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Thursday, September 26, 2013

Amid the increasing din of negativity, a Singular Positive

As we approach yet another phony crisis Day of federal Reckoning -- "defunding ObamaCare," "shutting down the government," "defaulting on the federal debt" -- piled atop the long-simmering partisan feuds over Health IT, I have to admit to some weariness over all of it. The inmates seem to be in control of the asylum these days.

But, from a Facebook post by one of my friends comes a waft of pure clean air. Fourteen minutes of fortifying inspiration.

FutureMed: The Future of Health

This archive file was compiled from audio and video documentation of a gathering of medical professionals, inventors & entrepreneurs, held at Singularity University in California, February 2013. The selected material gives a portrait of a time in which the field of health found itself at a crossroads between the mature medical institutions which had slowly evolved over hundreds of years, and a need to develop and integrate new, more flexible and scalable forms of care.

Worth every second of your time.
About FutureMed

Exploring and driving the future of health and medicine through fast moving, convergent game changing technologies.

FutureMed educates, informs and prepares physicians, innovators, inventors, investors and senior healthcare executives to understand and recognize the opportunities and disruptive influences of exponentially growing technologies within medicine and healthcare, and to understand how many rapidly developing and converging fields affect the future of wellness, prevention, clinical practice and the biomedical industry.
Understand how healthcare is being re-invented and disrupted through rapidly developing technologies such as low cost genomic sequencing, artificial intelligence, telemedicine, robotics, 24/7 body wearable monitors, smart pills, stem cells, synthetic biology, gene therapy, mobile phone apps and crowd-sourced health data affect the future of healthcare and medicine?
About Singularity University

 Singularity University is an interdisciplinary university whose mission is to assemble, educate and inspire leaders who strive to understand and facilitate the development of exponentially advancing technologies in order to address humanity’s grand challenges. With the support of a broad range of leaders in academia, business and government, Singularity University hopes to stimulate groundbreaking, disruptive thinking and solutions aimed at solving some of the planet’s most pressing challenges. Singularity University is based at the NASA Research Park in Silicon Valley.
I will be right down the street from these people while attending Health 2.0 2013 in Santa Clara next week. I will have to take a run over there.

The President just gave an hour-long speech defending the PPACA and touting the HIX launch next week. Interesting site here:

It will certainly be an interesting weekend heading toward October 1st.

September 30, 2013 is an important deadline for eligible hospitals and critical access hospitals (CAHs) participating in the EHR Incentive Programs. It marks the end of the fiscal year (FY) and the last day of the 2013 meaningful use program year.

Attestation Deadline
Hospitals participating in the Medicare EHR Incentive Program have until November 30, 2013 to attest to demonstrating meaningful use of the data collected during the FY 2013 reporting period. Hospitals participating in the Medicaid EHR Incentive Program need to refer to their state deadlines for attestation.

Hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

Payment Adjustments
Payment adjustments will be applied beginning FY 2015 (October 1, 2014) to Medicare eligible hospitals that have not successfully demonstrated meaningful use. The adjustment is determined by the hospital’s reporting period in a prior year. Read the eligible hospital payment adjustment tipsheet to learn more.

Fiscal Year 2014
October 1, 2013 marks the start of FY 2014 and many important milestones for eligible hospitals, including:

  • The start of Stage 2 for eligible hospitals that have completed at least two years of Stage 1.
  • A reduced EHR incentive payment for hospitals that begin participation in 2014 and later.
  • A 3-month reporting period in 2014, regardless of the stage of meaningful use to allow more time to upgrade to 2014 certified EHR technology.
  • The reporting period must be fixed to the quarter for Medicare eligible hospitals and CAHs.
  • The reporting period can be any 90 days for Medicaid eligible hospitals and CAHs.
Further ONC shakeup as No. 2 Muntz announces departure
By Joseph Conn,
David Muntz, the No. 2 official at HHS' Office of the National Coordinator for Health Information Technology, will be joining his boss, National Coordinator Dr. Farzad Mostashari, in heading out the door next month. Muntz intends to return to the private sector.

