Archive for October 16, 2012

The political healthcare week that was on Twitter

In a new Twitter record for politics, President Barack Obama’s Democratic National Convention speech spurred people around the world to Tweet at a rate of 52,757 per minute, tech blog Mashable reported.

In related news, Mashable noted, the $100,000-each Twitter trends Republicans and Democrats have been promoting — #RomneyRyan2012, #AreYouBetterOff, #16TrillionFail and #Forward2012 — haven’t really worked out for either of them. A lot of people using the hashtags have done so making arguments and commentary counter to their sponsored intent.

Editorial skepticism: It is somewhat hard to believe there are a lot of undecided voters on Twitter anyway.

In any event, on Twitter this week there was the usual partisan chest-thumping and also some interesting anecdotes from individuals about their company’s rising premiums and people day-tripping from Oklahoma to Mexico for prescriptions:

James Wolcott ?@JamesWolcott
“We’re building an America in which Walter White won’t have to become a meth cook because he lacks proper health care coverage.” #DNC2012

BikeWalkLee ?@BikeWalkLee
This bicycle bus at both conventions was the initiative of a health care company, with a goal of encouraging…

James JP Hawkins ?@jphawkins2009
Graph showing the dispicable lies told by obama & his minions regarding the future of healthcare under obamanocare:

Robert Faulhaber ?@rfaulhaber
CBO Fact Checks Clinton Claim Obama Controlled HealthcareCosts via @zite

Fred Pollack ?@FredPollack
If laughter is the best medicine, I’m surprised healthcare companies haven’t yet figured out a way to charge us a copay.

Kernel Wars ?@Kernelwars
Fox News Debunks Years Of Its Own Commentary By Accurately Reporting That Health Care Reform Reduces Deficit

Luke Russert ?@LukeRussert
Also significant: Very lite mention of healthcare reform and nothing on stimulus. 2 HUGE Obama legislative accomplishments avoided

David Limbaugh ?@DavidLimbaugh
No, the people most certainly did not endorse your health care plan — don’t try to foist that off on the American people.

David Swerdlick ?@Swerdlick
If you want healthcare passed, call Obama. If you want healthcare explained, call Clinton.

One public dollar invested in contraception saves $4 in Medicaid expenditures.

Lis Smith ?@Lis_Smith
The last time @MittRomney was on “Meet the Press”, he endorsed a federal individual health care mandate #flipflop

Brad Thor ?@BradThor
#Obama pledged that healthcare reform wouldn’t add a cent to the deficit, but #Obamacare will actlly have net cost of approx $1.2 trillion

Tabitha Hale ?@TabithaHale
“Freedom means keeping gov’t out of our most private affairs” unless we’re regulating your health care or forcing you to perform abortions.

Scott Rasmussen ?@RasmussenPoll
50% Favor Repeal of Health Care Law, 41% Opposed… #healthcare

Chris Ward ?@christopherward
In other completely unrelated news, Murdoch has started up a new health care company. #reshuffle

Michael Graham ?@MGraham969
Remember as you listen to Rubio that next week you’ll hear US politicians PRAISING the Cuban health care system. #NaturalTruth#DNC

Mark Cherrington ?@MarkCherrington
Have no doubt if it wasn’t for Quebec, we’d have the death penalty and no universal health care system. Quebec the social conscience of CDN

Arthur Brooks ?@arthurbrooks
If we’re serious about health care reform, that means getting serious about health care cronyism.

Matt Yglesias ?@mattyglesias
The best thing Bill Clinton did last night was try to bring Medicaid into the policy debate:

Drew Armstrong ?@ArmstrongDrew
Bill taking some liberties with that health care cost inflation statistic. (Bad) economy was a large part of that.

James Young ?@welcomebrand
Bike highways in Denmark. Will pay for themselves in healthcaresavings in less than a year. Take note UK govt!

