By Paul F. Levy and W. David Stephenson

Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care.  Doing so will help resolve important public policy issues.  It will help contain rising health care expenses.  And, it will even help save lives and improve the public health.

Doing this requires no new state law.  The law is already on the books.  It requires no addition to the state budget.  The costs have already been incurred.
What could cause so dramatic an impact?  Liberating data that is already in the hands of the state government.

In 2010, the Legislature and Governor Patrick enacted a bill, Chapter 288, that requires the collection of an “all payer claims database” by the Division of Health Care Finance and Policy.  As the name suggests, this database contains every health care transaction between insurers and providers in the state.  The numbers and patterns in this database explain more about our existing health care delivery system than has ever been assembled in one place.

A previous DHCFP commissioner asserted that the dataset would “allow a broad understanding of health care spending and utilization across organizations, population demographics, and geography.” And yet all that value remains trapped and hidden from view, burdened by unreasonable regulations regarding access.

Massachusetts universities and NGOs have the largest collection of health care researchers in the world.  It is time to make this database open and free of charge to those researchers.  Let them create hypotheses and test them — using real numbers.  Allow insurance companies and hospital systems, too, to view treatment patterns and finances to evaluate new policies and models of clinical care.  All this can be done safely and appropriately, because the law contains strict privacy safeguards.

If our leaders have the courage and vision, our state government can set a national standard for transparency in health care.  Let’s be really creative about this.  Imagine how the following idea would be noticed around the world:  Open up the data and announce a state-sponsored conference one year hence, at which researchers are invited to present papers and studies and conclusions reached from the use of this database.  Post those papers and studies on the Internet for all to see, informing public discourse and  generating yet additional hypotheses for further research.

The law, “to promote cost containment, transparency and efficiency in the provision of quality health insurance,” is a good one, but only if the data is really liberated. It must be automatically available to those who need it, when and where they need it, in forms they can use, and with freedom to use as they choose, while simultaneously protecting security and privacy.

Transparency’s societal value is that it allows hospitals and doctors, insurers and the government, to hold themselves accountable to the standard of care we say we believe in — providing the kind of care to everyone that we would want for members of our own family.

Among the other states — Kansas, Maine, Maryland, Minnesota, New Hampshire, Oregon, Tennessee, Utah, and Vermont — that have created similar data bases, we know of none that have taken this approach to freeing the numbers to enable the information to be used for the greater good.  Instead, most states have a governing board or advisory committee that administers or provides recommendations on the reports to be generated from the databases.  That kind of government is a hold-over from the centralized control of another era, a form of government that inconsistent with a world of web 3.0.

Six years ago, Massachusetts began a great experiment in providing universal access to health care.  That has worked well and has now been adopted as a model for the country.  But important issues remain to be decided.  Liberation and transparency can combine to take the foresight and creativity of the Massachusetts health care experiment to the next level, again setting an example for the entire nation.

Paul F. Levy, former CEO of Beth Israel-Deaconess Medical Center, is the author of Goal Play! Leadership lessons from the soccer field. W. David Stephenson of Stephenson Strategies (Medfield) is author of Data Dynamite: How liberating information will transform our world.

It substituted Points Plus, which factored in some of the latest nutrition science (a given food’s “thermic effect” and “energy density) in a more complex algorithm that “distinguishes among calories and ascribes values to a given good based on its makeup of protein, carbohydrates, fiber and fat.”

The new formula means that Weight Watchers now get more “points” to build their diets around, while it also penalizes processed foods and even distinguishes, for example, between OJ (which costs you points), versus oranges, which don’t, because they include a lot of food per calorie and also contain fiber.

The program continues the classic Weight Watchers’ emphasis on social support through weekly meetings (or their online equivalent) and techno-ad ons such as an iPhone app, but the company believes the new formula will lead to more sustained weight loss.

The story underscores an important fact about data: it’s not immutable, but requires continual re-examination in light of new science, and, most important, advances in monitoring data (i.e., the quantum leaps that will be possible with The Internet of Things and ubiquitous monitoring).