ONC executive Dr. Jacob Reider was named as the acting replacement for Mostashari, and Lisa Lewis was named acting replacement for Muntz. Mostashari announced last month that he would step down. Reider and Lewis will take over Oct. 6.

Muntz, the former senior vice president and chief information officer of the Baylor Health Care System, and board member of the College of Healthcare Information Management Executives, began his stint as principal chief deputy at ONC in January 2012...
A rush for the exits? Handwriting on the wall?

More news...
Fewer Stage 2 Certified EHR Systems Could Pose Problems
Thursday, September 26, 2013

Fewer software developers have certified electronic health record systems for use by health care providers under Stage 2 meaningful use requirements than under Stage 1 of the program, according to a Modern Healthcare review, Modern Healthcare reports.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
Modern Healthcare examined the Certified Health IT Product List, which is compiled by the Office of the National Coordinator for Health IT. The report found that only 79 companies, providers and other health care organizations have developed software that has been tested and certified to meet standards for Stage 2 of the program. In comparison, there were 988 developers of health IT systems that were tested and certified for Stage 1 of the program...
Maybe this vendor shakeout will turn out to be a good thing.


Well, I now have an Antioch address, a California driver's license, California tags on my car, registered to vote in CA while at the DMV, located and wrote to my Congressman, and got my prized Senior Discount BART Clipper Pass smart card. So, I'm now officially a citizen of The Peoples' Republic.

Next week I will be rubbing shoulders with the cutting edge Health IT digerati while covering the Health 2.0 2013 Conference in Santa Clara.

Tangentially apropos of that, from

Why we hate the new tech boom
Our new masters aren't going away -- and neither is a two-tiered employment world which makes inequality worse

...First, there is unsettling realization that the middle is losing economic ground while Silicon Valley execs babble on about “changing the world” for the better. Income inequality is growing ever worse, and it is increasingly clear that one of the forces fueling this trend is the technological innovation flowing out of the Bay Area. Second: The very fact that this boom is not a bubble, and will not suddenly vanish, means we can’t ignore it, or laugh it away. This is the new normal, and for those not lucky enough to have catered foodie gourmet lunches in brand-new downtown office complexes, the new normal sucks. Back in 1999-2000, the ridiculousness of what was happening was so obvious that it was hard to take it seriously. Everyone knew an economy boom built on online pet product company IPOs was doomed. Sooner or later, the bubble would pop and sanity would be restored and all those annoying dot-commers crowding your favorite bar or restaurant would go back to where they came from. The traffic would finally ease up.

But that’s not going to happen this time. The current boom isn’t a flash in the pan, doomed to disappoint arriviste gold miners. It’s here to stay. A mature Internet economy is generating huge riches, and it is remaking the face of San Francisco and the larger Bay Area in the process. But unless you really, truly want a job chauffeuring the new rich around town, or delivering their same-day groceries, or pouring their flights of craft beers — jobs that, incidentally, won’t pay enough to afford you an apartment anywhere in San Francisco — this new boom may not seem worth cheering about. Might as well root for it to fail...

...if you want to rent an apartment in the Mission district of San Francisco, you would need to work the equivalent of 5.5 minimum-wage jobs to afford the average $2,920 rent. Make that 7.5 such jobs if you want to live South of Market, where so many tech firms are headquartered. Also grounded: the shocking decline in the percentage of San Francisco’s residents who are African-American — nearly 20 percent in just the decade 2000-2010. All over the Bay Area, according to Joint Venture Silicon Valley, average incomes are rising, while median household incomes are falling — a strong sign that the wealth created by the thriving tech economy is not getting evenly distributed.

