January 2010

Remote Electronic Patient Monitoring Could Save $197 Billion Over 25 Years

The United States is faced with a choice to spend more on healthcare — money that does not exist — or cut costs over time, according to a report underwritten by AT&T and conducted by Kauffman Foundation and Brookings Institution economist Robert E. Litan. $197 in savings would result from implementing telehealth systems. Failure to make policy adjustments that encourage healthcare providers to take advantage of remote monitoring technologies will cut estimated savings by nearly $44 billion. Both forecasts consider results over a 25-year span.

Study finds gap between EMR vision, reality

A gap exists between policymakers' expectations that electronic medical records can improve coordination of patient care and clinicians' real-world experiences with electronic medical records (EMRs), according to a study by the Center for Studying Health System Change. The study, published online in The Journal of General Internal Medicine and supported by The Commonwealth Fund, indicates ambulatory care EMRs facilitate care coordination in a practice by making information available at the point of care, but are less helpful for exchanging information across physician practices and care settings. According to the study, clinicians have identified many areas where the design of EMRs could be altered and office care processes modified to improve EMRs' support for tasks involved in coordinating patient care. While current commercial EMR design is driven by clinical documentation needs, there is a heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management, the study found. Current fee-for-service reimbursement encourages EMR use for documentation of billable events - such as office visits and procedures - and not for care coordination, which is not a billable activity.

(12/30)

Health IT Provisions in Senate Health Care Bill

The Senate's version of the health insurance reform bill passed 60-39 on December 24. Among its health information technology provisions, the legislation includes:

1) the establishment of standards to allow the electronic exchange of health information among long-term health care facilities;

2) directs the Health and Human Services secretary to develop a program to award grants or contracts to establish community-based health teams aimed at supporting primary care practices on a variety of health care services, such as the application of health IT to support medical homes;

3) requires HHS to create a Web site to let Medicare beneficiaries compare physicians based on quality measures and patients' perceptions of care; and

4) authorizes the release and use of standardized extracts of Medicare claims data.

(12/28)

Justice Department Calls for Airwaves for Wireless

The US Department of Justice has filed comments in the Federal Communications Commission's National Broadband Plan proceeding and suggests the government should free "underutilized" spectrum for use by wireless companies to increase competition for high-speed Internet services.

"The scarcity of spectrum is a fundamental obstacle that the commission should address," the comments read.

Wireless services can provide an alternative to Internet providers that use wires, such as cable companies and telephone companies, the Justice Department said in its comments. It said a lack of airwaves, or spectrum, is a constraint on wireless companies "and new start-ups." The Justice Department said there are "unanswered questions" about whether wireless Internet services will be offered at prices to compete with wired Internet services.

The Justice Department said that "reallocating spectrum that is being underutilized" would encourage development of wireless services and "could help" to make them more competitive with offerings sent over wires. Reallocation "should be considered when the total value of that spectrum is significantly greater in a new use than in its existing use," the Justice Department said.

Search, but You May Not Find

[Commentary] The Federal Communications Commission errs in directing Network Neutrality regulation at Internet service providers. Today, search engines like Google, Yahoo and Microsoft's new Bing have become the Internet's gatekeepers, and the crucial role they play in directing users to Web sites means they are now as essential a component of its infrastructure as the physical network itself. The FCC needs to look beyond network neutrality and include "search neutrality": the principle that search engines should have no editorial policies other than that their results be comprehensive, impartial and based solely on relevance. The need for search neutrality is particularly pressing because so much market power lies in the hands of one company: Google.

With 71 percent of the United States search market (and 90 percent in Britain), Google's dominance of both search and search advertising gives it overwhelming control. Google's revenues exceeded $21 billion last year, but this pales next to the hundreds of billions of dollars of other companies' revenues that Google controls indirectly through its search results and sponsored links. The FCC is now inviting public comment on its proposed network neutrality rules, so there is still time to persuade the commission to expand the scope of the regulations. In particular, it should ensure that the principles of transparency and nondiscrimination apply to search engines as well as to service providers. The alternative is an Internet in which innovation can be squashed at will by an all-powerful search engine.

[Adam Raff is a co-founder of Foundem, an Internet technology firm.]

(12/27)

Boston Public Library and Partners Win Broadband Stimulus

The Boston Public Library (BPL) partnered with the Boston Housing Authority (BHA) and Boston Centers for Youth and Families (BCYF) to win $1.9 million in the first round of broadband stimulus awards. The BPL plans to add at least 281 public terminals for accessing the Internet. Among the winning application's promises was to organize a schedule of Internet usage classes to go with the new computers. The city's main library will offer one class per day, while the other 25 branches will run a minimum of a single class per week. At least one class in Spanish will happen at a single branch per month as well. The BPL's share of the stimulus winnings will be roughly $500,000, which will go mostly for purchasing hardware. The BPL needed to contribute $100,000 in matching funds. Half of it came from putting aside money within the BPL's existing budget for wiring the terminals. David Leonard, chief technology officer for the BPL, found the remaining $50,000 from other city sources. The library will do cross-promotion with the computer centers run by the BHA and BCYF. The three agencies crafted their stimulus application so that they wouldn't be in competition with one another. All three will offer classes, but in many cases, the BHA and BCYF won't offer courses already provided by the BPL. For example, the BHA and BCYF may leave Internet research classes to the BPL because librarians are especially well suited for teaching research.

