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Saturday, March 30, 2013

NHS As It Has Been Known For Years Changes Dramatically April 1st and Care for the Poor Will Suffer As Trust GP Services Are Outsourced To Private Industry

This is really kind of sad to see the same toll we face over here with problems with money and banks hitting the NHS too.  One industry destroying another one pretty much and all suffer.  London has become it’s own island ofimage sorts to where portions are where only the rich and wealthy go and the rest, well I guess is where their 99% live.  The English are not taking this lightly and are protesting as well, and why wouldn’t they.  Many jobs will be lost and rational of care will be more widespread.  The country is counting on the “haves” to buy insurance to leave what is left of the outsourced services to the poor and the article states it will be a 3rd class service.  You can read in the comments below they are not too hot on United Healthcare and their efforts in the UK as a private provider.  They say also that due to contracts being given out that the care is not improving either and nobody knows how many hospitals will be closed. 

They expect private providers to cherry pick patients and leave the worst to the care of the NHS, sound familiar, just what we have in the US when they can get away with it.  Israel said a few years ago that their big mistake was letting private insurers into the country and apologized to their citizens, so hopefully they don’t end up with the same mess we have here in the US as it is cold, calculating business with many working on flawed formulas and data just to make money anymore.  This is not the people who work there but rather those who run such companies.  BD


The act comes into effect on Monday. Very few people understand its implications but it will affect each of us arguably more than any other legislation passed in our lifetimes.  It is the final stage in the systematic dismantling of the NHS – a process that began about 25 years ago – carried out by stealth.

The Health and Social Care Act 2012 is virtually impenetrable but the main thrust of it is: primary care trusts and strategic health authorities will be disbanded. In their place, clinical commissioning groups – also known as GP consortia – will control about £60bn of the NHS budget and commission local services. Commissioning will take place through competitive tendering. NHS contracts will be opened to the voluntary and private sectors. Already, £250m of NHS services have been forced open, with 105 private firms granted contracts. This year, a further £750m of services will be tendered. The NHS annual budget is more than £100bn – there are huge profits to be made for private healthcare companies.

The NHS, as we know it, will effectively be abolished just short of its 65th birthday.  The marketisation of the NHS has driven up costs and produced worse results. The track records of some private providers now entering the NHS, such as UnitedHealth Group, are not impressive.

We now know that more than 20 NHS trusts, comprising about 60 hospitals, are at risk of going bust. This is, in large part, due to the financing of extortionate PFI debts projected to rise above £79bn despite the original cost of the hospitals being around £11bn. The rapid restructuring of South London Healthcare Trust, with the downgrading of neighbouring, solvent Lewisham hospital, is a template that can be used across the country. No hospital is safe from closure.

http://www.guardian.co.uk/commentisfree/2013/mar/30/health-act-means-death-of-nhs

mHealth and Other Technologies in Healthcare Experience Slow Growth Is As the Data Selling Epidemic for Shear Profit in the US Continues to Grow Leaps and Bounds Leaving Manufacturing in the Hole and Non Competitive

So, do you wonder why we can’t create more new jobs?  Well when one can hire a few technologists and mine data and create analytics by the barrel (which half will end up being useless) why would a company expand with tangibles when a few lines of code and some algorithms can made even more money that manufacturing a product?  There you have it, data selling.  The data selling business has reached an all time frenzy and for lack of better words has become an epidemic in the US and maybe the world for that matter.  When I say epidemic I mean just that.  Value is NOT created with every SQL statement or query that someone creates with data bases, learn that fact early and be aware.  If you read the web we are now seeing articles talking about “fake data scientists”.  Would there be articles about this topic if there were not fake ones running around out there, of course not.  There are.  As a side point here I made a satire post about 3 years ago about data selling and I’ll be darned if it is not almost true about needing a 12 step program of it’s own.  I guess you could call this yet one more example of satire becoming reality.  This post was a hit around Forbes and a few other major publications:)

Does the US Government Need a Department of Modeling and Algorithms–Is Data Addiction and Abuse the Next Up and Coming 12 Step Program, Some Classic Posts & Topics Revisited

The entire data selling business was originally set up to help people market you better with relative products and it might have not been too bad if it had just remained as such but it has not.  There are all kinds of analytics that claim to provide you with so many unlocked secrets of predicting the future.  Granted there’s value in crunching numbers for sure but not when you take models down to an individual level where nobody has created or questioned a “P” value, in other words did they write code just to make money?  Yes that is done out there with matching obscure data sources that “they “claim can be queried for tons of information relative to predictive behaviors. 

If some of this is used in context certainly there is some good trending information that offers direction, but not the way it’s being done and over sold today. The only folks who are really lining up to use most devices today are those who “have” to due to a medical condition where the numbers and stats report back to a web service of some sort, otherwise there’s very little interest.  Sure we have all the consumer apps and even those with the best interests at heart get bored and stop using many of them, just ask them.  Happens all the time.  Again knowing that someone is selling that data whether it be a profile or other more detailed information is enough to stop anyone from wanting to use one. 

If you don’t think dirty code and models are being created just to make money, then check out this next link to where the folks who have the talent to create models and algorithms to do so are creating their own code of ethics, which includes a couple sections about having the liberty of reporting those requesting numbers and formulas beyond what is ethical and legal to law enforcement.  The only problem with this is having folks in law enforcement that are smart enough to see and understand what is being done.  If you watched the PBS special on “Too Big to Jail” (video at the link) then you can hear in the first 5 minutes with DOJ prosecutor Manny talking that he absolutely had zero confidence and that this type of investigation was way over his head.  By the way he just got a new job after resigning from the DOJ making over $4 million a year.  Sure the data scientists want jobs to help the betterment of man kind and create efficiencies but want the 200 pound “greed gorilla” removed from the process so things are done correctly. 

Big Data–The Data Science Code of Ethics-Designed By Those Who Create Models - Don’t Fall Victim To Write Fictitious Code and Models Just to Make Money With Clients Demanding Such

You have social networks selling data about you right and left and some apps want you to include social networks so it can all be linked.  More data to sell for sure.  You should read this post on when machine learning makes errors as the social networks all want your “real names” so they can make sure they are selling data about you and not someone else.  See my Google Plus story, they told me or rather their algorithm told me my “real” name was not Google compliant.  It was Chapter 52 of my series called “The Attack of the Killer Algorithms”. 

“I’m Sorry Your Google Plus Name Does Not Comply With Google “Names Policies”…Barbara “Duck Algorithm” & Was Using My Real Name All Along…Killer Algorithms Chapter 52

This brings me to a great Twitter quote from Mathematician Professor Charlie Siefe from NYU who read it, saying what’s next, we will need machine compliant names?  If you are pregnant and expecting you might give this some thought:)  Actually since I mentioned him scroll down and watch his video about “Context” done at Google NY and you will learn a lot.  He did a good radio show too called “Numbers don’t lie but people do”…

image

Here’s another University Professor who likes the Algo Duping coin as well, why, because it’s true.

Back on track here you also have to realize that this stuff builds on itself.  So company A buys a data base and queries it with something they have in house or perhaps yet another data base they have purchased, and they sell that.  Company B buys this combined “new” data base and then they take it and query it with other data bases and then they sell it.  Company C gets data from both company A and B and queries it together and gee we have some new analytics for sale as they have determined by building a model that they were able to use some non linear methodologies in finding some scant relationships which may or may not really exist but what the heck, they market it and all get sucked in to the analytics having value, whether they do or do not.  Now let’s not forget there’s a lot of flaws in this data, especially if one is using non credible data from social networks where folks can lie their fanny off.  See how distorted and useless this data becomes when sold and resold and worked and queried.  It happens all the time and this is why your credit information is so out of sorts and flawed. 

So those devices, what are they selling and to who…only the shadow knows and we get one of those legal mumbo jumbo disclosures to read which basically tells us nothing and allows this to keep happening.  Who knows by the time stats under a profile without your name used are done making the circuit, shoot your data could be all over the place.  Let’s also not forget how data can be rematched too if the resources are available, ask any Quant on how this works.  It’s done all the time and sometimes is a process in writing software with sample data bases to check accuracy of work, I used to do it when integrating software tables to make sure I was on the correct track and of course nothing was for sale there, just part of a process to ensure accurate data and queries.  All developers work such processes.