Unemployment is obviously and thankfully down — but serious questions remain as to the distribution of the new jobs. It’s a familiar story nationwide: The last couple of decades have seen the middle class get squeezed, and new technological innovations that have resulted in the automation or outsourcing of jobs are a big part of that narrative. The rising antagonisms directed at the tech economy’s nouveau riche are a direct consequence of a couple of decades of seeing “Star Trek”-like technological advances accompanied by a measurable fall in individual living standards...
I love the Bay Area, and I'm glad to be back after a 45 year hiatus, but San Francisco proper is no longer the freewheeling bohemian paradise of yore. e.g., as written up in Vanity Fair:
Bluebloods & Billionaires
Trevor Traina, San Francisco’s undisputed social king, has enticed many of the Silicon Valley elite to his ultra-exclusive Pacific Heights neighborhood, showering them with advice about what to wear, how to entertain, and whom to know. But the concept of noblesse oblige may be harder to teach. Evgenia Peretz learns why the arrival of such high-tech moguls as Apple’s Jonathan Ive and Zynga’s Mark Pincus has put some Old Guard noses out of joint.

...The high-tech elite has arrived, with more money than anyone knows what to do with. At the helm of companies that are focused on social media and commerce, as opposed to algorithms, this new generation of Silicon Valley titans has abandoned the Valley and made homes and headquarters in San Francisco. Alas, San Francisco, with just 812,000 people, is one of the few American cities in which Old Money still carries formidable status, and traditions are entrenched. Edith Wharton, had she lived in the time of instant messaging, would surely have found rich fodder in the collision of these worlds. As in mid-19th-century New York City, some from the Old Guard find the new breed well short of scintillating.

“They bore the hell out of me,” says Denise Hale, a Serb refugee who married Hollywood director Vincente Minnelli and then San Francisco department-store magnate Prentis Cobb Hale. “They’re one-dimensional and can only talk about one thing. I’m used to brilliant men in my life who leave their work, and they have many other interests. New people eventually will learn how to live. When they learn how to live, I would love to meet them.”...

I cited George Packer on this blog back in June. He observed in The New Yorker in his fabulous piece "Change the World," that a peculiar, eclectic narcissism pervades the high tech Bay Area / Silicon Valley region:
In 1978, the year that I graduated from high school, in Palo Alto, the name Silicon Valley was not in use beyond a small group of tech cognoscenti. Apple Computer had incorporated the previous year, releasing the first popular personal computer, the Apple II. The major technology companies made electronics hardware, and on the way to school I rode my bike through the Stanford Industrial Park, past the offices of Hewlett-Packard, Varian, and Xerox PARC. The neighborhoods of the Santa Clara Valley were dotted with cheap, modern, one-story houses—called Eichlers, after the builder Joseph Eichler—with glass walls, open floor plans, and flat-roofed carports. (Steve Jobs grew up in an imitation Eichler, called a Likeler.) The average house in Palo Alto cost about a hundred and twenty-five thousand dollars. Along the main downtown street, University Avenue—the future address of PayPal, Facebook, and Google—were sports shops, discount variety stores, and several art-house cinemas, together with the shuttered, X-rated Paris Theatre. Across El Camino Real, the Stanford Shopping Center was anchored by Macy’s and Woolworths, with one boutique store—a Victoria’s Secret had opened in 1977— and a parking lot full of Datsuns and Chevy Novas. High-end dining was virtually unknown in Palo Alto, as was the adjective “high-end.” The public schools in the area were excellent and almost universally attended; the few kids I knew who went to private school had somehow messed up, The Valley was thoroughly middle class, egalitarian, pleasant, and a little boring.

Thirty-five years later, the average house in Palo Alto sells for more than two million dollars. The Stanford Shopping Center’s parking lot is a sea of Lexuses and Audis, and their owners are shopping at Burberry and Louis Vuitton. There are fifty or so billionaires and tens of thousands of millionaires in Silicon Valley; last year’s Facebook public stock offering alone created half a dozen more of the former and more than a thousand of the latter. There are also record numbers of poor people, and the past two years have seen a twenty-per-cent rise in homelessness, largely because of the soaring cost of housing. After decades in which the country has become less and less equal, Silicon Valley is one of the most unequal places in America.

