Archive for October 16, 2012

Finding a Home in Delaware Just Got Easier

Residents of Delaware have a new tool at their disposal when searching for a new home. A new website,, provides free listings for house rentals and house sales for landlords or property owners. In addition, renters can search for a new home to buy or rent by region or city.

“Access to affordable housing is critical to our economy and to the strength of our communities,” Gov. Jack Markell said. “We believe this service will help Delaware residents find the rental housing they need within their budget, within their time frame and in the community where they want to live.”

Powered by not-for-profit website, the website is supported by a free, bilingual call center. Listings can include photos and detailed information such as maps, whether pets are allowed, income restricted status, contact information for the landlord or owner, building history and more than 50 other details about each property.

“We’re excited about the ability of this service to connect our residents to housing opportunities,” Delaware State Housing Authority Director Anas Ben Addi said. “We encourage property providers to take advantage of the free advertising and list vacancies on to help make this service as useful as possible to all Delawareans.”

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Fire Department Tests QR Codes for Citizen Medical Data

Every second counts during medical emergencies, and quick access to medical information can be the difference between life and death.

Marin County, Calif., located just across the Golden Gate Bridge from San Francisco, is working to ensure first responders have access to this crucial information. In early June, the county’s fire department began piloting a yearlong project that offers residents tech-enhanced stickers that link to an online health profile.

Partnering with Lifesquare, a start-up company located in Menlo Park, Calif., Marin County is distributing free quick response (QR) code stickers, which when scanned by a camera-equipped mobile device, direct emergency responders to the resident’s online medical profile. As of August, the county had 1,100 enrollees in the program.

“We’ve utilized the Lifesquare technology, and it has worked well,” said Mike Giannini, Marin County’s emergency medical services battalion chief. “We’ve been able to get patient information and use it to our advantage.”

QR codes — which resemble a bar code — gained attention in city government in 2009, when Manor, Texas, CIO Dustin Haisler led efforts to have them placed throughout the city so residents and visitors could learn more about a location that held a QR code.

And these codes aren’t typically associated with capturing medical information, but more for disseminating information about historic landmarks and commercial products, such as in Manor. This is changing, however.

Marin County residents can participate in the program by creating a free online account on Lifesquare’s website. From there, they create a profile that includes essential health information such as allergies, medications and emergency contacts — whatever medical details they want to divulge. Information entered into the profiles is stored securely in Health Insurance Portability and Accountability Act compliant servers, according to Lifesquare.

Once a medical profile is created, Lifesquare mails the participant a package of stickers that feature their unique QR code. The idea is to place the stickers in convenient locations, such as wallets, bike helmets, refrigerators and car keys. If an individual is unconscious or incapacitated, paramedics can easily locate the sticker and scan it to bring up his or her medical information, said Ryan Chamberlain, spokesman for Lifesquare.

To access the medical information using the stickers, the county’s firefighters and emergency responders scan the QR code with a mobile device — and Lifesquare gave the county 50 iPhone units for use in the trial.

Currently, medical information can only be accessed by medical personnel participating in the pilot who have the Lifesquare EMS application on their mobile device.

Chamberlain said that unlike static medical information alerting methods like bracelets, the company’s QR code proprietary technology is cloud-based so users can update their online profiles at any time.

“[The QR code sticker] can go anywhere with you and it’s secure,” Chamberlain said. “If you’re sitting in a coffee shop, nobody can look over and read what your medical history is. It’s just a code, and only the professionals can get to that.”

Before experimenting with QR code technology, the county implemented a similar program — called Vial of LIFE (lifesaving information for emergencies) — to make medical information easily accessible to emergency responders, Giannini said.

According to the county fire department website, Vial of LIFE provides residents with kits that contain materials —like a refrigerator magnet, sticker for a front door and medical information form — that would help emergency responders find their medical data in the event of a crisis.

Giannini said because the fire department’s Vial of LIFE program is similar to the idea behind the stickers printed with QR codes, the department was a big proponent of working with Lifesquare to use the technology. In the near future, Giannini said he’d like to see information gathered from Lifesquare integrated into reports that responders must complete.

“We’re looking for them to create a bridge that will take all of that information from Lifesquare and populate the pertinent fields in our electronic patient care report,” Giannini said. “So that will provide us with not only more accurate information, but it will save us a significant amount of time during the course of patient care and over the long term.”

So why is Marin the first to pilot Lifesquare’s medical QR code program? Chamberlain said a combination of community interest and need were factors.

The county — a mountainous landscape and home to sites like film director George Lucas’ Skywalker Ranch — is also home to a vibrant senior citizen population and many cyclists. Chamberlain said these two populations alone made Marin County a good fit for the pilot’s launch.

Marin also is a stone’s throw away from Silicon Valley, a factor that could be seen as advantageous for bringing technology to the community.

Chamberlain said the next step to expanding the Lifesquare technology would be to connect it with an electronic patient care report system as a way to simplify how the medical information is transferred for a patient. If paramedics process the scene of an accident by first scanning a person’s Lifesquare QR code then directly upload that information to an electronic patient care report system, the information is more seamless and error free.

