This morning Dr. David Brailer, the head of implementing health information technology mandates in the federal government, gave the opening keynote. (There was also a bizarre and corny musical medley -- AT 8:00 IN THE MORNING -- but that's another post...) He was a good speaker, probably because he's given the bulk of his speech many times and talked in front of large groups of people more than most.
But there were two things that made me cringe in the government's-out-to-get-me manner. First, he was discussing the many benefits of HIT infrastructure interoperability and he brought up "bio-surveillance." I understand the desire for it, but it scares the hell out of me.
Later, he earned his small-government brownie points by saying that the "federal government will not build, own or operate the health IT infrastructure." (Broadly, this refers to the centralized storage of electronic medical records.) He's not saying that someone shouldn't own it, just that it shouldn't be the federal government. Given so many security breakdowns by private industry, or outright privacy violations by companies looking to make a buck on private information, this does not give me comfort. (NB: I don't know enough about the subject yet to know whether all the downsides of centralization outweigh the upsides.)
Posted from cwinters.com; read original
First, he was discussing the many benefits of HIT infrastructure interoperability and he brought up "bio-surveillance." I understand the desire for it, but it scares the hell out of me.
What, specifically, is so scary?
As I understand it, in the state of Massachusetts, public health monitoring is using Victorian-era monitoring techniques. Each county's public health office periodically gathers up reports of "interesting" cases, which are accumulated weekly and sent back to the State public health office. These are gathered together into state-wide summaries that take perhaps a week to prepare. Lots of paper is shuffled in the process. Automation is mostly limited to fax machines and (possibly) email for periodic reporting.
It's all very slow, lethargic, and bureaucratic. The net result is that if there's an outbreak of something, like viral meningitis or epidemic flu, it takes weeks to notice the patterns and alert practitioners. What makes it all the worse is that the local public health offices need to wait for a full state-wide reporting cycle to hear what's happening 2 miles down the road in another county. And that's not counting any of the reporting that falls between the cracks for whatever reason.
Sad thing is, that's par for the course at both the statewide and national level. About the only thing that does work is when a huge spike of something odd like legionella, e. coli or SARS crops up in a localized area within a single jurisdiction.
Re:Bio-Surveillance
lachoy on 2006-02-14T00:03:44
I didn't explain: it's not surveillance like the CDC would do, it's surveillance like the Department of Homeland Security would do. (I didn't get the exact wording of his statement, sorry.)
On a separate note: I can't believe how much money being poured into electronic health records. Well, I can believe it (there are no shortages of boondoggles in the world) but I'd be very, very surprised if we hit Bush's milestone of nationwide records by 2014.
Re:Bio-Surveillance
ziggy on 2006-02-14T01:14:37
I didn't explain: it's not surveillance like the CDC would do, it's surveillance like the Department of Homeland Security would do.Sorry, but I still don't understand what's so scary. CDC needs to be on top of the public health response if, say, there was a smallpox outbreak. But DHS also needs to be hyper-aware about many of the same situations. Doubly so when you start to hear about some of the plans afoot to mobilize the Army/Nat'l Guard to quarantine a locality (like, say, Haskell County, KS) at the first signs of a pandemic outbreak (natural or otherwise).
On a separate note: I can't believe how much money being poured into electronic health records. [...] I'd be very, very surprised if we hit Bush's milestone of nationwide records by 2014.Believe it. It'll happen. 2014 is super-secret Presidential Code for a time in the far future when I'm long since out of office. "2014" is just fewer syllables.
;-) Re:Bio-Surveillance
lachoy on 2006-02-15T00:09:07
Yeah, you're probably right. I think I had my tinfoil anti-Big Brother hat on at the time.
And I don't think the 10 year timespan is super secret
:-) Every president wants to issue an edict as inspirational as JFK's "10 years to the moon", the problem is that they generally don't follow it up with money so it's just another hollow speech.