Private-school attendance has surged, while public schools in poor communities—such as East Palo Alto, which is mostly cut off from the city by Highway 101—have fallen into disrepair and lack basic supplies. In wealthy districts, the public schools have essentially been privatized; they insulate themselves from Shortfalls in state funding with money raised by foundations they have set up for themselves. In 1983, parents at Woodside Elementary School, which is surrounded by some of the Valley’s wealthiest tech families, started a foundation in order to offset budget cuts resulting from the enactment of Proposition 13, in 1978, which drastically limited California property taxes. The Woodside School Foundation now brings in about two million dollars a year for a school with fewer than five hundred children, and every spring it hosts a gala with a live auction. I attended it two years ago, when the theme was RockStar, and one of Google’s first employees sat at my table after performing in a pickup band called Parental Indiscretion. School benefactors, dressed up as Tina Turner or Jimmy Page, and consuming Jump’n Jack Flash hanger steaks, bid thirteen thousand dollars for Pimp My Hog! (“Ride through town in your very own customized 1996 Harley Davidson XLH1200C Sportster”) and twenty thousand for a tour of the Japanese gardens on the estate of Larry Ellison, the founder of Oracle and the country’s highest-paid chief executive. The climax arrived when a Mad Men Supper Club dinner for sixteen guests—which promised to transport couples back to a time when local residents lived in two-thousand-square-foot houses—sold for forty-three thousand dollars.

The technology industry’s newest wealth is swallowing up the San Francisco Peninsula. If Silicon Valley remains the center of engineering breakthroughs, San Francisco has become a magnet for hundreds of software start-ups, many of them in the South of Market area, where Twitter has its headquarters. (Half the start-ups seem to have been founded by Facebook alumni.) A lot of younger employees of Silicon Valley companies live in the city and commute to work in white, Wi-Fi-equipped company buses, which collect passengers at fifteen or so stops around San Francisco. The buses—whose schedules are withheld from the public—have become a vivid emblem of the tech boom’s stratifying effect in the Bay Area. Rebecca Solnit, who has lived in Sari Francisco for thirty years, recently wrote in The London Review of Books, “Sometimes the Google Bus just seems like one face of Janus-headed capitalism; it contains the people too valuable even to use public transport or drive themselves. Right by the Google bus stop on Cesar Chavez Street immigrant men from Latin America stand waiting for employers in the building trade to scoop them up, or to be arrested and deported by the government.” Some of the city’s hottest restaurants are popping up in the neighborhoods with shuttle stops. Rents there are rising even faster than elsewhere in San Francisco, and in some cases they have doubled in the past year.

The buses carry their wired cargo south to the “campuses” of Google, Facebook, Apple, and other companies, which are designed to be frilly functioning communities, not just places for working. Google’s grounds, in Mountain View—a working-class town when I was growing up—are modelled on the casual, Frisbee-throwing feel of Stanford University, the incubator of Silicon Valley, where the company’s founders met, in grad school. A polychrome Google bike can be picked up anywhere on campus, and left anywhere, so that another employee can use it. Electric cars, kept at a charging station, allow employees to run errands. Facebook’s buildings, in Menlo Park, between 101 and the salt marshes along the Bay, surround a simulated town square whose concrete surface is decorated with the word “HACK,” in letters so large that they can be seen from the air. At Facebook, employees can eat sushi or burritos, lift weights, get a haircut, have their clothes dry-cleaned, and see a dentist, all without leaving work. Apple, meanwhile, plans to spend nearly five billion dollars to build a giant, impenetrable ringed headquarters in the middle of a park that is technically part of Cupertino. These inward-looking places keep tech workers from having even accidental contact with the surrounding community. The design critic Alexandra Lange, in her recent e-book, “The Dot-Com City: Silicon Valley Urbanism,” writes, “The more Silicon Valley tech companies embrace an urban model, the harder it becomes for them to explain why they need to remain aloof. People who don’t have badges aren’t just a security risk.”

The industry’s splendid isolation inspires cognitive dissonance, for it’s an article of faith in Silicon Valley that the technology industry represents something more utopian, and democratic, than mere special-interest groups. The information revolution (the phrase itself conveys a sense of business exceptionalism) emerged from the Bay Area counterculture of the sixties and seventies, influenced by the hobbyists who formed the Homebrew Computer Club and by idealistic engineers like Douglas Engelbart, who helped develop the concept of hypertext and argued that digital networks could boost our “collective I.Q.” From the days of Apple’s inception, the personal computer was seen as a tool for personal liberation; with the arrival of social media on the Internet, digital technology announced itself as a force for global betterment. The phrase “change the world” is tossed around Silicon Valley conversations...
This next chapter in my life will certainly be interesting.