If you read around the web you can see where Experian has a marketing arm that sells lists of names of expectant parents with newborns.  Equifax collects salary and paystub information for about 38% of US citizens and gets that from your employers.  Epsilon can sell you a list of people who donate to international charities.  Drug stores are a big source of data and Walgreens made short of $800 million selling data in 2010, so I’m sure in the last couple of years that number had to rise over a billion for 2011 and 2012.  Why do you think companies have so much cash, they are selling data.  Keep in mind all your prescription data is not subject to HIPAA so you have open game there.  United Healthcare has been making a killing for years selling this data first via their Ingenix division and now called Optum. 

Now health insurance companies are buying your debit and charge card records.  They stated they are using this to target those who are buying large size clothes and who knows what else.  That’s all they admitted too but data in the hands of folks who can write SQL and need to keep a job as a data scientist will look for all kinds of other ways to use the information, i.e. buying candy bars, etc.  You can’t really do that with any accuracy as the candy might be for your child, a friend or the homeless man in front of the drug store looking for a helping hand.  Why does an insurance company need to know where you buy your gas for your car, where you eat out at and everything else that goes on debit and credit cards?  This is over done by a long shot.  Ever think of why your health insurance rates are so high…something has to pay for all of this and IT services and analytics don’t run cheap so you can thank all this undue data mining for contributing to higher policy charges.

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

How much of this expense is really needed and how far will they encroach before nothing is sacred?  Remember what is paid for policies these days and this all costs money.  They are addicted in thinking that some small bit of data will develop better risk assessments.  For goodness sakes we already have the MIB and others that already do a “death assessment” with estimated information on how long we will live.  Yes, just what I want more device data going into those types of data bases, right?  They are already incorporating some lab information.  There is something to be said for predictive modeling and trending but it has to be used in context…here you have United pushing Medicare for their pie in the sky report stating billions and trillions to be saved.  Nobody can predict that accurately.  They get duped, refer to the videos at the Algo Duping 101 page for more on this with the videos that help explain. 

United Healthcare Wants to Expand Predictive Modeling for Medicare and Medicaid–Billions in Savings Predicted in Report Only As Good as the Day It Is Published

On the other end of the marketing stick we can’t as consumers even rely on these rating sites, takes me 5 minutes or less to find errors and I barely look at them.

Flawed Data With Physician and Hospital Rating Sites- Want To Go See Michael Jackson’s Former Dermatologist? Vitals and HealthGrades Says He’s Still There - Not…Flawed Data & Algorithms Persist…

So this brings up a good question, without any laws with some real teeth and rules and a path of regulation spelled out, are all these company algorithms becoming the law?  Think about it.  This is the real deal folks as nothing changes until the models and algorithms are checked for accuracy and that they are not just coded to make profits. 

It is also wise to pay attention to subsidiaries and acquisitions and I thought I was the lone blogger reporting on this but even the guys at Forbes wrote about all the big money United was going to make with the Humedica acquisition via their “non profit” organization they set up with using the Mayo Clinic Medical records.  They have enough subsidiaries to get a cut out of almost every transaction/service today in most areas of healthcare from analytics to cheap Chinese hearing aids they distribute and sell through a subsidiary they created to do so. 

Anceta, the subsidiary of the AMA is in there too as a partner, so if you read this far you know the AMA has subsidiaries in the data business too and they sell data and that’s partially how they stay alive as Humedica might be buying data from them too or vice versa.  Humedica also has a banker in there too with Leerink Swann so this is posed to make money and now they have United analytics and data if they want to add more, as subdiaries of big corporations certainly share an sell tons of data.

United Healthcare Buys Humedica and Gets More Data to Analyze and Sell To Medical Device and Drug Companies–More Big Profits From Health Data

And on the other hand through all of this massive data management the AAFP found that they were, with the use of complex contracts were paying doctors in several areas of the US, less than Medicare. Actually Medicare could sue them I think if they wanted for paying less than they do, but they would have to bring in all the MDs who have signed those contracts and that would hurt the doctors. 

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

There are good analytics when done properly and I write about those too like the one that Kaiser did with their registry on orthopedic knees and hips, now that has value to see what works best and for what types of patients.  I wish we had more of this instead of the garbage we are getting now with everyone just trying to make a buck selling data.  It’s time to devaluate those algorithms and ensure some accuracy and ethics with models, flat out as the data selling epidemic is out of control in more ways than one.  With a PHR, I would much rather connect a device that feeds data to it, like HealthVault does with many of their devices rather than rely on a web based app for sure as that keeps me in control of what I want shared.

Consumer Mobile Health Monitoring Has Issues That Stifle Faster Growth, Epidemic Data Selling In Healthcare and Unrealistic Immediate Expectations With Patients Changing Their Behaviors

I have a friend of mine who recently filled out some health background information who is not a diabetic and listed parents as having diabetes later in life and now she’s deluged with “pre-diabetic advertisements”  When does this crap stop!   The states license and sell data from the public information archives and this too gets to be a problem as some states have had to put governor software in their systems to limit the amount of bots in the system and then some of the mining companies are too cheap to pay for updates at times, so do you wonder why it takes so long to get errors corrected, and of course we do this on our own dime while corporate USA profits in the billions with selling data. 

Another company, sells lists of people classified as allergy sufferers and dieters and sells those lists.  Be careful too as yet another company, Acxiom sells data on what you search online for a certain ailment or prescription.  I think a nice DOS of everyone searching in the US for some kind of ailment would be fun, just kidding and had to say that since this is being scraped as well.  How non valuable this could be when connected to data from Facebook that someone made up, right?  They do it. 

So those who sell products that create “saleable” data, well is there any wonder consumers are not jumping on this bandwagon?  It has gone way beyond just marketing and now we have flawed data and judgments being made that are also flawed due to this entire epidemic.  And it is getting worse as data scientists don’t even really know what they are doing and where value lies…watch this panel of IT executives talk about it…they don’t know what they are doing and flawed data for the sake of profit is being used against consumers in a big way. 

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game

We do need to license and excise tax the data sellers to get this under control as we won’t have any new jobs either until this epidemic is brought to a manageable level, plain and simple. 

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

I know we have HHS still stumbling around and swapping spit with penalties and trying to get their analytics in better shape so we can expect little help from that end as they seem to be still searching for some black and white Algo Fairies so the FTC seems like they should get their act together big time on this issue. 

Privacy Wanted–So Let’s Require Those Who Sell Web Data to Register and Tax the Transactions and Publicly Disclose Who They Sell To With a Federal Registry

We just don’t seem to have anyone smart enough in government to see what a violation of human rights this is becoming and that how much of this is in fact a waste of money but we pay for this with insurance premiums and services we receive..  Some Australian bankers made the comment that half of the analytics bought will be a total waste of investment and I agree with them on that point for sure, especially in light of what I am seeing with corporate USA behavior in thinking that every model and formula has value, they are absolutely behind the 8 ball and furthermore, why should any consumer trust any of the devices and software that sells data?

Half of Analytics Investments By Companies and Banks Will Be a Waste–What Do We Analyze with Big Data and Does It Have Value–Some Algo Fairies Would Do Better at Disneyland…

I don’t trust much of it as most of the consumer apps and software are not much more than a big rip that really doesn’t do much to help the consumer and instead pads bank accounts. 