John S ?@gottahavej
Obama isn’t making sure YOU GET HEALTHCARE! He is selling HC insurance that DOESN’T PAY enough of the bill for doctors to accept. #rnc #dnc

Old Man Potter ?@HenryFPotter
Turned out empty chair did not raise my taxes. Well, of course not. It’s a chair. But when I wasn’t looking, it socialized health care.

Rebel Leader ?@UntiLimInCharge
#DNC: You guys r gonna decide health care for 300 million yet can’t decide if God should be in your platform? … #tcot #tlot #glbt #p2#gop

Buckley Brinkman ?@PBuckley
Healthcare is 18% of GNP. Up from 7.2% in 1970. Projected to be 40% in 2050. WOW! 40%!?! @WMEP_News

GS Elevator Gossip ?@GSElevator
Would Bill Clinton’s cosmetic surgery be covered under Obamacare?

The Hill Healthwatch ?@hillhealthwatch
Fact-checkers find few flaws in Clinton’s healthcare claims

cole thomas ?@coletrickle0
I love how they zoom in on the diseased looking people whenever they talk about healthcare. #DNC

Nicholas Halcomb ?@NHalcomb
#DNC you think Healthcare should be free? Ok, you go to school for 10-12 yrs and see what it’s like to not get paid for your service.

Amy ?@inspiredzone
Half my monthly take home pay goes to student loans. If I gethealthcare through my job, I lose another 1/4 of what’s left #DNC#Clinton

Bec ?@Brocklesnitch
My gf’s grandparents who live in Oklahoma make a fun day trip over the border to Mexico to get their prescriptions #dnc #healthcare

Domenick Cilea ?@dcilea
I question Clinton’s stats on healthcare costs; my company’s premiums went up 57 and 25 percent in the last two years. #dnc

jasonscottjones ?@jasonscottjones                                                                          Speaking of #healthcare #BillClinton is running a #clinic @ #DNC

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QR Codes Used in Searches for Missing Children

On March 9, 2009, Stephen Watkins’ children never showed up to  their school in Newmarket, Ontario. During a weekend court-ordered visit, his ex-wife Edyta Ustaszewski, the noncustodial mother of their sons Alexander and Christopher, took them and fled the country. She escaped to the U.S. before heading to Europe, sending authorities on her trail for more than two years.

But Watkins was proactive, using modern technology to bring international attention to tragedy. He created custom quick response (QR) codes, 2-D bar codes people can scan with smartphones once they’ve installed a free code reader app. The scan takes users to websites, videos or whatever content the code maker desires. In Canada, missing kids’ pictures are printed on bills and bank statements, but Watkins went further.

Many of Watkins’ codes took viewers to a mobile Web page loaded with information about the case. The page, which is still up today, has the boys’ photos, dates of birth and physical descriptions, as well as videos of news coverage about the investigation. Links abound on Watkins’ Facebook, Twitter, YouTube and blog accounts with abduction details. There are also phone numbers to missing children’s hotlines and links to organizations’ websites where people provide data about the boys’ whereabouts.

Watkins put his codes on press releases, fliers, posters and websites.    

“My objective was to try to give my sons a fighting chance to be found by littering the Internet world with as many links to their photos as possible,” he said.

Authorities found Alexander and Christopher in Poland in 2011. Watkins doesn’t know if QR codes led to the discovery, but he thinks they can make an impact elsewhere. He creates codes and campaigns for cases in other countries, hoping to capitalize on widely available technology. In America for example, 14 million people scanned QR codes in June 2011, according to a comScore report.

“QR codes are still probably the best way of getting people off the page and online to a direct site,” Watkins said.

Going Mobile and Global

Watkins helps organizations and families use QR codes to make missing person’s posters portable. People can write information on paper posters and memorize children’s faces, but it’s easier to share the information virally if they scan a code that puts the data in their phone.

He’s partnered with Child Quest International to help the Santa Clara County Sheriff’s Department find Sierra LaMar, a 15-year-old who disappeared in March 2012 on her way to a bus stop in Morgan Hill, Calif. They put QR codes on posters and fliers to take the search beyond county borders.