“You don’t have people trying to write out a long form of medications, prescriptions and medicine names, or misspelling a person’s name and things like that,” Chamberlain said. “So not only is it quicker for paramedics, it also removes that element of human error.”

Chamberlain said Marin County has just finalized a contract with an electronic patient care records company. Once a system is implemented, the Lifesquare technology will be synced with it.

So far, the program has only been deployed in Marin County, but Lifesquare ultimately plans to expand the QR code stickers to other counties. Chamberlain said for the technology to have optimal utilization, it will be important for major health-care providers to participate as a way to target critical mass.

“I think the bigger picture is it needs to be adopted in large scale,” Chamberlain said. “Marin County was a great test of how it works, but for it to really work well, we need to have everyone on board.”

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Hacking of Utah Health Insurance Exchange Raises Security Questions

With the news that the Utah health exchange — one of just two state-run online insurance marketplaces in operation — was recently hacked, states planning their own exchanges as prompted by the Affordable Care Act (ACA) might want to take a closer look at how they’ll handle cybersecurity.

The exchanges will hold digital records of a potential minefield of personal information — Social Security numbers, federal tax and income data and more. To gain approval from the U.S. Department of Health and Human Services (HHS) for their exchange, states must prove they meet five provisions related to privacy and security.

In short, the federal guidance for applications, which are due Nov. 16, requires that states provide “adequate safeguards” to protect personal information on the exchange. States must also secure a letter of acceptance from the IRS, affirming that they’re capable of protecting federal tax information, which will be used to determine eligibility for Medicaid and tax subsidies on the exchanges.

According to the exchange rules, “Personally identifiable information should be protected with reasonable operational, administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.”

States must comply with the federal Health Insurance Portability and Accountability Act (HIPAA), as well as the standards set out in the ACA, but they do have significant leeway in how they meet those parameters.

For example, Rhode Island (which is viewed as a case study for exchange planning) will require the company building the digital infrastructure for its exchange to hire a security manager. The vendors must also purchase an insurance policy that would cover up to $1 million in damages for any security failure.

California, which sent out its request for proposals for the exchange in January, is requiring its vendors to sign a confidentiality agreement. Broadly speaking, the California outline for its exchange says that its software vendors “should leverage government, industry and federally funded academic research on security, privacy and continuity of operations, with a strong link to available and emerging products and solutions.”

California is also requiring that the exchange be able to verify users’ identities with state agencies, such as the Department of Motor Vehicles, before allowing them to access confidential information. The software must also include layered firewalls and data encryption to protect the data in the exchange.

Utah officials stressed that no personal information was at risk during the hacking, which took place three weeks ago, according to the Salt Lake Tribune. Only informational pages, which outline insurance options available to consumers, were affected. State officials portrayed the breach as a “pure act of graffiti. Words were garbled, headlines were blurred.”

It wasn’t the first time that the state’s health sector had been compromised. Back in April, the state’s Medicaid database was breached, with hackers gaining access to the Social Security numbers of as many as 280,000 Utah residents. Less sensitive information, such as names and birth dates, for about 500,000 others was also exposed, according to the Tribune.

With an increasing push to digitize medical information, data breaches are one of the risks. As Kaiser Health News reported in June, HHS has received more than 22,000 complaints about privacy violations since HIPAA was enacted in 2003. Some of the largest breaches (which usually involve private health-care providers) compromised the information of millions of individuals.

“Strong privacy and security rules are crucial to the success of the new health insurance exchanges,” wrote Kate Black of the Center for Democracy and Technology, a nonprofit that advocates for Internet freedom. “If adequate privacy rules and security safeguards do not protect the information collected by exchanges, individuals will not have sufficient trust in an exchange to take advantage of its benefits.”

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As Obama goes so go many groundbreaking ACA benefits

The presidential election holds potential to alter the Patient Protection and Affordable Care Act’s (ACA) fate.

For most of the ACA’s impactful benefits to be realized, President Barack Obama must be re-elected, because GOP nominee Mitt Romney has spent many months campaigning on the promise that he will repeal the ACA on his first day in office.

Acknowledging that the health reform law “is not the end of efforts to improve healthcare,” the Democratic Party National Platform lays out the vision to “continue to fight for a strong health care workforce” by “emphasizing primary care,” and “eliminating disparities in health” as well as strengthening Medicaid.
That last phrase also shows up in the Republican’s National Party Platform, which lists ‘Strengthening Medicaid in the states’ as one of its top two tenets; the other is ‘Saving Medicare for future generations.’

[One-liner: Health IT in the Democratic platform. And Don’t blink: What health IT means to the GOP.]

Both platforms are indicative of parties looking toward the future. Indeed, the health reform law will become more popular over time as it is put in place and people use its benefits, according to an advisor for the Obama campaign. “People get used to the law, and they become dependent upon it. And it becomes very hard to repeal it,” said Chris Jennings, who is also president of Jennings Policy Strategies Inc. and former senior healthcare advisor to former President Bill Clinton, at a recent conference sponsored by the Bipartisan Policy Center. Historically, the initial response to Social Security and Medicare were similar.