Those that don’t go to web apps to mine and sell the data are fine.  I have never seen anything in the US that is so shameful and at the same time leadership that fails to recognize and act on such and continues to drive inequality as the intelligence here appears to be over the heads so so many.  Keep on trying to educate patients on devices that sell data I guess, but I for one am not buying as the trade off is not worth it and would rather see jobs created where technology is used there rather than a lot of this nonsense. Nothing happens until the code that runs on the servers 24/7 is changed, so politicians can talk all they want and nothing will change, so sad state of affairs for them as well.  BD

“Dead Patients Can’t Be Readmitted” As Relates to HHS and CMS and the Elusive Search for Some Penalty Assessing Algorithm Fairies…

I am all for education and all the efforts hospitals are making in this area, it helps but the penalties by the numbers here with folks in executive positions that think that living by the algorithms is making me crazy.  We end up just swapping spit if you will as some of these hospitals will end up finding that CMS perhaps shorted them in some kind of reimbursement too.  I report on all this stuff and it goes on and on and on.  We can sit around and capture and analyze stats forever and that’s what’s happening today and luckily some of the “human” efforts are working with educating patients.  One doctor in this article made the comment about “dead patients not returning” and when you read all the formulas and numbers tossed out there, it does make you wonder. 

We have people at the top who are not mathematically trained per se and they believe all of these methods of evaluation and get stuck there.  We have too many around like that and can’t bring the human element in and nothing happens until they experience something along the line of what happens to the rest of us.  You can go back a couple years and see the influence of insurers, like at the link below to were they have the administrators of HHS totally sucked in to what they are selling.  I am not saying all analytics are bad by any means, but when you have a huge for profit company selling, you better check both sides.  Today the world of Algo Duping is growing and those again running departments with little or no math or IT in their backgrounds are pure “sitting ducks” for lobbyists and corporate USA.  The other side knows it well and works to sometimes disguise things as a win-win when in actuality it flat just means more money for the company.  Marketing on steroids today does some pretty remarkable things out there with repetition and taking advantage of those who don’t understand data structures and the power of algorithms and models.  We see it all the time in the news. 

"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site

The goals are good with re-admissions but the penalties and how they are assessed just suck and it denotes a department that has no clue with algorithms and formulas and tries to run the same analytics across a group of hospitals where some are apples and others are oranges.  So what’s the real deal here, swapping more spit (money) with paying penalties?  If we could avoid some of this back and forth exchange of funds and educate patients better on their care and conditions I think we would have a winner.  Instead we have HHS taking the role of a heavy duty enforcer rather than a caring agency dedicated to better health in the US, and save the enforcement efforts for those who are cheating as we all want those folks caught. 

HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day

The more I see these flawed formulas used and enforced, the least amount of confidence I have for HHS and CMS as their ethics are beginning to dissolve and common sense with swapping money is no longer making sense.  This is “busy work” and we can choose to keep it going if we like but what’s it doing?  Would it not be better to assess a percentage of follow up calls, education sessions that are completed with each patient?  imageAgain some hospitals have higher mortality rates and see sicker patients…it’s the old HHS digital illiteracy in thinking the mathematical algorithms can solve all.  I still could never figure this one out before the election with the letter sent out with even sucking in Holder from DOJ as one month showed higher Medicare expenditures…not understanding algorithms is what I say…and still stuck on “witch hunt” methodologies with bringing nothing to the table and comments like mine were not unique, it was all over the web as it just stuck out like a soar thumb with lack of knowledge and more like someone scared of their job? 

HHS and DOJ Send Letters to Hospital Trade Associations Warning of Gaming Billing System Via Use of Electronic Medical Records–Hospitals Just Learned How to Bill Better & Hired Consultants–Case of Being Algo Duped With Numbers?

If we just had some better knowledge at the top on how to use analytics and formulas that could work for all, it would be a lot better and some folks who could turn loose of some of the stuff that doesn’t work.  Really, how many people does HHS and the hospitals employ to reach this re-admittance number to avoid fines?  If the hospitals are paying the fines anyway what is being done?  All hospitals are not the same but yet they are judged as if they are.  So here we go creating more busy work with fines instead of perhaps “real education” goals to meet such as numbers of follow up calls, education sessions with patients, etc. and that’s where the focus really needs to be.  Corporate USA algorithms are still running on servers 24/7 moving money from the 99% to the 1% and nobody has touched that topic yet as they can’t see it and we have the same swapping spit ethics happening here.  So if hospitals due to their methods of operation and the community they serve are eating up the fines anyway, what is being accomplished?  BD


It is no longer enough for hospitals to make patients healthy enough to leave. Now, as part of the Obama administration’s health care overhaul, they are spending millions of dollars to keep those patients from coming back, often acting like personal assistants to help them manage their post-hospital lives.

While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care.

But increasingly, health policy experts and hospital executives say the penalties, which went into effect in October, unfairly target hospitals that treat the sickest patients or the patients facing the greatest socioeconomic challenges. They say a hospital’s readmission rate is not a clear measure of the quality of care it provides, noting that hospitals with higher mortality rates may also have fewer returning patients.

http://www.nytimes.com/2013/03/30/business/hospitals-question-fairness-of-new-medicare-rules.html

Friday, March 29, 2013

Johnson and Johnson Recalls Millions of OneTouch Verio Blood Glucose Meters

This is an international recall and it being conducted as the machinesimage can malfunction with an extremely high reading.  LifeScan is the company that makes the product.  The machine still works for lower readings.  Be aware if you are uploading information to your PHR via the unit as you might get a warning that your glucose levels are very high.  Again the low readings seem to be ok but the high readings is where the malfunction comes in.  Getting a new unit looks to be pretty easy with using the serial number on the back of the unit.  BD 

Johnson & Johnson is voluntarily recalling almost 2 million of its OneTouch Verio blood glucose meters because they malfunction at extremely high blood glucose levels. Laura Talavera, RN, from the Scripps Whittier Diabetes Institute, speaks with NBC 7’s Chris Chan about the recall and what actions patients should take…

http://www.scripps.org/news_items/4455-scripps-nurse-speaks-with-nbc-about-recent-blood-glucose-meter-recall?utm_source=social

FDA Approves J and J New Class of Drug for Diabetes 2, Expelling Sugar Via Urination

Some MDs are cautious with the results and use so far as the drug is basically using a “side effect” as a treatment.  I wrote this up a imagefew months ago on how it differs from current products on the market.  It’s not cheap though as anything new goes for more money and at almost $9 a tablet, it will be interesting to see how it sells.

Johnson and Johnson Diabetes Drug Canagliflozin Manages Blood Sugar Levels in a New Way

It has some other added benefits like reduction in weight and some reductions in blood pressure but there are side effects too such as elevated risk of stroke and raising LDS, the bad cholesterol levels. J and J will need to conduct post marketing studies to iron out more of the side effect risks along with a clinical trial.  The drug is not for use for patients that have kidney disease.  BD


The U.S. Food and Drug Administration approved the drug, Invokana, after data showed it was effective in lowering blood sugar in patients with Type 2 diabetes, the most common form of the disease.

The FDA has asked for five post marketing studies for the drug including a cardiovascular outcomes trial, an enhanced pharmacovigilance program, a bone safety study and two pediatric studies, the agency said in a statement on its website.

In January, 2012, the FDA rejected a similar drug, dapagliflozin, made by Bristol-Myers Squibb Co and AstraZeneca Plc, citing concerns over a possible increased risk of cancer and liver injury. The drug was subsequently approved in Europe under the brand name Forxiga.

http://www.reuters.com/article/2013/03/29/us-usa-johnsonandjohnson-diabetes-idUSBRE92S0EY20130329

VA and Department of Defense Medical Records Integration/Aggregation Gets A New Twist as DOD Entertains Canning AHLTA & Getting a New System-VA Suggests Choosing VistA

Data, data and more data.  I’m sure there’s been a ton of work here with using the existing AHLTA system from the DOD and working with the VA VistA system as there have been several progress reports and trials as well as VistA working with other commercial medical record systems.  Now, scrapping ALTHA and getting another system before integrating or aggregating with the VA yet adds more to the challenge. If ALTHA was that bad, why were they not discussing canning it sooner one might ask?  I think that’s a good question.  Now we come back to the original question about moving medical records from AHLTA into the VistA system, that is if the DOD will “choose” VistA as their medical records system.  Both systems are written in MUMPS as the back end which is a big plus without having to do data base work conversions with tables, etc.  Some of the front end is done in dot net, just as some of the commercial versions of VistA have been converted. 