Now back to fulfilling that New Year’s Resolution of shedding another 15 lbs…..

Catching up on my reading, I came across an article in CIO  about MIT’s Africa 2.0 forum, which included a presentation by Nathan Eagle of Jana, which uses the incentive of free mobile airtime to get consumers in developing nations to complete surveys or purchase products.

In this case, Jana was working with hospital nurses in rural Kenya to get them to text blood supply information to a central data base. Since African cell users may spend 10 per cent of their annual incomes purchasing air time, Jana found that compensating the nurses by giving them air-time credit would directly increase their willingness to participate in the program.

The program was a win-win: the nurses got the usage credits they wanted and the public health authorities got the blood supply information they needed. I must admit I’m a little ambivalent about Jana’s wider mission of marketing to people who are barely surviving economically, but if they are getting something that is so valuable — cell minutes — in return, at least there’s more of a beneficial tradeoff.

There’s also the added benefit of making vital public health data available by harnessing the profit motive.

Let’s hope the new year brings more such clever win-win collaborations to make data more widely available.

It should be a hit with those of us who are into the Quantified Self movement, which involves recording and analyzing your daily fitness routine, diet, sleep patterns and general sense of well-being.

If you leave the Up on your arm all day, you can:

• monitor your workouts
• program it to vibrate when you have been idle for whatever interval you input, to remind you to move around
• track your general activity level — those steps to the coffee machine can add up!
• record how much sleep you get.

Using the accompanying iPhone app, you upload your daily stats, so that you can track your performance over time.  There’s even a rudimentary component to analyze your diet.

I’ve attended several meetings of the Boston Quantified Self Meetup, and it is fascinating to see how many new devices and apps are emerging to take advantage of smart phones’ accelerometers, GPS and camera components.

I’m convinced that keeping health costs down as the population ages will require more individual emphasis on prevention and wellness. The UP bracelet and similar devices such as the Fitbit (a little to clunky for my tastes) will play a growing role in that effort.

Bravo!

Yes, it’s nice that FEMA now uses Twitter and Facebook, but it seems they’re much more into using them as alternative broadcast media for agency announcements than as a way to actually gather information from us in a disaster.

I urged DHS to take two steps:

1. provide formal public education on the kind of information (again, especially visual information using the power of mobile video) that they’d like to receive from us. Vacuous “If you see something, say something” PSAs just don’t cut the mustard: see what? We’re smart: we can report, but DHS must tell us what kind of information would be truly helpful. Otherwise, we’ll report every woman in a burqa, while ignoring the Timothy McVeigh-type who’s buying large quantities of fertilizer.
2. provide a formal way to report that information. The National Weather Service does this with its #wxreport hashtag on Twitter, which it encourages amateur weatherspotters to use when posting information about local extreme weather conditions.

I’ve said it for years, and every disaster proves my point again: you and I can and will use the combination of mobile devices and social media when disaster strikes. If DHS starts to give that information a formal role in determining response needs, it can dramatically increase its effective eyes-and-ears on the ground.  We’re ready to help: we just need guidance and an attentive audience in response.

End of sermon.

But I digress….

We ended the trip in Iceland, which certainly seems to have been chastened by its out-of-control banking excesses during the height of the global mortgage binge of the last decade. Equally impressive, as one of the most computer-savvy nations on earth, it is gaining attention for crowd-sourcing its new constitution.

That got me thinking that Iceland might be an ideal test bed for the concepts I outline in Data Dynamite:

• the country’s commercial banks were so thoroughly disgraced during the banking crisis that I suspect nothing they can say will re-assure the public: the only way they can earn public support and confidence is through a “don’t trust us, track us” approach in which they are utterly transparent in their practices, using an XBRL-based operating system in which documentation for any loans (with appropriate safeguards for privacy and security) would be released on a real-time basis. This would both be a safeguard against internal practices that put the bank at risk and would allow regulators to quickly intervene to avoid further problems.
• There’s debate within Iceland about how to exploit the country’s tremendous geothermal energy supplies. An XBRL GL-based internal reporting system would be ideal for managing a resource that is as dynamic as geothermal and would benefit from the ability to price the supply and monitor maintenance issues on a real-time basis.Requiring that any geothermal operation use XBRL to report to the government as well would be a simple extension of an internal XBRL GL reporting system, and could result in the kind of “Regulation 3.0″ system that I’ve described before.

