Tag Archives: transparency

Highlights from President Obama’s First State of the Union Address

President Obama delivered his first State of the Union Address last night. The Presidential blog at www.whitehouse.gov/blog has an excellent summary of all the initiatives Obama announced and the entire 90 minute video. The full script is also available at http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.

I am going to highlight just a few initiatives that are particularly important to me:

  • 3-year federal budget freeze – Beginning in 2011, Obama has called for a 3-year federal budget freeze that applies to everything but defense, Medicare/Medicaid, and Social Security. He claimed that without true health reform, it would be impossible to freeze spending on health.
  • Financial reform package – use the Stimulus bank bailout money that banks are repaying to go towards funding small business loans; create a small business tax credit; eliminate all capital gains taxes on small businesses (the latter 2 received bipartisan clapping while imposing a fee on large banks to repay the stimulus bailout is not supported by republicans)
  • College Financing Reform – this one is big! “To increase college access and completion, the Administration will make student loans more affordable by limiting a borrower’s payments to 10 percent of his/her income and forgives remaining debt after 20 years – 10 years for public service works. We will also make permanent the American Opportunity Tax Credit. The President urges the Senate to pass the American Graduation Initiative, which invests more than $10 billion over the next decade in reforming our nation’s community colleges, promoting college completion, and moving toward the President’s goal of having the highest proportion of college graduates in the world by 2020. The President is also asking colleges and universities to do their share to make college affordable for all Americans cutting their own costs.”
  • Health IT – despite all the political action surrounding health IT right now (and a good amount of talk for and against it), this was not mentioned at all
  • Nuclear Power Plants – FINALLY the government is going to pave the way to open up some more power plants, after a 30-yr hiatus
  • Changing the way the government does business – The administration is going to continue with lobbying reform, increasing government transparency, and creating a public “earmarking” database so that the public can see what budget amounts have been earmarked for certain purposes. To see how serious this administration is about transparency, check out http://www.data.gov. For a very specific example, I have been able to call into every workgroup meeting and download the materials related to the Office of the national Coordinator’s work on meaningful use and the HITECH Act. Here’s the schedule: https://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/
Also, a few quotables:
  • And what the American people hope -– what they deserve -– is for all of us, Democrats and Republicans, to work through our differences; to overcome the numbing weight of our politics.  For while the people who sent us here have different backgrounds, different stories, different beliefs, the anxieties they face are the same.
  • It’s because of this spirit -– this great decency and great strength -– that I have never been more hopeful about America’s future than I am tonight. Despite our hardships, our union is strong.  We do not give up.  We do not quit.  We do not allow fear or division to break our spirit.  In this new decade, it’s time the American people get a government that matches their decency; that embodies their strength.
  • To recover the rest, I’ve proposed a fee on the biggest banks. Now, I know Wall Street isn’t keen on this idea.  But if these firms can afford to hand out big bonuses again, they can afford a modest fee to pay back the taxpayers who rescued them in their time of need.
  • Now, let’s clear a few things up. I didn’t choose to tackle this issue to get some legislative victory under my belt.  And by now it should be fairly obvious that I didn’t take on health care because it was good politics. I took on health care because of the stories I’ve heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who’ve been denied coverage; families –- even those with insurance -– who are just one illness away from financial ruin. After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans…Here’s what I ask Congress, though:  Don’t walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  Let’s get it done.
  • for the first time in history –- my administration posts on our White House visitors online.  That’s why we’ve excluded lobbyists from policymaking jobs, or seats on federal boards and commissions.But we can’t stop there.  It’s time to require lobbyists to disclose each contact they make on behalf of a client with my administration or with Congress.  It’s time to put strict limits on the contributions that lobbyists give to candidates for federal office. With all due deference to separation of powers, last week the Supreme Court reversed a century of law that I believe will open the floodgates for special interests –- including foreign corporations –- to spend without limit in our elections. I don’t think American elections should be bankrolled by America’s most powerful interests, or worse, by foreign entities.  They should be decided by the American people.  And I’d urge Democrats and Republicans to pass a bill that helps to correct some of these problems.
  • In the end, it’s our ideals, our values that built America — values that allowed us to forge a nation made up of immigrants from every corner of the globe; values that drive our citizens still. Every day, Americans meet their responsibilities to their families and their employers. Time and again, they lend a hand to their neighbors and give back to their country. They take pride in their labor, and are generous in spirit. These aren’t Republican values or Democratic values that they’re living by; business values or labor values. They’re American values.

Meaningful Use Privacy & Security Concerns

The Privacy and Security requirements of the recently released Meaningful Use NPRM and Certification IFR have received a lot of attention due to their lack of definition. I joined in on the Jan 22 ONC Privacy & Security Workgroup meeting to discuss which topics the workgroup will comment on and send to the HIT Policy Committee. The topics included risk assessments, the phrase “implement security updates as necessary”, HIPAA investigations, privacy and data transparency, and “consumer preference”.

  • Risk assessments – There is still a lot of concern about the lack of clarity surrounding risk assessments. The ONC will need to ensure that education on risk assessments is available, especially targeted at small providers. Most organizations currently think they are HIPAA compliant, but few would feel comfortable if the government performed a HIPAA audit, because there is no guidance as to what the government would audit against. Guidance is needed on the “intended outcomes” of MU Security objective and greater transparency, such as Audit Program Compliance Guidelines, is needed on the audit process that will be used. It is unlikely that any guidance will be available by the time the final rulings are released. Large organizations commonly perform internal or 3rd party security/privacy audits, but this is rare (and not feasible) among smaller providers. Many of the comments related to this topic will not change the objective but how the ONC responds to the need for additional information.
  • “Implement security updates as necessary” – The term “updates” is both a technology (i.e. software update) and business process (i.e. modify password policy) term, and its intended meaning (whether one or the other or both) should be clearly stated. Time requirements were discussed, such as software security patches must be updated within 90 days of release, but this was thrown out due to complications of implementing updates, especially in enterprise settings.
  • HIPAA Investigations – ~5k HIPAA investigations are currently underway. Unclear if these are ~5k different hospitals, individual doctors, multiple investigations per entity, etc. Unclear if an open investigation will prevent an eligible professional or hospital from receiving incentive payments. The “expected” length and cost of investigations will be important to allow providers to make informed decisions. Unclear which HIPAA investigation types are relevant to MU.
  • Privacy and Data Transparency – No objectives or measures for privacy and data transparency are present in Stage 1. The Committee wants to propose these for Stage 2. “Accounting of disclosures” is included in Stage 1 and is already required by HIPAA. The connection between the security/certification piece and the MU/privacy piece is weak. For example, the capability to prevent many breaches is a part of certified EHR, but there are no objectives or measures to guide providers in the use of these certification criteria.
  • “Consumer-preference” – Also referred to as “patient-choice” requirements, consent management, or access control. There was some disagreement as to what the proper language was to discuss  patient preference. Dixie Baker, who is also involved in the Security Standards Workgroup, posted a presentation (available on the ONC website), to address Access Control and its relation to privacy. There is no IFR criteria for access control to help entities manage the patient consent requirement with which they must comply. This discussion was cut short due to time and will probably be completed in private conversation.

Refer to my previous post to join in on future workgroup meetings: https://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/