VA and DOD To Work to Accelerate EHR Integration - CACI International Was Awarded $91 Million Dollar 5 Year Contract in 2010 to Provide the Services-Big IT Infrastructure As Such Requires a Lot of Time/Money

I last reported that the two agencies were going to create a split dashboard with each system on a screen where both systems could be seen and utilized.  Granted the AHLTA system is going to have some battle ground record keeping that VistA may not have currently too, but why in the world does the DOD want to look at yet buying another potential commercial system at this point in time?  I know it’s a ton of work and engineering to move medical records from one massive system to another, such as we have here and it will take time and thus the “dual screen” option was created instead of actually moving records.  You can see some of the testing at the link below that was done to test an overall user interface with both systems a year or so back. 

VA and Department of Defense Begin Testing A Common User Interface for VA VistA and AHLTA Medical Records in Hawaii

So again now the DOD is questioning whether or not the VistA medical records system from the VA is the best choice for them.  From a data standpoint it certainly makes sense rather than bring additional software into the situation and with war time and battle ground record keeping that may not be relative to the VistA program, run a platform on top of VistA if it is needed for some veterans and at least that way all would have their basic medical records in one system.  This is expensive to engineer all of this and takes time imageso again adding yet another commercial program to replace AHLTA is a huge cost.  VistA is certified as a modular EHR too, even though there are no stimulus incentives, the agency wanted to show that the system works as well as commercial systems that also get certified.  The MyHealthVet PHR is also a certified module.  I even tried to give them a little room on this post explaining the software program for claims and how long it took to evaluate what to do with the two medical record systems.  The sad state of affairs though with claims is getting the software to handle much of the job sadly and that does nothing for those who are waiting and the only real way to speed it up is to hire some humans temporarily until the software is up and running in more facilities it seems. 

VA Claims System Still Has a Large Back Log- Software development and Implementation Working to Correct But All Things Take Even More Time Today With Complexities

Also too if the DOD wanted to look at other systems they might want to look at commercialized versions of VistA that are sold such as Medsphere for one and there are a couple others out there.  Good old Jon Stewart sums it up pretty good with his video.  It starts out talking about the VA and graduates into the medical records systems. 

So it appears now with the VA suggesting the DOD use VistA we have come full circle back to moving medical records from one system to another with a full migration if DOD decides that is what they want to do with now scrapping the AHLTA system.  I do understand some of the soul searching here as the VA VistA system was also busy with connecting to other system as well in the meantime and there’s many ways to go here.  The slide show below gives you an idea of what AHLTA look like and references some new modifications that were made last year.

It would make sense to have VistA as the main system for sure at this point versus bringing in more expense with other commercial record system, so if that ends up being the case, bring in the data technicians and coders and let’s get the show on the road.  BD 


Ever since the Defense Department and the Veterans Affairs Department decided to step back from their approach to building a joint electronic health record earlier this year, DoD has been searching for a new electronic records system. As DoD nears a decision point, VA is making the case that its own system, VistA, would make a great fit for both departments.

The two departments' original vision was to build a single electronic health record that would follow a service member from the time he or she enlisted in the military to the time they exited VA care. Both agencies say that's still the fundamental goal, but under a revised program they announced last month, rather than building a record system from scratch, they'll each begin from separate "core technology" starting points and focus more on sharing data than integrating their systems.

http://www.federalnewsradio.com/538/3266156/VA-pushes-DoD-to-adopt-VistA-as-starting-point-for-electronic-health-record

Hoag Hospital in the OC CMS Inspection Finds Major Safety Issues

You can read the safety issues below and as the Orange County Register points out the vaccines not being stored properly was one of the main issues among other items listed.  The hospital has until May to imagecorrect and no doubt I’m sure all will be in compliance when another inspection is conducted.  The one item that stands out more so than others is allowing the anesthesiologists the option of using their own intubation equipment and the inspection found that it has not been sterilized properly.  Five charts were also deemed illegible.  Hoag and the Hoag Orthopedic Institute have always been top rated by patients so I’m sure the matters found by the inspection have been addressed and as the article states Medicare funding was threatened but that is the case with all inspection violations.   BD


Hoag Hospital and Hoag Orthopedic Institute have been threatened with the loss of federal Medicare funding after inspections turned up patient health and safety deficiencies in Newport Beach and Irvine.

In a January inspection of the Hoag Orthopedic Institute in Irvine, the Centers for Medicare and Medicaid Services issued a finding of immediate jeopardy – the highest level of potential patient harm – because flu and pneumonia vaccines and medications were stored at improper temperatures. Hoag Orthopedic Institute is a separately licensed for-profit hospital owned by surgeons and Hoag Hospital.

During a separate January inspection of Hoag Hospital in Newport Beach and Irvine, regulators found Hoag did not meet federal standards in six areas, including patient rights, infection control and surgical services.

Among the deficiencies noted in the report:

•Dust and blood stains were found in the drawers of anesthesia carts used in operating rooms. Doctors brought personal items, such as briefcases, into sterile operating rooms in violation of hospital policy.

•A doctor carried two medication-filled syringes in his pocket and then administered them to a patient instead of keeping them sterile and wrapped until use. Doctors also administered IV medication without sterilizing the IV ports first.

•Some anesthesiologists were using their own intubation equipment rather than the hospital's, but were not properly sterilizing it after use.

•Patients in the chemical recovery program were asked to write their full names on a sign-up sheet allowing other patients to identify them. A hospital employee faxed a surgery schedule with 145 patient names, dates of birth and surgeries to be performed to a real estate office instead of a surgeon as intended.

•Staff failed to obtain advanced directive wishes from several patients whose charts were reviewed. Medical records were illegible for five patients.

•Some patient meals failed to comply with physician orders or fully meet recommended dietary guidelines.

•Not all staff who performed imaging procedures wore badges to monitor their radiation exposure.

http://www.ocregister.com/articles/hospital-501987-hoag-institute.html

Thursday, March 28, 2013

Medical Device Companies Not Putting Up a Real Smart Battle to Reverse Device Taxes–Need to Offer Alternative Solutions for Missed Revenue, Taxing & Licensing Data Sellers Would Do It

I read yesterday where the Senate voted to repeal the tax but it doesn’t look real promising for the future.  I said this about a year ago about taxing data sellers as a replacement and it even being a larger producer of taxes and revenue to go after a crying need that is there under everyone’s nose.  This is a tough one that those who are not in touch with the way algorithms move money to digest I assume.  I see it and have several posts on this blog on the topic.  Shoot I even wrote to the NIH, FDA, and AdvaMed (the lobby group for devices) suggesting they at least entertain this methodology.  In today’s world if you don’t have a suggestion up your sleeve, it’s hard to make progress.  I sent the idea off to Elizabeth Warren too so I don’t think I missed anyone and included the FTC as well.  They all don’t get it, and that’s a pretty big crowd of bliss that’s forming here.  It’s amazing that the data selling in the US continues to go largely unmonitored and that fiction and error factors continue to erode accuracy in some areas for the sake of making money. 

I guess at this point digital literacy and how IT Infrastructures run everything is still a bit of a mystery to most.  The folks that write and create this stuff know exactly how it works though and those formulas, models and algorithms keeping moving the money.  Why do you think the White House jobs act was closed down?  Same thing as that you can’t fight this battle with big rules of text, you need to get down to where the action takes place.  I did this post a couple weeks ago with banks making big profits on selling our credit card information to health insurance companies, so again how do you feel about your health insurance company knowing what you spend on your debit and credit cards?  They get everything.  Ever think about why premiums keep going up?  They have to man their analytics departments and all the data they buy, look in the want ads, see United Healthcare on a hiring frenzy all over for Quants and Analysts and they make as much selling the data and have for years, one of the bit profit makers in the data selling business. 

