The KHIT Blog: "Data flowing at the speed of trust"?

Friday, June 7, 2013

"Data flowing at the speed of trust"?

"Data flowing at the speed of trust"?

That statement was made last year by ONC chief Farzard Mostashari, extolling the promise of HIE (Health Information Exchange). Today, following a long, delayed trip back to Vegas from Orlando, I groggily arose to a total media shitstorm over new revelations regarding personal data apparently flowing to the National Security Agency (NSA) absent any private citizens' knowledge, consent, or "trust."

See my 2008 blog post Privacy and the 4th Amendment amid the "War on Terror"

"You have no privacy, anyway. Get over it."
- Scott McNealy, 1999

I've been studying and writing about privacy issues since grad school in the mid 1980's. I helped kill the original DARPA "Total Information Awareness" proposal. I served on the privacy and security task force for our Nevada HIE, HealtHIE Nevada. I know my HIPAA stuff. I know my 4th Amendment stuff.

Ironic to a significant degree, given that I am so public. Same website address since the 80's. I never post on blogs and news sites anonymously or using some untraceable handle. I'm pretty open.

Will have to watch how this NSA story develops.

MSNBC story link here

Bits of you are all over the Internet. If you've signed into Google and searched, saved a file in your Dropbox folder, made a phone call using Skype, or just woken up in the morning and checked your email, you're leaving a trail of digital crumbs. People who have access to this information — companies powering your emails and Web searches, advertisers who are strategically directing ads at you — can build a picture of who you are, what you like, and what you will probably do next. Revelations about government counter-terrorism programs such as PRISM indicate that federal agents and other operatives may use this data, too.

"Google knows what kinds of porn everyone in the world likes," Bruce Schneier, a security and cryptography expert told NBC News. Not only are companies tracking what you are doing, they are correlating it, he said.

Since news of PRISM broke, the leaders of the tech companies have denied knowledge of government access to their information. At Facebook, one of the world's biggest data collectors, Mark Zuckerberg posted a message that read: "When governments ask Facebook for data, we review each request carefully to make sure they always follow the correct processes and all applicable laws, and then only provide the information if is required by law. But the law already permits quite a bit of digital sniffing — much of it without a warrant."...

Painting a picture of you
Gather all of these shreds of metadata, apply some algorithms that spot clues in patterns, and you can put together a pretty good idea of who a person is, and what they're up to.

For example, when a group from MIT analyzed location data from cellphones of 1.5 million people in a single country over 15 months, the team could identify individuals simply by knowing where they were on four separate occasions...

Back to health care, and Big Data analytics

I was driving back from the music store today, listening to NPR. They had a piece on the "Health Datapalooza" conference going on while I was at the LEI Lean Conference (mp3 audio embedded below). It featured the ever-so-interesting and garrulous AthenaHealth CEO Jonathan Bush (cousin of GWB).

Below:
Speaking of Big Healthcare Data and "trust"

SUNDAY UPDATE

We now have the next Bradley Manning

Boston.com

A British newspaper Sunday revealed the source of the leak revealing the NSA’s extensive surveillance of US communications.

Edward Snowden, a former CIA technical assistant who now works for a defense contractor with ties to the National Security Agency, asked the Guardian newspaper to reveal his identity.

“I have no intention of hiding who I am because I know I have done nothing wrong,” he told the newspaper in a remarkable, rambling interview that touched on his reasons for the leak, how he took precautions in not revealing documents that could harm particular people, how he became disillusioned, and how he expects his life as he knows it to end. “I don’t want the story to be about me. I want it to be about what the US government is doing.”

“I’m willing to sacrifice all of that because I can’t in good conscience allow the US government to destroy privacy, Internet freedom and basic liberties for people around the world with this massive surveillance machine they’re secretly building.”...

There will be total bipartisan cohesion around making the story all about you, son.

USDOJ hasn't done squat about the trillions of dollars of Wall Street crimes in more than 4 years, but has gone after after this young man in less than 12 hours.

BEWARE OF GEEKS BEARING GIFTS

Below: just got this link from Jon Taplin:

FT.com

On Monday, Barack Obama’s administration begins its court martial of Bradley Manning, the former US army private who uploaded hundreds of thousands of classified documents to WikiLeaks. Reasonable people disagree on whether Mr Manning “aided the enemy” (as President Obama’s prosecutors allege) or is a hero for helping to educate us about Washington’s shadowy drone programme. Most are surprised the White House is demanding a life sentence four years after putting Mr Manning behind bars. In their view, Mr Obama is a self-confessed geek with Silicon Valley’s transparent “Do no evil” values. Yet he regularly betrays these with his “Nixonian” mania for secrecy...

...[W]hile big data brings innovation, it also has dangerous side effects. Culture is already pushing Americans towards “data nudism”. Such currents will only get more acute. Before long, it will be possible to map an individual’s genetic sequencing at an affordable price. No one will be forced to attach their genetic record to online dating profiles. But potential mates may assume that anyone who chooses not to is concealing a genetic disorder.

America’s middle classes are already in thrall to their often capricious credit scores – a determination that is notoriously hard to correct. In a world where the average home will have hundreds of sensors, and where ubiquitous tracking systems can intimately map an individual’s habits, the right to privacy could become an economic tool of survival. Already, US employers often demand a credit score, a drugs test and fingerprinting from many kinds of applicant. In the new digital world, the right to expunge past blemishes may turn into a rumbling civil struggle.

Should such futurology bother Mr Obama? Yes. A century ago, Theodore Roosevelt pushed back against the power of the rail barons and oil titans – the great technological disrupters of his day. Mr Obama should pay closer heed to history. And he should become wary of geeks bearing gifts.

May we live in interesting times, indeed. It will certainly be an interesting Beltway week.

Can't wait to hear what Michele Bachmann has to say about all of this.
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Friday, June 7, 2013

"Data flowing at the speed of trust"?

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