“If my flier’s just posted in San Jose, is it going to reach L.A.? With a QR code, it will,” said Anthony Gonzalez, Child Quest’s senior operations director. “It increases shareability, awareness and time-efficiency when reporting a sighting.”

In LaMar’s case, the code takes visitors to a mobile Web page similar to the one Watkins created for his sons, but with one crucial difference: Users can tweet the page or “like” it on Facebook, extending the search to social networks. The page also has LaMar’s physical description along with photos, videos and phone numbers.

Watkins used the service to create the code and landing page for free. Users create an account to generate QR codes with adjustable appearances called vanity QR codes. People can change the color or embed photos if they don’t like the default black-and-white QR code.

Watkins embedded photos of LaMar and his sons on their QR codes to give the two campaigns a personal touch. He thought standard QR codes look too dehumanizing for missing children’s cases.

“They have a level of humanity in them because they actually have a picture of a missing individual,” Gonzalez said. “It means a lot to the searching families, but it also is very distinguishing between each one and the normal marketing QR code.”’s user interface allows the Web page owner to change site content without modifying the QR code itself. These are called dynamic QR codes because people can alter the connected media without having to discard the code, which is what’s required with static code. Many QR code generators create code permanently linked to content at the time of creation, so new code is needed if content changes. is one of several generators with the dynamic option.

Is the Battle Uphill?

Watkins creates QR codes for cases for free and hopes to educate the world in the process. He sometimes encounters organizations that don’t know what those QR codes are, and there can be complications when they do.

Problems can arise even when law enforcement wants to use QR codes, Watkins said. “They’re not techies,” he said. “so we want to make it as simple as possible for them.”

The resources to deploy campaigns aren’t always there either. In California, for example, Gonzalez said budget constraints impede viability.

“They don’t have the personnel and time to put somebody in a position to do it, whereas nonprofits and secondary agencies can fill those gaps for them,” he said.

Additionally, people like Watkins and organizations like Child Quest International have more freedom to try unconventional strategies that government either doesn’t have time to experiment with or doesn’t see the value in.

Finding Fido

Dynamic QR codes also exist to help people find lost pets and luggage. People can create a free account at and choose their tag type, then upload a photo, and either fill out a form describing their pet or luggage or leave a general text message. All information is stored in the cloud. Users press a button to create a QR code that they print on a sticker to attach to a bag or pet collar. If either is lost, someone scans the code with a phone to generate data to locate the owner. The free accounts offer 4 MB of storage per tag, and $4.99 accounts offer 50 MB. Stickers with codes also can be bought through retail outlets, which customers activate online.

Users edit the information stored in the tags online without needing to create a new tag. “We are giving, essentially, everybody a piece of cloud,” said CEO Murat Divringi. “They enter information and update it anytime. It’s under their control, and we wanted to make it easy to use, like postage.”

Online pet tracking with QR codes is relatively new, but there’s already competition. Pet Hub, which allows similar functionality, launched in fall 2011 around the same time as Dynotag. Divringi  expects QR code use to expand past typical corporate use.

“They are going to go from being a curiosity to being a utility item,” he said.

Despite such issues, however, police have used QR codes successfully. The Vancouver (British Columbia) Police Department printed them on crime alert posters in 2011 to spread information about murder suspects, and the Portsmouth, N.H., police used QR codes that year to link residents to information about police programs. Portsmouth Police Chief Lou Ferland told that the codes’ possibilities were endless.

Watkins hopes working with high-profile cases will teach the world about QR codes’ benefits. “The more the media reports it, the more society will know what QR codes are,” he said, adding that years ago, he decided to use the technology when he saw people pass missing persons posters in Walmart without paying much attention.

QR codes, he said, seemed like a good way to enhance traditional methods in the search for his sons. His professional background in corporate advertising helped him understand the technology’s usefulness in outreach.

Watkins says he’s the first person to use QR codes this way, and wants the trend to pick up. According to Gonzalez, the movement hasn’t spread far beyond a few jurisdictions and organizations like the Laura Recovery Center’s campaigns in Texas.