Iceland is small enough, and has a small enough private sector that I think it would be relatively easy for them to implement such a system.  Hey, Prime Minister Jóhanna Sigurðardóttir, gimme a call!

But write it I did, and now I’m back, because my book, Data Dynamite: how liberating information will transform our world, is now in print, and I’m returning to my blog, albeit with a new name (don’t worry, once I get back into the swing of things, I’ll also be blogging on my other love, networked homeland security strategies), both to promote the book’s content and to update it and amplify it with interesting new examples of people and organizations that “get it” about strategic use of data.

So let’s get right to it, with the crucial conclusion of Data Dynamite, my attempt at creating a comprehensive 13-point Liberating Data manifesto to guide efforts in government, business, and private lives, to make data more accessible and usable:

1. Structure data immediately as it is entered. Attaching metadata trans- forms words and numbers into valuable information. It also means that data doesn’t have to be constantly re-entered.This is the single most important step to assure the benefits of data sharing are fully realized. When data is structured (that is, metadata that explains it is attached or mapped to it) the data is given context and is transformed from mere words and into valuable information that can be automatically accessed by any programs and/or machines that recognize that metadata.

   That means the data doesn’t need to be re-entered, with the resulting risk of error, higher costs, and longer time. Whenever possible, the goal should be a system in which data only needs be entered once and is automatically propagated ev- erywhere. Benefits will include streamlining, coordinating, and automating opera- tions by providing real-time, machine-readable data.

2. make data freely available unless there are substantive security and privacy concerns.The most fundamental change to facilitate liberating data is to make the default presumption in dealing with government and corporate data that it should be shared by those whose roles depend on access to it, rather than assuming it should be kept locked in data bases and access limited. Of course there will be legitimate security and privacy reasons requiring that some data be kept private, but those objections must be legitimate, rather than simply “We’ve always done it that way.”
3. unless there are compelling reasons to the contrary, make data available on a real-time, data-in- data-out basis.Historical data is, of course, important, and should be readily available. ?? However, data is most valuable when provided on a real-time basis. That is when it can most improve decision-making and analysis by grounding us in current reality. Now that there are relatively low-cost analysis dashboards that will make ubiquitous business intelligence a reality, it is more likely that a growing number of companies and government agencies will begin to provide real-time data streams to their entire workforces, with the exact level of detail and confidential data depend- ing on each individual’s role and level of security clearance.
4. don’t charge for data unless there is a compelling reason to do so.Data wants to be free, literally and figuratively. In the case of government data, our taxes or fees already paid for its collection, and frequently it is individuals’ lives that are the basis for this data. In the past, when entering and retrieving the data was costly and time-consuming, charging for access to data was justifiable. Today it is not.

   In the UK and other countries, sale of data, especially geospatial data, is a significant source of income. That should not serve as justification for continuing to charge for data: the potential revenue loss for government is more than offset by potential tax revenues from new services that can be created because of the data.

   One positive sign: after the US Open Government Directive was announced, one valuable Health and Human Services Medicare data file that had previously cost $100 and was only available on CD-ROM became available free of charge on the Web.

5. Make organizations data-centric, with data at the core of their operations and strategy, and with access for all employees determined by their roles.To fully capitalize on the benefits of access to data, the organization must regard data as at the heart of everything they do. That requires restructuring and managing operations so that data is central, rather than on the periphery: a data-centric organization revolves around its data.
   
   
6. Provide tools to make data understandable and meaningful.Data is only really valuable when users are able to easily work with it and experi- ment with it, trying a variety of visualization styles to see which is most illustrative and sharing it with others using Web 2.0 tools.