Internet effort aims to get more Detroiters connected

By the end of 2010, thousands of low-income Detroit residents could gain Internet access through an initiative to connect targeted areas with wireless broadband service. The Detroit Connected Community Initiative project -- mainly funded by an $800,000 grant awarded from the Knight Foundation in November -- is expected to develop a broadband infrastructure in three areas within Detroit's Midtown-Northend and Osborn-Northeast areas. Patrick Gossman, executive director of the Community Telecommunications Network and Wayne State University's deputy chief information officer, said the number of Detroiters with access to broadband or wireless Internet in most areas of the city is less than 40%. Some residents have computers, he said, but only slow dial-up Internet service. To help provide the Web access in neighborhoods, CTN is partnering with 4C's Family Place, Focus: HOPE and Matrix Human Services. The service will be free, at least initially. CTN is also adding $100,000 to the initiative and working to get federal grants to help get computers for residents.

FierceTelecom 2010 Prediction: Middle mile march

In bridging the broadband divide, service providers in underserved areas will need competitively priced interconnection and backhaul facilities to major network interconnection points. Enter the middle mile. The middle mile really is a reinvention of a concept that has already existed -- with many telephone cooperatives (Iowa Network Services and Syringa Networks) who pooled resources to provide their members with everything from long-distance voice transport, optical and even video transmission. Now the middle mile has become the center of attention in the Obama administration's broadband stimulus funding grant award process. Thus far, the National Telecommunications and Information Administration and Rural Utilities Service have awarded four states (Georgia, Maine, New York and South Dakota) funding grants for their middle mile projects. Of course, these projects came with the usual protests from the large cable and telephone companies.

Google Is Becoming a Media Company

[Commentary] Google, despite its protestations to media companies that it is here to help them, not compete with them, is officially becoming a media company.

Google has, of course, many win-win advertising rev-share partnerships with media companies. But you know what's totally awesome for Google? When it doesn't have to share revenue! Which it can do by buying media companies like Yelp.

Yep, Yelp is a media company: It offers content to consumers. It's gussied up in social-media dress, but the bottom line is you go to Yelp or use its mobile app to access its content. Yelp, of course, gets its content basically for free, because it's all user-generated. So if Google buys Yelp, it gets 100% of the advertising revenue, because it doesn't have to rev-share with a pesky little media company, because Google itself becomes a media company -- one that doesn't have to pay media people to create media.

What's hilarious about Google chasing local-listings site Yelp in 2009 is that, back in 1997 -- last century! -- Microsoft also was trying to get into the local-listings business. The lesson here: It's time to ignore Google's insistence that it doesn't want to be a media company. The fact that it is not, like Microsoft in 1997, hiring a ton of journalists is meaningless -- because, well, even media companies (except, weirdly, AOL) have stopped hiring journalists. Mark my words: By not hiring journalists, but instead dominating the user-generated content business by buying companies such as Yelp, Google will become a massive media company (that, among other things, will kill off the city-and-regional magazine market, and what's left of local alternative newspapers).

Ten for the Next Ten

[Commentary] The musician offers ten ideas that might make the next 10 years more interesting, healthy or civil.

He cautions that the only thing protecting the movie and TV industries from the fate that has befallen music and indeed the newspaper business is the size of the files. The immutable laws of bandwidth tell us we're just a few years away from being able to download an entire season of "24" in 24 seconds. Many will expect to get it free. A decade's worth of music file-sharing and swiping has made clear that the people it hurts are the creators — in this case, the young, fledgling songwriters who can't live off ticket and T-shirt sales like the least sympathetic among us — and the people this reverse Robin Hooding benefits are rich service providers, whose swollen profits perfectly mirror the lost receipts of the music business. We're the post office, they tell us; who knows what's in the brown-paper packages? But we know from America's noble effort to stop child pornography, not to mention China's ignoble effort to suppress online dissent, that it's perfectly possible to track content. Perhaps movie moguls will succeed where musicians and their moguls have failed so far, and rally America to defend the most creative economy in the world, where music, film, TV and video games help to account for nearly 4 percent of gross domestic product. Note to self: Don't get over-rewarded rock stars on this bully pulpit, or famous actors; find the next Cole Porter, if he/she hasn't already left to write jingles.

[Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and (Product)RED]

(1/2)

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