Conflicting data on QR code adoption and awareness paints a murky picture of how much work Watkins and his allies must do to promote the technology’s application in abduction cases.  

These studies provide insight on QR codes’ popularity in North America:

In May 2011, a Mobio report said QR code scanning increased by 4,549 percent in the year’s first quarter on a year-over-year basis; yet

A 2011 study of 500 students from 24 U.S. universities found that nearly eight in 10 didn’t even know what to do with a QR code, and 75 percent said they were unlikely to scan one in the future; and

In March 2012, Forbes downplayed the importance of the 14 million Americans in the comScore report who scanned QR codes in June 2011, claiming they represented a mere 17 percent of the 82.2 million Americans who had smartphones in July 2012.

The story differs elsewhere. In Japan, for instance, 76 percent of those surveyed in 2009 said they knew what QR codes were and could scan them.

Despite the conflicting data, Watkins isn’t slowing down. He wants to create software that automatically generates QR codes and campaigns for North American groups like the National Center for Missing and Exploited Children in a centralized fashion, though he’s a long way from getting there.

“I’m prepared to build the software program,” he said. “I can’t fundraise and get in all that stuff until we get more of the media and society to know what QR codes are.”

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New York City Agency Simplifies the Data Warehouse

In New York City, the Human Resources Administration employs about 15,000 people who deliver Medicaid and other services to more than 3 million residents — and its enterprise data warehouse stores so much information that employees can potentially sift through hundreds of millions of rows inside just one table in a spreadsheet.

“Our largest table had more than three-and-a-half billion paid Medicaid claims,” said Anna Stern, assistant deputy commissioner of new initiatives in management information systems. “And the public assistance and food stamp data comes out of the state system, which is a mainframe system, so we’re dealing with old, complex systems [and] very big data.”

But that’s not the case any longer, thanks to Stern and her colleagues. Because the enterprise warehouse’s data groups often are much larger than employees need, they created dataSmart, a compact version of the warehouse that only contains the most needed data for staff members, while presenting users with a simpler interface.

The massive enterprise data warehouse had been around since 2001, so developers learned over time what the most popular data sets were to include in dataSmart. “We took everything we’ve learned over the years and built a streamlined model,” said Data Warehouse Director Jane Neimand. “We’re very pleased with it.”

DataSmart, which went live with Phase I on Feb. 14, 2012, is housed on the same Oracle database as the enterprise data warehouse, and only department employees can access the systems. Both versions are side-by-side, and users must determine which to query for their needs.

Most people use the Oracle Business Intelligence Discoverer tool to access dataSmart, but other tools like SQL are available. In Discoverer, users query the system and receive the data in spreadsheet tables. DataSmart tables contain fewer rows than those in the data warehouse. “The step-by-step is going to be sort of the same, but each step is just simpler,” Neimand said. “[DataSmart] only has what they absolutely need. It’s not all this other data that they probably don’t need.”

For instance, the enterprise data warehouse holds more than 20 years of data history, which amounts to 1,500-plus data elements with tables containing hundreds of millions, and in one case billions, of rows. On the other hand, dataSmart holds three years of data history and only the most requested data elements.

Stern, Neimand and their co-workers work continually to keep dataSmart fresh. They rebuild the database from scratch each year to house only the past three years’ worth of information. “One advantage of doing that is that it keeps it small,” Neimand said, “but another advantage is that, let’s say some data element becomes important that was not important the last time we did a build, that gives us the opportunity to build in that new element.”

Education and experience have taught them which elements are the most important to include. Roughly 10 years ago, Stern learned in Data Warehousing Institute courses that only about 15 percent of a warehouse’s data is actually used. The administration therefore started developing dataSmart as a means to offer the most desired data more conveniently.

“We said, ‘What if we could come up with something simpler?’ And that’s what dataSmart is,” Stern said, noting that she believed many users lacked the analytical skills needed to access the original system effectively. “It is a distillation of everything we have learned from 10 [or] 11 years of running this data warehouse in this agency. Our premise is, small is beautiful.”

