense of commitment to the need for an electronic health record for all U.S. Citizens.  I don’t believe that the efforts behind the Connect software solution will be a solution.  Read this open Letter to Aneesh Chopra for my reasons.

If we don’t address the need for a personal database to keep our personal information we will have bigger problems soon.

As an early member of the Computer Based Patent Record Institute and a committee member I agreed with the findings of that organization.  We need a birth to death electronic medical record.  At some point in time, they gave up on this goal and decided to burden health care providers with the collecting, managing and securing of this data.  With no defined architecture and a lack of understanding about how to fix this problem we are ending up with multiple vendor solutions with no hope of a birth to death electronic medical record.  We have created islands of data.  Haystacks.

What we are planning with local, regional and national data collection nothing could be further from the solution that is needed.  We need a different information management solution for the electronic medical record.  The relational database will fail.  The problem is not a relational data management problem.  It is a personal data management problem.  It is about collecting individual data and storing it in the person’s individual database.

The solution exists.  It works with our current technologies.  Just don’t use a relational database.

Missouri Hospital Association Data Reporting Mandate

03 Apr

Since 1993 all Missouri hospitals have been required to report personal data on all hospital patients receiving care.  Data has been collected beginning in 1986 and Kansas and Missouri are jointly collecting data since 2000.   Reporting data is sent on CD’s (Compact Discs) monthly to member hospitals.  (I would guess without any security or encryption.)  That is a lot of CD’s.  I wonder if all of them are accounted for?  Have any been “thrown away”?

In a recent meeting in February 18, 2010 they have started to enforce rules about a 1% error threshold with the quality of data.  Here is a summary of the February 18 meeting.  I wonder if they have provided any historical data of provider error rates?

HIDI will provide an overview of the guidelines for data submission, including the collection, editing and correction of discharge data.

HIDI recently conduct regional meetings at MHA-member hospitals to review HIDI’s inpatient and outpatient discharge collection process. Staff provided an overview of the guidelines for data submission, including the collection, editing and correction of discharge data. Staff also provided an update on the required discharge data submission to the state.

In November, the Missouri Department of Health and Senior Services notified hospitals and ambulatory surgical centers of its intent to enforce the 1 percent field level error threshold for reporting patient abstract data included in 19 CSR 10-33.010. The rule, effective since Dec. 31, 1992, established procedures for state reporting of patient abstract data for inpatients and outpatients by hospitals and ASCs. HIDI processes and reports discharge data for most MHA-member hospitals and for HIDI-contracted ASCs. According to DHSS, enforcement of the 1 percent error threshold will begin with federal fiscal year 2010’s first quarter data submission — discharges between Oct. 1 and Dec. 31, 2009. Reporting organizations not able to meet the 1 percent error threshold must submit a corrective plan of action to DHSS.

The full report can be found here.  http://www.sos.mo.gov/adrules/csr/current/19csr/19c10-33.pdf

(click on this image to enlarge)

In addition to the personal data required the medical diagnosis, condition, procedure codes, charges, patient disposition, physicians and medical record number were provided.

This information is kept in it’s original form and can be used for other purposes if approved by the HIDI Data Release Advisory Committee appointed by the director.  Unique patient data can be used for detailed studies though subsequent release of data cannot identify patient, physician or provider.

In a letter dated November 18, 1992 from Kenneth L.  Kuebler, Executive Vice President of HIDI,  he provided a concern about this data collection process.

“7.              In addition, legal counsel has brought to our attention the fact that compliance with certain of your reporting requirements will place hospitals in violation of a federal patient confidentiality statute (I will provide the precise citation later when it is provided to me) that precludes the release of the identity of patients treated for drug or alcohol abuse.  The rules will need to reflect this restriction and exempt from the reporting requirements the name or social security number of patients discharged for these types of treament.”

I wonder if compliance to this Federal Patient confidentiality statute was monitored or enforced.  It would have fallen to the reporting hospitals and ambulatory surgery facilities.

HIDI provides many reports to…

The following data are available to MHA-member hospitals.

Hospital Inpatient Reports

These reports contain comprehensive information concerning hospital utilization patterns and patient characteristics and are valuable tools for hospital planning and evaluation. Available since 1986, the reports are mailed to member hospitals that provide inpatient discharge data. Beginning with the 2000 Hospital Inpatient Reports, inpatient discharge data for Missouri and Kansas are combined and reported at the hospital level. Participating Missouri hospitals may purchase reports for Kansas, and participating Kansas hospitals may purchase reports for Missouri. In 2003, the utilization rate tables for Missouri were added to the CD as a convenience to members. The tables report the 500 most frequent principal diagnoses, the 500 most frequent principal procedures and all diagnosis-related groups (DRG).

Interim Hospital Inpatient Reports

Hospital Outpatient Reports

Census Data

Management and Productivity Reports

Monthly Utilization Report

Do all states collect this type of data?

I searched through the 19 CSR 10-33.010. (The rule, effective since Dec. 31, 1992, established procedures for state reporting of patient abstract data for inpatients and outpatients by hospitals and ASCs.)  I did not find the word privacy.  I don’t know what privacy laws protect this data.