Individuals and families are already taking advantage of ACA benefits, namely young adults staying on their parents’ plans until they are 26; insurers unable to refuse to cover children with pre-existing conditions; and seniors able to close the funding gap known as the “donut hole” for prescription drugs.

The 2012 Democratic National Platform, released Sept. 4, also highlighted provisions, such as preventive screenings for women and contraception with no out-of-pocket costs; small businesses receiving tax credits to help them cover their workers, and insurers paying rebates to businesses and families when they are overcharged based on the ratio of medical-to-administrative costs.

As more elements of the health reform law take effect, insurers will no longer be able to deny coverage based on pre-existing conditions; Medicaid will cover more working households; and those who don’t get insurance through an employer will shop for coverage on exchanges and may be eligible for tax credits to help afford it.
The re-election of Obama will offer more certainty that those elements will be realized.

Whereas the Democratic platform views health care as a linchpin for economic prosperity and security “so people, business and government are not constrained by rising costs,” the Republicans offer stark contrast.
Romney pledged in his speech in accepting the GOP nomination to repeal and replace the Affordable Care Act, which the Supreme Court recently upheld for the most part. In addition to repealing the law, Romney has indirectly supported strong cuts for Medicaid through calling for its conversion to a block grant program, Jennings said.

[Survey analysis: Romneycare vs. Obamacare, do Americans care?]

Not only would the millions of citizen who stand to gain coverage under the ACA lose it, but many who are currently covered could see reduction or elimination of such coverage.

“It means a shifting of cost and burden to people and to states and fundamentally undermining the insurance market and making it even worse than what we already have,” Jennings said (pictured at right).

For Republicans, however, the effect of the Supreme Court decision on health reform feeds into the GOP view that the elections will be about choosing “big government or not so big government,” said Tom Scully, general partner, Welsh Carson Anderson & Stowe, senior counsel, Alston & Bird; and a Romney campaign designee. He was also an administrator of the Centers for Medicare and Medicaid Services under former President George W. Bush.

Scully doesn’t anticipate hearing a lot of details revealed about health care between now and the election. The perception of the health reform law is more about “taking on a massive entitlement expansion and massive growth of the federal government.”

“Doing massive entitlement expansion, even though it may be something you morally believe in, is not responsible,” Scully said, with debt and entitlement spending at unsustainable levels.
“Someone has to take leadership in fixing our national problems,” he added. “You can’t punt everything forever.”

For the Republican view, reining in healthcare costs is about state-based and market incentives.

“Money is getting tighter across the board. Even with Democratic governors, the world is moving to capitation and Medicaid managed care,” Scully said. It makes sense shifting to a third party contractor and reducing risk, referring to them as “private managed care bundlers.”

Scully knows about entitlement expansion. As CMS administrator, he was instrumental in shepherding the Medicare modernization law and the prescription drug plan, which favored using the market to provide services.

[Related: Political strategists on how candidates should shape healthcare messages in the election.]

“In Part D, once you came up with the money, and if the structure can work and provide the services they predict that they can manage and market, they will show up,” Scully said.

For the Obama administration, it was important to have broad healthcare industry and consumer support for the health reform legislation to make the market work, Jennings said.

“Coverage is a moral imperative, but that really wasn’t their driver. Theirs was to make sure people were in the system so you can have plans compete on cost and quality and not on their ability to avoid certain people, which creates all sorts of strange and warped incentives,” Jennings said. “We can have a discussion of allocation of resources and making it work, but the fundamentals of coverage, exchanges, insurance reform, tax credits are all pillars to make the system work.”

And a number of those pillars will likely die or survive depending on the outcome of Tuesday, November 6, 2012.

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L.A. County’s Most Tech-Savvy 100-Year-Old

Los Angeles County’s public library system now includes thousands of e-books, computers with broadband Internet, and a virtual library. What began as a single branch with 50 books has grown to a system of 85 libraries serving 3.5 million people, and technology had a lot to do with the expansion.

“We still have the same mission we had in 1912 — delivering information, culture, literacy and lifelong learning,” County Librarian Margaret Donnellan Todd said, reported the Daily News. “We’re just delivering it differently than 100 years ago.

“Probably the biggest change you can see in the 21st century is the virtual library. People can now get on our website 24/7, download e-books, place holds on books, take classes on”

Last year, the library circulated about 17 million items, said Ken Kramer, the public affairs manager. Despite the growing popularity of e-books and online information, people still visit libraries in great numbers.

Ultimately there may be room for both digital and physical books and magazines, but the library plans to continue expanding their e-book offerings to meet the growing demand of e-book and tablet users, while maintaining their huge collection of physical books with a computer management system.

In 1912, the County of Los Angeles Board of Supervisors established a free public library shortly after passage of the the state’s County Free Library Act in 1911.

Photo: Compton Library and a ceramic tile mural by Dora De Larios, a local Los Angeles ceramics artist. Photo courtesy of Facebook.

To celebrate the occasion, the L.A. County library system unveiled a new library card marking its centennial, and gave free books away to children at its numerous branch locations.

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