Phase I of dataSmart includes data from the welfare administration system; later phases will incorporate additional information, including GIS, supplementary security income and Medicaid data. Stern estimated that Phase II will go live on Labor Day, followed by Phase III at an as-yet-undetermined later date. The money for the phases came from the department’s budget, and Stern estimated that it will cost an additional $200,000 to complete the second phase.

Today, Stern oversees training programs that employees must complete before they can query either database, and the learning curve for dataSmart certification isn’t steep. Users complete four three-hour training sessions to learn dataSmart, compared to the nine two-hour sessions for the enterprise data warehouse. A division liaison must nominate someone for training before that person can be eligible for courses.

Business analysts are currently trained on Oracle’s Discoverer tool, but the company eventually will migrate the department to the Oracle Business Intelligence Enterprise Edition (OBIEE) platform. Stern and Neimand are unsure when exactly that will take place, but they wouldn’t be surprised if it took about a year to convert Oracle’s database modules to the new system. For example, Discoverer has files called “workbooks” that contain worksheets displaying data retrieved from the database, and migrating users’ personal workbooks to OBIEE will take a lot of work.

“Oracle cannot predict how well the Discoverer workbook will convert to OBIEE, so we’re going to try to get people to get rid of the workbooks they don’t need,” Stern said. “But that’s something that could take a lot of time.”

But no matter what happens, she and her team will work to ensure that dataSmart continues to deliver information conveniently. They’re even using Google’s search capabilities for inspiration.

“My goal would be to get as close to Google as we could get in terms of querying,” Stern said. “Google’s figured out how to give you all the information in the world with one little box on the screen. [It] makes all sorts of information that is complex acceptable to normal people. That’s the goal of dataSmart relative to the agency’s data.”

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QR Code Treasure Hunt Brings Teens to Libraries

A group of teens sign up for the iHunt program during a library event.

As a way to teach teens about library resources, the Chesterfield County, Va., public libraries gave them a challenge: Solve problems with the help of quick response (QR) codes.

QR codes are a unique series of patterns that — when scanned with a camera-ready smartphone or mobile device — pull up information such as facts about an object the QR code is attached to.

At the Chesterfield County Public Library, QR codes were deemed a fitting technology to use for teaching teens information about the county libraries.

“We wanted to try to reach them on their own terms, so we thought about using technology,” said Carolyn Sears, the library services administrator for community services. “… that’s how we got the QR code idea.”

In November, the county libraries tried a two-month program called “iHunt: Crack the CCPL Code.” The program  challenged teens to learn about library resources by completing a digital treasure hunt inside the library.

Librarians strategically placed signs equipped with QR code readers throughout the facility for the teens to find.

Participants started by answering a question about one of the library’s resources. By following the clues in the question, they could find the item the clues led to. They’d also find a sign with a QR code, which when scanned would give them the clues for the second question.

For example, the hunt tasked its participants to locate a specific DVD title. Once participants located the DVD, they’d find a QR code that would help them find the next item in the hunt.

Teens were allowed to use their own devices such as iPhone and iPod Touch, or could borrow a device from the library to complete the challenge. Sears said while the program wasn’t overly challenging – the hunts consisted of about eight questions – the big-picture goal was to show teens connect what’s available.

 “We wanted to do a teen program because teens are notoriously hard to reach in the library setting,” Sears said. “They don’t tend to know what resources are available and they don’t tend to use them as much as other groups do.”

The contest also came with an additional incentive. Winners received prizes such as an Amazon gift card.

Three of the county’s nine libraries hosted a hunt, bringing in a total of 54 participants. Chesterfield County libraries won’t make the QR code hunts a regular activity, but Sears said similar hunts will be conducted for specific occasions.

The program was funded through a $500 grant awarded by the Library of Virginia, an agency of the state government.

For more ideas on integrating QR codes into libraries, click here.