   The “Tools” section of the U.S. Data.gov site, which combines data extraction tools with a variety of widgets, is a good start. However, the best example so far is Many- Eyes.com, because it combines a variety of data visualization tools with social me- dia tools such as threaded discussions that will encourage collaborative analysis. Government and corporate sites may be reluctant to host freewheeling discussions of data, so this may remain the province of sites such as Many Eyes.

7. Protect security and privacy with unified data is simpler than with multiple, fragmentary files.Unifying data and emphasizing structured data that just only has to be entered once makes it simpler to protect security and privacy than with multiple, fragmentary records. Allowing only permission-based access to parts of these records based on an individual’s role and security clearance is much easier to regulate and limit than trying to supervise a wide range of fragmentary databases with varying levels of security.
8. make the public and employees trusted partners in using and generating data.For too long, employees and the public have been given only the data crumbs, not full access, and were discouraged from actively becoming involved in data use and collection. When employees and the public are elevated to the level of full partners in analysis and use of this data, organizations and society will gain the benefit of their individual interests and life experiences. ?All workers, not just a few e?lites, should be treated as “knowledge workers” and given access to valuable, real-time data that will help them do their jobs more efficiently.
9. Build a “data culture”, beginning in schools, in which the general public and workforces will be comfortable working with data and have the skills needed to do so.If people have access to data but don’t know how to use it, the data will be wasted. Beginning in the early years of education, expose children to using new data visu- alization tools and data feeds as part of the curriculum. In the workplace, provide tutorials and opportunity for workers to experiment with data to build their confi- dence and ability to use it.
10. encourage data-centric public policy debate with active involvement from all political perspectives. encourage discussion of the data, not just its interpretation.In the political process, widespread use of, and debate about, data might reduce the level of rancor and make the political process more fact-based and realistic. People and parties on all sides of an issue should be encouraged to monitor data and incorporate it in their deliberations. ?Debating not just the interpretation of the data but also factors such as assumptions that might color the data itself will improve data quality over time.
11. encourage global adoption of data- centric governmental reporting processes to simplify and reduce businesses’ costs while facilitating interagency review and improved regulation and public protection.Tools such as XBRL are free and have been adopted as global standards. Multina- tional companies that already must report using these standards in one or more countries will be able to amortize their costs if all nations and local governmental entities adopt the same standards.

    Allowing companies to file a single structured data file instead of the multiplicity of traditional reports with individual agencies will let them save money while simultaneously improving the quality of regulation, because several agencies can coordinate reviews for the first time. For regulatory reports that are released to the public and corporations, this form of reporting will also allow users to make better comparisons because the reporting standards will be identical for every company.

12. Encourage rapid spread of liberating data’s benefits through open-source and crowd-sourced applications.Liberating data has already spread rapidly in part because pioneers have released a variety of apps and widgets created with open source tools, which lowers the cost of creating them. The solutions they create are themselves open source, explicitly inviting others to imitate and improve on the first ones. In this way, global adoption of liberating data will accelerate and poorer governments and their citizens as well as small businesses and individuals will be able to enjoy the benefits as well.
13. Streamline, coordinate, and automate operations by providing real- time, machine-readable data.Data that is in “machine-readable,” structured formats can automate and drive ma- chinery and devices. This can be a particular boon to businesses, which will be bet- ter able to streamline and optimize their operations, while also leading to more devices similar to GPS ones that are automatically updated based on real-time in- formation.

While the mechanics of tagging and distributing data are likely to change radically in coming years, it is also likely that two elements of the liberating data revolution will not only remain but also become more powerful in the years to come.

Never again will we believe that data is best carefully controlled.

Any new systems that emerge to structured data will, if anything, increase and simplify the ability to link data and to reuse it seamlessly, further integrating our experiences and globe.

Once set in motion, liberating data can never be reversed, and our world and our lives will be better for it.

Watching the coverage of the Maersk Alabama piracy incident, it seemed to me that conventional responses are ineffective because of the extreme asymmetrical aspect of the situation and because conventional treaty-based mutual defense approaches aren’t relevant on the high seas.