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

The reality here is that most all have been duped and have no clue on how much data is really being sold and the huge profits made.  Walgreens made short of $800 million selling data only in 2010, so does that give you an idea of the billions in profits made here for just writing some code and mining data?  Do you wonder why companies don’t build factories and expand when it’s this easy to sell data and the government seems as bliss as every in this area too.  Just listen to the privacy conversations in Congress and in other places to get this.  They never address it in the way it should be…digital illiteracy thinking that text can do it all when it cannot.  Just scroll down on watch the 4 videos at the bottom of this blog page and get educated.  These folks are telling you right up front what the deal is, that is if you want to listen and find out what really is making all the money move, the algorithms in place and nothing changes until they are changed. 

Anyway, I have been suggesting to the device folks to come up with an alternative solution for revenue, but they don’t do it, whether it be my idea (which is desperately needed for regulation purposes for sure) or something else.  They just don’t get it.  In the meantime, data riddled with errors everywhere you turn is used against consumers.  Watch the video at the link below and see how this works..elementary if you are a tech person, but even the layman can get quite a bit out o the panel discussion video as you hear big companies that don’t have a clue as to what they are doing with some of their analytics works, the gal from T-Mobile says some of what they were doing was “silly”…listen up, good stuff. 

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game

In view of the above, also be prepared to realize that about half of the analytics purchased in the near future will be a total waste of time for a couple reason, one they are made to make money with little attention paid to reality and accuracy and second of all they don’t know what they are creating.  I like data and how smart it makes us and how we can make better decisions, but it’s over cooked and you can hide formulas in code and in models to make money and others will never see it unless the government takes on the task of getting smarter and hiring some anti Quants to decipher it for them and really prosecute a white collar crime like it should be.  In the meantime you just get a lot of talk and garbage from those who have no clue on how all this was built and what to do to remedy.   Scares the daylights out of me and it’s gets worse every day. 

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

So in summary this is sad that they just don’t get this with going to battle with an alternative suggestion.  You have to do that today.  Here’s an article where I was trying to help the cause with Cook Medical..I guess they didn’t want to jump on this either?  I don’t know but I tried?  I guess the problem is that this is not just a one step process as all seem to want?  If the revenue is removed from one area it has to come from somewhere else as I see it and would think the government would serve to inquire as well. 

Cook Medical Cancels Plans for Factory Expansions–We Need Companies That Create Tangible Products As They Create Jobs–Tax The Data Sellers/Brokers Who Make Billions With Data Mining “Killer Algorithms” And Give the Device Companies a Break

Again I agree with the device tax being levied against the companies that provide jobs as we need them, but darn, fight a smarter battle and go after the algorithmic formulas and models and do it right and cure another evil when you go to battle if they would? 

Check out the page on Algo Duping and the Killer Algorithms for additional video information with a collection of lectures done by people smarter than me…this is where it’s at and not in a huge collection of text that ends up being some kind of a law…it’s not that way anymore.  BD 

One Company Markets A Service To Send Patients Home With A Tablet To Communicate and Monitor Patients Discharged from Hospitals

We all know by now that follow up with patients discharged from the hospital is key and all are trying to figure out which way works best and what can be sold to allow this to happen whether it be wearable monitors, an electronic monitoring system and of course the most important part of all imageof this, keeping humans in here too.  I don’t care what anyone says with technology being able to do it all you still need that human touch in here combined with technologies.  Just think of it yourself if you were in the position of being discharged, would you like 100% machine communications?  Again it’s a balance of making it work correctly and not being impersonal.  You only get one if you are a patient at high risk of being admitted. 

I have been in many doctor’s offices and have asked why tablets are not used to collect information and many don’t like them and have not accepted them.  They work and do their job but some offices tell me their seniors have difficulty with the tablets and using them, while on the other hand a younger patients would adapt right away.  So this will be interesting to see how the tablets do in this area with collecting information as the product is being sold as a way to reduce re-admissions.  The interface and ease of use would be key for sure.  My mother just had surgery and was released from the hospital so I have seen the follow up efforts by insurance, the hospital and doctors first hand of late.  The insurance company was kind of funny as they asked if she had been admitted for a heart attack so you can see they knew there had been a stay at the hospital but had not clue on why she was there and it was not a heart attack.  BD


Through HRS, hospitals give patients with the highest risk of readmission a tablet preloaded with educational videos and information about what they need to do to stay out of the hospital. At the end of each video there's a short quiz; the answers allow the hospital staff to determine that patient's educational needs. Once the patient goes home, they use the tablet to record -- and transmit to their care team -- the medication they take, their weight, their activities and any side effects they experience.

"Our goal was to get to five hospitals by the end of next year," Pulim says. Seven have already requested the company's services. HRS expects to close a $600,000 round of funding in March.

It's still early days for the company, but right now 14 (soon to be a study group of 25) U.S. hospitals patients have been sent home with an HRS tablet; none have been readmitted. In March HRS signed its first client, Hackensack Alliance ACO, an organization that focuses on Medicare patients.

http://money.cnn.com/gallery/smallbusiness/2013/03/27/obamacare-startups/

Wednesday, March 27, 2013

MyMedicalRecord PHR To Begin Offering HL7 Connections to Connect/Interchange With EHRs and EMRs And Push PDF Documents In April

Many PHRs have worked with using an HL7 interface and now MyMedicalRecords adds this capability to their PHR.  4Medica on another note is one of the imageEHRs that has already signed a license agreement with MMR Global back in December of 2012 as I posted (link below) relative to the protected company patents, so it appears there’s no apparent issues to stop the exchange of any medical data and the company has worked with MMR to bring this interchange to light.  4Medica is the first to work with MMR, however the HL7 exchange format will be available to any medical records system that uses HL7 so that should be about all of them. 

4Medica Electronic Medical Records Company Signs Agreement With MMRGlobal (MyMedicalRecord) To License Health IT Patents

In addition, the system will also be able to push PDF documents to the EHR or EMR system as well.  The professional product MMRPro is a document manager and an e-prescribing system that works with the PHR.  Patients get a message when a new document is added for those who are not set up with a full medical records program.  The Pro version is not needed to use the new HL7 interface.  I included the video as there are some portions of interest with voice communications and secure patient/provider emails too.  BD 

4Medica Introduces Master Patient Index Engine Using Big Data Technologies and Algorithmic Processes In the Cloud

LOS ANGELES, CA -- (MARKETWIRE) -- 03/25/13 -- MMRGlobal, Inc. (OTCQB: MMRF) ("MMR"), a leading provider of Personal Health Records ("PHRs"), MyEsafeDepositBox storage solutions and electronic document management and imaging systems for healthcare professionals, today announced the launch of seamless connectivity between the MyMedicalRecords Personal Health Record and Electronic Medical Record ("EMR") systems in medical clinics starting April 15, 2013. The new features facilitate connectivity with any EMR or EHR system and also laboratory reporting systems.

Using an HL7 interface, MMR will be able to populate data, such as a Continuity of Care Document ("CCD"), directly to the patient as well as lab test results, medication lists and other discrete data which will be directly deposited into the MyMedicalRecords PHR. At the option of the patient, the system will also be able to push PDFs and other personally managed health information from the patient's confidentially maintained files directly into an EMR or EHR. The April 15th deployment is part of a joint development effort with a 4medica client using 4medica's Certified for Meaningful Use Integrated Electronic Health Record (4medica iEHR®); however, the system will be available to any EMR system.

This capability is made possible through MMR's patented online MyMedicalRecords PHR and extensive healthcare IT patent portfolio. The MyMedicalRecords integrated technology platform allows individuals and families the ability to store, retrieve and share documents, images and other forms of protected health information and vital documents using a variety of methods, including fax, phone and Internet among other protocols without relying on any specific Electronic Medical Record platform to originally populate a user's account.

http://phx.corporate-ir.net/phoenix.zhtml?c=178404&p=irol-newsArticle&ID=1799915&highlight=

Walgreens Enters Contract and Investment With Amerisource Bergen for Drug Purchases and Distribution, Using Global Interests to Flex Pricing Muscles–Independent Pharmacies Concerned

Cardinal Health will be replaced when their contract expires.  Amerisource is global and thus with adding Alliance Boots to the distribution, there’s a lot more negotiating power with purchasing.  The deal will add $28 billion in revenue to Amerisource.  Meanwhile at the shop, Walgreens imageis close to making over a billion a year just selling your data.  See how this all grows and makes profits for the big companies?  We won’t notice much as far as what we pay though as new distribution patterns are set up and the best for the consumer out of this deal is the availability of a few more drugs.  Walgreens will be able to take stock as well and own up to 23% of AmerisourceBergen. 