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In Arkansas, building an HIE from scratch

Ray Scott was pretty much ready to retire when Arkansas Governor Mike Beebe asked to him to work as a consultant in the state’s health IT office. With Arkansas lagging in electronic health record use and also ranking as one of the poorest, sickest and most obesity-plagued states, Beebe, a Democrat, was trying to improve and modernize the state’s health system, and wanted Scott to help craft an application for the ONC’s HITECH Act grant to build a statewide health information exchange.

“He said, ‘We only need you for 90 days,’” recalled Scott, a veteran Arkansas politico and bureaucrat who’s worked for seven governors, including Bill Clinton and Mike Huckabee, and most recently was head of the state’s health agency. “I tried to convince him that I wasn’t the guy.”

[Related: Delaware HIE wants to be ‘another pillar’ of health information.]

Scott then became Arkansas health IT coordinator in 2010, and has led the construction of Arkansas’ statewide HIE, the State Health Alliance for Records Exchange or SHARE. SHARE, its infrastructure and policy, has basically been built from scratch. A few community health systems, hospitals and Blue Cross Blue Shield Arkansas had internal HIEs, but there wasn’t much regional exchange, and at one large hospital, Scott said, more than half of the patients have been coming from outside its network. In a state where a lot of areas still lack broadband Internet, small practices are just starting to use, or consider using, digital health records.

“I knew we were way behind in terms of how health information is used, compared to how IT is used in finance,” Scott said.
SHARE has been built as a public utility, a model that in other states, like Kansas, has been controversial and not panned out as intended. Although the details about data ownership and financing haven’t been worked out, leaving some stakeholders, like the Arkansas Hospital Association, with lingering concerns, SHARE seems to have mostly broad support.

“He’s gone out of his way to be inclusive of all parties,” Paul Cunningham, vice president of Arkansas Hospital Association, said of Scott.

Experience with public policy — where politics, business and science intersect — is probably why Scott was chosen for the job. He recalls Governor Beebe saying to him: ‘’I need you to do this because you know the players and this ain’t your first rodeo.”

“We weren’t trying to build a new large bureaucracy that would control and run everything,” Scott said. “I tried to disarm any notion that folks had of ‘Here goes Ray building an empire.’”

The public utility model evolved out of stakeholder talks, Scott said. He focused on what functions the HIE would have and how to build it, rather than the more controversial question of who owns the data, who’d be running the HIE and how it would be financed.

“If we started there,” Scott said, “we would never get anywhere.”

Those are central questions, of course, and they haven’t been answered yet. Now doing direct messaging with 2,000 providers (and about as many signing up currently) and with query functionality set to go live in a year, SHARE, its IT built by the vendor OptumInsight, is operating on the original $8 million ONC grant and set to start financing itself with provider fees in the future, their nature still to be decided.

Those issues aside, the progress with SHARE is palpable, said Joe Thompson, the state’s surgeon general and director of Arkansas Center for Healthcare Improvement.
“I think we’re in a transition period, we’ve got to find the balance between how do we keep the IT nimble enough and secure,” Thompson said. “We’re really trying to transform the whole system,” referring to Arkansas plan to shift private and public healthcare away from a fee-for-service system to a pay-for-quality model, as recently noted in The New York Times Opinionator blog.

Both Thompson and Cunningham, from the Arkansas Hospital Association, note that there is always the option to turn SHARE into a private nonprofit or create private HIEs.

“Whichever route you take, there’s going to be a cost for it,” Cunningham said.

[Q&A: Taking a radiology practice from no IT to HIE — with ROI.]

And whichever route SHARE ultimately takes, the ONC is pretty impressed.

“One state that seems to truly have embodied the goals of the State Health Information Exchange (SHIE) Cooperative Agreement program is Arkansas,” ONC spokesperson Peter Ashkenaz said. “They look towards the overall bigger picture of the quality and efficiency of health care, and are always seeking ways to increase meaningful exchange, including collaboration with other programs such as payment reform initiatives.”

And Scott, who is also a noted nature photographer and is retiring at the end of the year, has much praise for the ONC and federal government: “I think the wisdom by those visionaries who wrote the HITECH Act is that you’re not going to transform the healthcare system in this country if you don’t build a comprehensive communications network.”

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