I think my “networked homeland security” theory may be an appropriate model for response. Here’s why:

• these situations are fluid and fast-moving, so any response has to have the same fluidity.
• real-time, location-based information is critical.
• the response needs to be collaborative — reflecting “social data analysis,” in which a large number of individuals, each of whom make have some of the relevant information, can use Web 2.0 tools such as threaded discussions, wikis, etc. to analyze the situation.The likely result of such a collaborative analysis (and one, incidentally, in which the cast of characters will likely be different in every situation depending on who happens to be in the vicinity and/or has relevant information) is likely to be a more nuanced, comprehensive and accurate one than if only one analyst or a small group was involved.
• the exact mix of data will vary in each case: in some situations there may be live, streaming video available to document the situation; in some, still photos relayed by camera phone, and who knows what other information may or may not be available depending on variables such as location, weather and/or Internet access. As long as the relevant information is relayed in an IP- and packet-based fashion, it an be shared by an ad hoc network of those who happen to be in the region at the time.

Given the pirates’ asymmetrical strengths of speed and surprise, ad hoc communications and decision making through networked homeland security may be our best countervailing power…

Let me know what you think!

Technorati tags: homeland security piracy Maersk Alabama Somalia War on Terror U.S. Navy terrorism antiterrorismtechnology crowd-sourcing wisdom of crowds social data analysiscrowdsourcing smart mobs swarm intelligence emergent behavior networked homeland security current affairs government IT mobile social networks government
collaboration

However, I feel compelled to break my silence to let you know about the Vivek Kundra I know better than most — and trust implicitly!

As you may be aware, President Obama appointed him as the first U.S. CIO less than 2 weeks ago. Then, on Thursday he took a temporary leave of absence because the FBI had arrested an employee of his former office, the Office of the Chief Technology (OCTO) for the District of Columbia, and an outside contractor.

Since then, there’s been a lot of baloney and innuendo in the blogosphere that has besmirched this fine man’s reputation.

I don’t know anything more than you do about the investigation, but if anyone wants to set up a prediction market, I’ll be you dollars-to-donuts that when the truth comes out, it will show that the FBI was tipped off precisely because of policies and procedures Vivek set up immediately after he took office in early 2007.

Most important, this crime was exactly the kind of thing Vivek and Mayor Fenty worked so hard to eliminate from D.C., which unfortunately still has a reputation for corruption left over from the Marion Barry days, despite 10 years of reform mayors. They did that through a wide-ranging transparency strategy that — while it obviously hasn’t made corruption impossible — sure has made it easier for all of us, not just the FBI, to examine.

Most dramatic (and something that Vivek will bring to the feds through the new Data.gov site when he’s back on the job!) is the Citywide Data Warehouse, which feeds 274 streams of real-time, un-adulterated statistics about all sorts of DC governmental activities directly to the media,watchdogs, and the public, and invites us to scrutinize what they do. As the site says, the city views the feeds as “a catalyst ensuring agencies operate as more responsive, better performing organizations.”

In particular, I’d draw your attention to the feeds for:

• Purchase Orders 2009
• Purchase Orders 2008
• Purchase Orders 2004-2007

If memory serves (I’m too busy to check ‘em out myself right now with the book thing) these files document all purchase orders for more than $2500 during that period ( incidentally you might want to search for the names of the two accused: Yusuf Acar, chief security officer for the CTO’s office, and Sushil Bansal, an outside contractor!).

To my knowledge, no other jurisdiction anywhere provides that kind of transparency about purchasing (and, had Vivek remained on the job, he and Mayor Fenty had additional steps in mind as well). Isn’t that exactly what you and I want for the massive stimulus bill, and don’t you want a guy with that kind of dedication & imagination back on the job ASAP designing the Recovery.gov. site to make certain it offers the same degree of transparency? I do.