Independent pharmacies will probably need to worry again as the company distributes to most of them and what prices will they pay compared to Walgreens and Boots?  For Cardinal, Walgreens is their second largest account and that will hurt a bit.  BD


Walgreen, the largest U.S. drugstore chain, will use AmerisourceBergen's network to start daily distribution of drugs. Previously Walgreen used its own employees, transportation and warehouses to ship products on a daily basis and used an outside company like AmerisourceBergen weekly.image

Walgreen and Alliance Boots have the right to buy up to 23 percent of AmerisourceBergen, starting with a 7 percent stake on the open market, now valued at about $800 million. Walgreen and Alliance Boots also received warrants exercisable for 16 percent equity in Amerisource. The first tranche, an 8 percent stake, can be exercised at a strike price of $51.50 in March of 2016.

http://www.reuters.com/article/2013/03/19/us-amerisourcebergen-walgreens-idUSBRE92I0EP20130319

Moen Retirees to Lose Health Insurance January 1, 2014, Off To Medicare And Exchanges for Coverage

In addition, there’s no money given out to help retirees to purchase health insurance as some companies offer, so I am guessing the exchanges may help fill the gap?  Moen makes those nice pretty faucets you see in your bathrooms and kitchens.  Current employees are also getting less with a new higher deductible plan.  The high deductible plan change is becoming more common place with both big and small companies it seems.  BD


LORAIN — Judy Starcovic was one of nearly 230 Moen Inc. retirees who opened letters last week informing them their company-provided health care insurance will end as of Jan. 1, 2014.image

“I was there 35 years and they told me I had health care with them,” Starcovic, 71, said Monday.

The letter, which was signed by Moen President David Lingafelter, informed retirees that as of Jan. 1, Moen will no longer offer health care insurance to approximately 440 retirees in the U.S., including the almost 230 who live in Northeast Ohio and the rest of the state, according to Robyn Hill, Moen vice president of human resources.

Hill cited the cost of insurance, coupled with adapting the company’s health care to conform to changes mandated by the health care reform bill for its current workers as the reason for the change. Those moves include extending the coverage to age 26 for dependents and paying 100 percent coverage for birth control.

http://chronicle.northcoastnow.com/2013/03/26/moen-retirees-to-lose-health-care-insurance/

Not Receiving Reimbursement on Some Molecular and Other Diagnostic Lab Tests From Medicare, They Didn’t Develop a New Algorithmic Payment Guideline System, So It Came To A Halt

According to this article, which goes into detail if you read the entire summary at the link below pretty much says Medicare was changing their system and way to reimburse and has not done so with some of the newer proprietary tests and so now those in question are just sitting there without getting paid.  We come back once again to IT INFRASTRUCTURE,  as I keep saying and elaborating on the fact that things take more time today due to complexities.  The code stacking explanation was interesting as if a test included portions of other steps, they were sort of rolled into the process. 

This affects LabCorp and Quest and who doesn’t seem to get a test done by one of them somewhere along the line.  This is a serious area as patients are getting bills and nobody can explain why they are not getting paid.  As it normally goes private insurers usually follow Medicare with their pricing and may add a little, but they have done nothing either with the exception of Palmetto, a company owned by Blue Cross Blue Shield who is a Medicare contractor and covers the state of California who have been working to create some kind of system but it is far from being complete or who knows how accurate, and it sounds like they stack up until all want their money.

Just like insurers the complexities with lab tests also cloud the waters and can hide things and make the cost of certain lab tests go up, as if nobody knows how to price it based on the work and labor provided, it sounds like a real estimate game here to where the labs can also call their price.  I find this interesting since we have HHS over thereimage telling all to “hurry up” with Health IT…you can clearly see where the technology and political disconnect lies here without having someone at the top who has some technology in their background, but that’s what we have.  I said back in 2009 that to have someone in charge of HHS without some substantial IT in their background would simply eat that person up and that’s what we have, nothing personal, just the way the world and technology works today.

Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”

This is other things like the chatter about a Medicare Voucher system just grind on me as we keep hearing that in the news as being something that could be done, but it can’t as the budget would be huge, maybe second only to DOD and the time and inconvenience of disruptions would be astronomical, so we have digital illiterates on both sides of politics and we end up with these “fantasy battles of words” that in reality can’t be done.

This really hurts small labs too who are on the cutting edge with new proprietary diagnostic tests who don’t have a lot of money to operate with but represent knowledge we have never been able to test for before and could represent new lie saving treatments.  Anyway, we come back to the data and the math once again as that’s what has to function here with someone taking the front run.  Breast cancer and prostate cancer tests are right up at the front of some of this too.  Some may argue too that some of the tests are not necessary at certain points for certain patients.  Well the end result here is that someone has to provide some kind of guidelines even if they are not detailed where that might not be possible.  BD  


The Obama Administration has stopped paying the bills from hundreds of health care companies, and it has nothing to do with sequestration.

This is a story of bureaucratic mismanagement at the Centers for Medicare and Medicaid Services, and the harm it’s visiting on the diagnostic testing industry.

At issue is the way that Medicare reimburses everyone from the big laboratory companies such as the Laboratory Corp of America (LH:NYSE) and Quest Diagnostics Inc. (DGX:NYSE), to the molecular diagnostic labs inside academic hospitals, and especially smaller firms that make proprietary tests used by doctors to more effectively target treatments to patients with conditions like cancer.

The molecular diagnostics in question are used to screen for everything from genetic markers that predict disease to proteins that help diagnose illnesses and guide peoples’ response to treatments. These tests are transforming the treatment of cancer, among many other maladies.

The Medicare agency decided to change the way it reimburses these sorts of diagnostic tests. But it’s been slow to decide on its new approach. So in the absence of a policy, the Medicare program is simply not paying its bills.

But instead of coming up with a new system, CMS took the full year to do largely nothing. The agency sat on its hands. Then, only after winding down the clock, the agency announced that it would let the local Medicare carriers figure out what prices to assign to each of the different diagnostic codes (through a byzantine process called “gap filling”). In other words, Medicare punted.

Diagnostic tests were supposed to usher in an age of personalized medicine. Now they’re being actively priced controlled. And by a bureaucratic regime that can’t even figure out what prices they want to pay for these services.

http://www.forbes.com/sites/scottgottlieb/2013/03/27/medicare-has-stopped-paying-bills-for-medical-diagnostic-tests-patients-will-feel-the-effects/

“The Creative Destruction of Medicine”–Colbert Report With Dr. Eric Topol–mHealth (video)

I’m returning back after a few days with family and what better way to start that with Steven Colbert and his interview with Dr. Eric Topol formerly affiliated with theimage West Wireless Institute and now the Chief Academic Officer of Scripps Health.  I first started covering some of his presentations dating back to 2008 and 2010 with TED and agreed with him back then that wireless was somewhat forgotten along the line and perhaps everyone was just not ready yet.  He was also involved with the Scripps personalized medicine program that began back in  2008. 

The Wireless Future of Medicine – The Forgotten Element of Meaningful Use -Eric Topol –TED 2010 (Video)
Scripps, Navigenics, Affymetrix and Microsoft team on groundbreaking health study – Personalized Medicine

At any rate, Colbert does a good job here with the interview and demonstration of the mobile products with the demonstration of the AliveCor cell phone ECG cardiogram.  A few weeks ago I told my dog’s vet about using it for dogs and cats which is where the testing began before the FDA approved a few months ago for us.  In addition, small wrist monitor is shown that can be used at hospitals, saves room and all on the wrist for critical conditions. 