George Packer cited this book, so I bought it.

Silicon Valley is guilty of many sins, but lack of ambition is not one of them. If you listen to its loudest apostles, Silicon Valley is all about solving problems that someone else— perhaps the greedy bankers on Wall Street or the lazy know-nothings in Washington— have created.

“Technology is not really about hardware and software any more. It’s really about the mining and use of this enormous data to make the world a better place,” Eric Schmidt, Google’s executive chairman, told an audience of MIT students in 2011. Facebook’s Mark Zuckerberg, who argues that his company’s mission is to “make the world more open and connected,” concurs. “We don’t wake up in the morning with the primary goal of making money,” he proclaimed just a few months before his company’s rapidly plummeting stock convinced all but its most die-hard fans that Facebook and making money had parted ways long ago. What, then, gets Mr. Zuckerberg out of bed? As he told the audience of the South by Southwest festival in 2008, it’s the desire to solve global problems. “There are a lot of really big issues for the world to get solved and, as a company, what we are trying to do is to build an infrastructure on top of which to solve some of these problems,” announced Zuckerberg.

In the last few years, Silicon Valley’s favorite slogan has quietly changed from “Innovate or Die!” to “Ameliorate or Die!” In the grand scheme of things, what exactly is being improved is not very important; being able to change things, to get humans to behave in more responsible and sustainable ways, to maximize efficiency, is all that matters. Half-baked ideas that might seem too big even for the naïfs at TED Conferences— that Woodstock of the intellectual effete— sit rather comfortably on Silicon Valley’s business plans. “Fitter, happier, more productive”— the refreshingly depressive motto of the popular Radiohead song from the mid-1990s— would make for an apt welcome sign in the corporate headquarters of its many digital mavens. Technology can make us better— and technology will make us better. Or, as the geeks would say, given enough apps, all of humanity’s bugs are shallow.

California, of course, has never suffered from a deficit of optimism or bluster. And yet, the possibilities opened up by latest innovations make even the most pragmatic and down-to-earth venture capitalists reach for their wallets. After all, when else will they get a chance to get rich by saving the world? What else would give them the thrill of working in a humanitarian agency (minus all the bureaucracy and hectic travel, plus a much better compensation package)?

How will this amelioration orgy end? Will it actually accomplish anything? One way to find out is to push some of these nascent improvement efforts to their ultimate conclusions. If Silicon Valley had a designated futurist, her bright vision of the near future— say, around 2020 or so— would itself be easy to predict. It would go something like this: Humanity, equipped with powerful self-tracking devices, finally conquers obesity, insomnia, and global warming as everyone eats less, sleeps better, and emits more appropriately. The fallibility of human memory is conquered too, as the very same tracking devices record and store everything we do. Car keys, faces, factoids: we will never forget them again. No need to feel nostalgic, Proust-style, about the petite madeleines you devoured as a child; since that moment is surely stored somewhere in your smartphone— or, more likely, your smart, all-recording glasses— you can stop fantasizing and simply rewind to it directly. In any event, you can count on Siri, Apple’s trusted voice assistant, to tell you the truth you never wanted to face back then: all those madeleines dramatically raise your blood glucose levels and ought to be avoided. Sorry, Marcel!

Politics, finally under the constant and far-reaching gaze of the electorate, is freed from all the sleazy corruption, backroom deals, and inefficient horse trading. Parties are disaggregated and replaced by Groupon-like political campaigns, where users come together— once— to weigh in on issues of direct and immediate relevance to their lives, only to disband shortly afterward. Now that every word— nay, sound— ever uttered by politicians is recorded and stored for posterity, hypocrisy has become obsolete as well. Lobbyists of all stripes have gone extinct as the wealth of data about politicians— their schedules, lunch menus, travel expenses— are posted online for everyone to review...
Gotta love it.

More to come...

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