And, if that’s not enough I directly your attention to testimony that Vivek gave before the DC City Council on Dec. 2007, on the specific steps he’d taken to put in place policies and procedures to eliminate and uncover corruption (including creating a wiki with specific whistleblower protections for those who report corruption to the FBI — which I bet may well pan out as the impetus for the FBI investigation :

“These controls are all part of a culture of accountability and innovation that, as I mentioned in my confirmation testimony, we are actively creating throughout OCTO. Innovation not only solves problems, it’s one of the best deterrents to corruption. Accountability and innovation keep processes, and personnel, from becoming so entrenched that an individual can beat the system by knowing every process, and every person, down to the tiniest detail and then exploiting them ….. I recognize that we can’t change people’s intent to do harm. But we can do our best to prevent the bad from entering our workforce. We can help the good to report the bad so we detect fraud early. We can deter the in-between from temptation through training and a culture of transparency, accountability, and innovation.”

Was this crime deplorable? You bet! Should it have been detected earlier? We’ll have to see what comes out in the trial.

However, mark my words: eventually this case will be seen as vindicating Vivek and underscoring the need for extending this kind of transparency to the federal government. The sooner he’s back on the job the better!

Technorati tags: publicdata public data dataviz government transparency e-gov e-government 2.0 e-government transparent government e-democracy government IT government politics Democratizing Data Vivek Kundra

1. I fell hook-line-and-sinker for Twitter, which I once poo-pooed as an exercise in narcissistic navel-gazing. By contrast, I’ve found that not only is it an effective means of communicating, sometimes on pretty sophisticated topics, but also that it’s great for the kind of ad hoc emergency communication that I specialized in. Therefore, if you want to track what I’m doing, your best bet is to subscribe to my Twitter feed.
2. More important, I’m facing a really tight deadline, the end of March, to complete a book manuscript, “Democratizing Data — to transform government, workplaces, and our lives,” about what I believe is a revolutionary approach perfectly suited to the combination of circumstances we face today: total loss of faith in government and business, the need for fewer remaining workers to do more with less, and to come up with creative solutions to increasingly complex problems.I believe the democratizing data is the way:
   • making our organizations data-centric: by that I mean instead of laboriously retrieving data from organizational data bases, adding informative metadata to it with XML or KML tags, and distributing it automatically through syndication.
   • designing software (open-source is particularly well suited to this approach) so that all users will be able to automatically share the data, rather than the past practice, in which data pasted into applications was then trapped in those applications.
   • designing a seamless cycling in which workers (with varying levels of permissions based on their roles), regulators, and even the public, will have access to this data, on a real-time basis. Experience from leaders in the field have shown this can be done while respecting strict privacy and security standards.
   • The results will include:
     • giving workers the real-time, often location-based information they need to do their jobs more effectively, and to collaborate with those in other offices and programs who need to share the same data. In many cases, this will be the first time they have had access to this data
     • substituting “smart” regulation for the abysmal failures of the Bush Administration. Following the Dutch model can dramatically reduce corporate compliance costs, and improve regulation by allowing various agencies to share the same data on a real-time basis (there is some evidence such an approach might have actually avoided the excesses that led to the economic collapse).
     • rebuilding public confidence in government and business through a “don’t trust us, track us” approach to transparency that provides facts and lets the public, media and watchdog groups judge for themselves whether officials are truthful.
     • even leveraging the “crowdsourcing” phenomenon to actively involve the public as co-creators of valuable new services, as was done by the District of Columbia’s innovative “Apps for Democracy” contest.

     I’m getting great initial reaction to the approach (probably due in great part to the fact that I was originally going to co-author the book with Vivek Kundra, the charismatic DC CTO who is now likely to become the Obama Administration’s e-government director, in which case it’s likely he’d have to withdraw from the project. Whether or not Vivek is an active participant, the book reflects much of his thinking). The video above (there are 3 other sections, which you can also find on You Tube — it was a hand-held version shot by an attendee at a recent O’Reilly IgniteBoston event) will give you a good introduction to what I’m talking about, as will numerous Slideshares I’ve done.

     So that’s why I haven’t been blogging and am unlikely to resume doing so in the near future (although look for a new wiki I’ll be launching in the next week or so to test sections of the book and solicit crowd-sourcing ideas for it! See you around campus!

     Tell a friend:

     Technorati tags: publicdata public data dataviz government transparency e-gov e-government 2.0 e-government transparent government e-democracy government IT government Vivek Kundra XBRL Democratizing Data