What is also great here too is the fact that Colbert hits the marketing side of this and that’s where we need to start licensing and excise taxing data sellers as his example asks “Will I be getting a text message offering big discounts on caskets”…this remark made after Dr. Topol explains how monitoring works.  This can all be good if the “profit folks” don’t’ twist and turn things and accuracy with ethics is maintained.  They talk about a heart attack ring tone to give advance warning and Colbert says, “oh yes insurance companies will give a discount to those wearing devices”…and then again we return to the “casket ad”…pretty good IF kept in context with allowing people to use technology with living a normal life as one thing we all have to be aware of is that alerts and monitors activate a sense of urgency and how many can we really live with before one goes nuts? 

Certainly the casket ad is way down the ladder but when it comes time to make a buck off selling data, and some used out of context, the vultures are there with a form of Attacking Killer Algorithms.   BD 

Start Licensing and Taxing the Data Sellers of the Internet Making Billions of Profit Dollars Mining “Free Taxpayer Data”–Attack of the Killer Algorithms Chapter 17 - “Occupy Algorithms”– Help Stop Inequality in the US
“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

http://www.colbertnation.com/the-colbert-report-videos/424776/march-26-2013/eric-topol

Tuesday, March 19, 2013

Bill Gates on Washington DC–You Don’t Run a Business Like This…

Bill Gates begins talking about the Gates Foundation and their success with imageeradicating polio and other vaccine efforts.  Somebody cancelled a meeting with Gates to see Obama and there’s a little laugh.  Nobody says who it was.  This was recorded at POLITICO’s Playbook Cocktails first annual event.  He talks about models being needed.  He says government is dysfunctional where people don’t know what their budgets are.  “We might have money or we might not” is what he says is part of where the problems lie and he’s referencing the sequester.

He does talk about cyber crime and how it needs to stop and needs focus.  He varies off on other topics and keeps coming back to healthcare, science and engineering.  He thinks Obama has done a good job on education and is unappreciated in those efforts.  He says some days he wished we had a system like the UK but says the US system seems to work better and wishes the President had a little more power to avoid so many of the deadlocks.  Bloomberg says Bill Gates reads everything.  BD

Gates has waded into everything from AIDS research funding to infant mortality. He and his wife have interacted with some of the world’s most influential leaders through their charitable work with the Bill & Melinda Gates Foundation.

Gates pointed to Twitter as “the best thing right now” for big audiences, assured the demise of print textbooks and even weighed in on the gay Boy Scout ban. Should the rules change? “Yes,” he said without hesitation. “It’s 2013.”

http://www.politico.com/story/2013/03/bill-gates-on-dc-you-dont-run-a-business-like-this-88830.html#ixzz2O1TtlTvV

Big Data–The Data Science Code of Ethics-Designed By Those Who Create Models - Don’t Fall Victim To Write Fictitious Code and Models Just to Make Money With Clients Demanding Such

This of course is very much alive in the financial areas and one of the reasons myself and others who know technology think it is absolutely insane that we are looking at anther attorney to run the SEC.  Nothing personal but they can’t move fast enough to keep up.  This is sad that so many out there like me keep repeating it over and over and for some reason the government can’t see this, sad.  We all also have models and code in healthcare.  If you look at job openings you will see that Untied for one has a never ending stream of openings for Quants, those who write the models and math which designs the analytics they create and use.  The Quants are the next level up from a programmer, as I used to be and the programming portion takes the model and builds the software to execute models and that’s how the algorithms work. 

Granted I know this is a little deep here but it is what it is.  Stop and think why do we have folks like me warning about this, folks who write models warning about this?  It’s real and I have pointed out a few examples and am living one right now with Medicare stipulations in getting a member of my family taken care of.  We have too many folks out there that believe in Algorithm Fairies and while analytics helps up make better decisions when done right it also is an easy to make money as most of the world doesn’t understand how this works.  It worked well during sub prime days as you saw who make money but there’s also the downside when reality comes crashing in as the world of math and coding does have a side of fiction that can be used to snow all.  If you scroll down and watch the videos at the bottom of this blog, or take time and watch the same and additional videos at my Algo Duping page, you will understand a lot more. 

We have clashing worlds in healthcare with for profit insurers versus the clinical data which is credible working with and against each other.  Fraud can enter at any time when there are big profits to be made.  Cathy O’Neil who is in one of the PBS videos below writes about this on her blog.  She worked it on Wall Street and saw what happened and what continues to happen if ethics are not in place.  Model builders can go wild and create fiction that reduces risk and it happens all the time, and thus so, models need to be verified.  This is the problem with the Department of Justice in not having investigators to go this route and investigate and verify validity of code and models.  If you happened to watch the PBS special called “The Untouchables, Too Big to Jail” from what is shown here not only was the obvious not touched by there was no mention anywhere of the DOJ even looking at the “models” used to create the sub prime loans.  It’s not the guy who wrote the software that all the banks purchased, it’s what they did with it. 

“The Untouchables-Too Big to Jail” Frontline Documentary Shows Department of Justice’s Fear of Prosecuting Big Banks–No Confidence In Using Current Day Technologies To Investigate –Video

In her latest post she references yet one more Code of Conduct document, again created by those who want clean and non fraudulent code.  Scroll down again to the bottom and watch the documentary “Quants, the Alchemists of Wall Street” and you will see Emanuel Derman and Paul Wilmott discuss their code of ethics they came up with a long time ago.  They wrote their Financial Modeler’s Manifesto after the financial crisis…see both tin the Quants video at the bottom of this page.  They both tell you how common sense drops and that a major rethink is needed before we have a mathematical market meltdown.  If the market melts down with math, so does healthcare as so many are traded on the open markets, same thing. 

In her blog writings she found yet one more document from a company who employs Quants and again their efforts to again talk about not cheating and what to do when working for a client whoimage wants one to “work the numbers” for the models.  Again this is all over and in healthcare too, and Quants get paid a lot of money for writing models and when things come crashing down, who do they go to, the Quants.  Now there’s a point in time too where the Quants say “no” and that’s what this is all about, refusing to write models and code for money with no concern about  ethics and the impact on the general consumer.  Here’s the document she references and the site looking for comments on their draft.  You should read it and below are a few paragraphs that outline what the data scientist should do and respond if the client is pursuing areas beyond what the data substantiates for profit for example. 


“Rule 8 - Data Science Evidence, Quality of Data and Quality of Evidence

(a) A data scientist shall inform the client of all data science results and material facts known to the data scientist that will enable the client to make informed decisions, whether or not the data science evidence are adverse.

(b) A data scientist shall rate the quality of data and disclose such rating to client to enable client to make informed decisions. The data scientist understands that bad or uncertain data quality may compromise data science professional practice and may communicate a false reality or promote an illusion of understanding. The data scientist shall take reasonable measures to protect the client from relying and making decisions based on bad or uncertain data quality.

(c ) A data scientist shall rate the quality of evidence and disclose such rating to client to enable client to make informed decisions. The data scientist understands that evidence may be weak or strong or uncertain and shall take reasonable measures to protect the client from relying and making decisions based on weak or uncertain evidence.

(d) If a data scientist reasonably believes a client is misusing data science to communicate a false reality or promote an illusion of understanding, the data scientist shall take reasonable remedial measures, including disclosure to the client, and including, if necessary, disclosure to the proper authorities. The data scientist shall take reasonable measures to persuade the client to use data science appropriately.”

And a few more words here….

“(g) A data scientist shall use reasonable diligence when designing, creating and implementing algorithms to avoid harm. The data scientist shall disclose to the client any real, perceived or hidden risks from using the algorithm. After full disclosure, the client is responsible for making the decision to use or not use the algorithm. If a data scientist reasonably believes an algorithm will cause harm, the data scientist shall take reasonable remedial measures, including disclosure to the client, and including, if necessary, disclosure to the proper authorities. The data scientist shall take reasonable measures to persuade the client to use the algorithm appropriately.”


As you can see the word “algorithms” is spelled out plain and clear.  If you visit this blog often enough then you have read about either Algo Duping or the Attack of the Killer Algorithms, the second of which is usually the result of the first.  So why does a profession of Quants feel this is necessary?  They have worked hard to excel in their professions but yet they are also wise enough to be aware of what greed can do and how they can be coerced.  We have a long history of it on Wall Street and again watch the video about the Quants of Wall Street.   The folks speaking out here came from the old school when they were hired to create efficiencies for banks and companies and we are way beyond efficiencies today as models make money when combined with algorithmic code that executes and not much changes without model and code updates. 

Sure they get paid well but nothing compared to what the front offices make and they are at times end up being what some call the “grunts of code and models” as none of this happens without their talent.  They don’t want to be jailed or brought to trial over models and math that is written that is unethical either, they want to create models that are as accurate as possible and bring clarity and good decision making to light.  You can read their comments at the document referenced above and at other places on the web.  They see the storm brewing and you can’t blame them for speaking out and not wanting to be put in a situation with using unethical models and code.  If you have knowledge in the quantitative area, they are looking for comments for others to add as they call this a “draft” as it stands now.  Here’s another good post to read about the complexities of data today and the call for bankers, accountants, modelers and others to be one on one with honesty. 

I felt it necessary to bring this topic up again as everything operates off business models and algorithms out there today.  Laws need to have these types of rules lined out today and we can’t rely on tons of text to do it, it’s not that kind of a world anymore.  One of our own weaknesses is the fear of math and that is so profound and sure are times I don’t want to do or think about math either, but there are those that use for profit so our fears and lack of knowledge from the top all the way down allows dirty code and bad models to exist without anyone ever asking a question.  DOJ needs to bone up on this as that’s where the heart of their investigations lie as nothing changes until the execute code is changed on the servers running 24/7. 

Algo Duping” – PLOS One Journal Publication Explains Why The Fear of Math Plays a Big Role As One Underlying Reason We All Get Duped And Those Who Don’t Fear Math Take All the Money, Gradually, Using “Mathematical Formulas & Algorithms”

Models can be used out of context and marketed that are marginal or knowingly not verified to be accurate enough to produce substantial and accurate results.  This brings me around to all the data selling that is going on out there.  It’s a virus and banks and companies are making billions in profit.  Once data folks get their hands on data bases they go to work with either linear or non linear methodologies and create analytics.  It’s the way it works and has for years.  This presents yet another danger of flawed data and we are all seeing it grow out there.  Models and algorithms can be written to find fraud and they can also be written to create fraud. 

Bill Gates has come out and said the same thing when it comes to healthcare about the “models” used with stating that more money is spent on curing baldness than tackling disease.  So here we go again, it’s all around us if we want to pay attention and listen as markets are all algorithms and models. 

“Our priorities are tilted by marketplace imperatives,” he said at the Royal Academy of Engineering’s Global Grand Challenges Summit.  Mr. Gates, who is one of the world’s richest men with an estimated $67bn fortune, said governments should act to offset what he described as this “flaw in the pure capitalistic approach”. His comments will be interpreted as another blast at the large pharmaceutical companies, which have long been criticized for ploughing money into developing “lifestyle drugs” and neglecting research that could save the lives of the world’s poorest.”

We have data scientists trying to figure out what to do with the data and in some cases it’s pretty easy, like registry information in healthcare, and that’s a good thing for sure as shown by Kaiser Permanente.  As a matter of fact some of the models written in other areas can benefit healthcare too, valuable analytics.  So again when we see the activity of the Quants themselves with a “code of ethics’ should you not stop and think?  

I still go back and revisit the Russian coder situation with Goldman and how that was never done right and we have people who know nothing about this complexity trying to hold court!  I sad you better sent the jury to Code Academy so he could get a fair trial.  No way can the person off the street understand all the complexities of what Goldman accused him of.  I’m not saying innocent or guilty but tech folks like want “the code truth” and not one more fantasy out there. You know what if I were a Quant I would be working on a code of ethics too because they know that temptations and offers will be there from those who are less than honest and go about their business of hiding risk to profit.  It’s not like this is a big secret either it’s just that everyone is bliss. 

Goldman Sachs Programmer Who Went to Jail for Stealing Code Has His Conviction Overturned–You Can’t Get A Jury of Peers Off the Street for Crimes With High Tech Algos

Now to move on this is another post yet talking about the value and validity of models and algorithms…used to make analytics.  A bunch of bankers from Australia made this observation originally and I agree with them.  The Algo Fairies that HHS, CMS, the Heritage Foundation (just to name a few) and others think that fly around out there to give black and white answers belong at Disneyland.  You are going to get marketed in healthcare and everywhere else and the big job is going to be to find value and accuracy.  You’ll get sucked in as we all do at times.

Half of Analytics Investments By Companies and Banks Will Be a Waste–What Do We Analyze with Big Data and Does It Have Value–Some Algo Fairies Would Do Better at Disneyland…

If you want to see a great video with NASA and several other large entities stumbling around with value with big data, watch the video below and here’s a forum and yes they are talking right up front about their Quants they have working for them.  Quants work all over and not just at banks. You can read my entire post here but here’s the video below, watch it as flawed data grows and data content can be used “out of context”.  You won’t know as you have been marketed so well and still think the US has enough money to rewrite Medicare with vouchers:)  Goodness I wish we had Congressmen that understood the cost of IT infrastructure as the cost to do such would probably run 2nd to the budget of DOD by the time it was done in about 8 years or so:)

So you want to stop inequality…get to the root and stop the outrageous data selling that goes on that feeds the greedy process above with analytics created to make money without any concern on how it hits the consumer, that’s where the control is, not politicians and I wish they would get educated here, all of them before they send us further down the river.  Unless this is somehow regulated with a DOJ that has no clue on how to investigate models and high tech crime, we are screwed. 

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

Now after all of this do you understand why the Quants want a code of ethics?  They are not the bad guys but they have the talent and it’s the code and models they write that controls all.  Over three years ago I made this post…do we need a department of algorithms?  I saw it then so did many others but nobody wants the education process out there as it messes up the game of code for cash. 

Does the US Government Need a Department of Modeling and Algorithms–Is Data Addiction and Abuse the Next Up and Coming 12 Step Program, Some Classic Posts & Topics Revisited

Do you like the fact that insurance policies keep going up?  Well the money has to come from somewhere to keep their quants and algorithms developing and they are a mixed bag at times as they do produce value in some areas and mess up in others, like the United Healthcare algorithms that short paid doctors and hospitals for 15 years…algos for money until someone questioned the code. 

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

Again in the Quant video you can hear Paul Wilmott stating “Quant fix the numbers, get the risk down”…would you love to be a fly on the wall over the last number of years to hear how many times that request was probably made?  When there’s billions to be made as they did with sub primes, I bet it was a lot. 

So to sum this up when you think about and read about Big Data, give this some thought on how the queries, data and algorithms are being created.  If something sounds fishy, then question it.  Watch the first video below from Charlie Siefe at NYU and he will cue you in with a lot of knowledge on the Algo Duping side of this and how you get marketed and fooled.  As he says, “numbers don’t lie but people do”.  Again I thought this was important to talk about Big Data and let all know that all analytics are not accurate and not useful and some can fool youThere’s no Algorithm Fairies to give you black and white decision making power all the time today but there is good data to help us make better decisions.  So when you hear Big Data next time, think about it as it is not always the best thing since sliced bread and there’s a long ways to go, as again, data and models can catch fraud and they can create it. 

Consumer Mobile Health Monitoring Has Issues That Stifle Faster Growth, Epidemic Data Selling In Healthcare and Unrealistic Immediate Expectations With Patients Changing Their Behaviors

So take this topic of a Data Science Code of Ethics seriously because they wouldn’t be talking about it if the Quants themselves were addressing within their own field.  They see it and know it is there with the temptation of big money with models and codes and nobody checks them as we don’t seem to have the talent and I guess enough tech knowledge in government to actively pursue fraud and bad code when it is needed.  For some reason or another folks just seem to think that all code is good and accurate..wake up as the experts smarter than me are telling you otherwise, folks with hands on experience and we can certainly stand to get all the transparency we can get our hands on today.  BD 

http://mathbabe.org/2013/03/18/data-science-code-of-conduct-evgeny-morozov/