Paying – Repeatedly – for Epic’s Walled Garden

Taxpayers have spent more than $38B (!) since 2011 on a backdoor electronic medical record subsidy [1]. Verona based Epic Systems lobbied [2] for these expenditures and has benefited greatly from this federal taxpayer largesse.

Interoperability, that is the ability to move your digital health data anywhere, was one of the arguments for this lavish spending.

However and unfortunately, Epic’s Founder and CEO, Judy Faulkner is now lobbying once again [3], this time to prevent such open movement. Her actions seek to reinforce Epic’s “walled garden” [4], that is creating roadblocks to data leaving their systems.

Curiously, former Wisconsin Governor Tommy Thompson is also advocating Epic’s walled garden position, to the detriment of entrepreneurs everywhere. [5]

Citizens pay for healthcare and therefore vendors such as Epic in many ways, from our local, state and federal taxes to exploding insurance premiums and co-pays.

The ability to move our data opens up many opportunities, including more cost effective services.

[1] $37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018.

[2] Mike Ivey:

Officials at Epic Systems are not commenting on a New York Times report Wednesday that the firm was central in lobbying Congress on a $19 billion “giveaway” (now $37B and growing) to convert all U.S. medical records from paper to computers.

[3] Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info.

[4] Walled garden, or closed platform.

[5] Tommy Thompson HHS’ new health IT rule would hurt Epic and Wisconsin’s economy. Tommy Thompson links: open secrets search

P.S. A few more links on Epic.

Airdrop trumps $40B taxpayer medical record subsidies.

Madison’s property tax base growth and the backdoor electronic medical record subsidy.

2007. Then Governor Jim Doyle’s failed $30M electronic medical record taxpayer subsidy proposal.

Apple and Microsoft representatives are set to join a meeting on Monday promoting patient access to health data.

A Letter to Ms. Judy Faulkner & Mr. Tommy Thompson.

This is what information blocking looks like boots on the ground.

These are the realities people face when they are living with life-altering, life-limiting, absolutely earth-shattering diagnoses.

While patients and their loved ones can’t get the information they need to make educated, empowered decisions about their care, even while actively dying, hospitals, EHR vendors like Epic, as well as MANY other entities, have ludicrously shared and sold the same patient information for commercial purposes, to “improve hospital operations”, for “re$earch”, leveraging the legal loopholes of HIPAA, stating all is legal, this is business as usual. Without needing informed, explicit patient consent. Without any effort dedicated to patient education, public awareness, and transparency under the guise of “Nothing to see here”.

As patients and carepartners, WE WILL NOT STAND FOR THIS A MOMENT LONGER.

Thank you Ms. Judy Faulkner, CEO of EPIC, for your recent letter urging some of the biggest hospital CEO’s and presidents to oppose the proposed rules to improve interoperability and grant patients access to their information. You have made it crystal clear that you are not aligned with the real-world unmet needs and the barriers patient and carepartners face daily. Thank you for illustrating what paternalism looks like in 2020.

Thank you, Mr. Tommy Thompson, former governor of Wisconsin, for your guest column on why the proposed health IT rules would be a detriment to EPIC and Wisconsin’s economy. You have made it crystal clear that the business priorities of Wisconsin are of a greater importance than legal rights and the sanctity and dignity of the lives of all the patients of this great country of the United States of America.

Thank you for helping me refocus. Thank you for helping me answer the questions and address the self-imposed imposter syndrome that can momentarily cloud one’s perception. The answer is: IT IS ALL WORTH IT.

Heather Landi:

“We’ve often looked at interoperability in a narrow view, which is just as a replacement for moving the patient’s chart. Modern computing and APIs offer a vastly richer and more empowering global computing environment. Well-built APIs can do almost anything that your creativity allows,” he said.

Before Rucker took the stage at Health Datapalooza, HHS Secretary Alex Azar also addressed the upcoming interoperability rules and the Trump administration’s commitment to putting “patients in charge of their data” and called out industry stakeholders who are “defending the status quo.” They are protecting a health records system that is “segmented and Balkanized,” he said.

“We have a serious problem—and scare tactics are not going to stop the reforms we need,” Azar said.

Dr. Bharani Padmanabhan:

John Ehrlichman authorized breaking into Dr. Fielding’s office on September 3rd, 1971, to steal Daniel Ellsberg’s medical chart. In those days, medical charts were confidential and access strictly controlled. Any break-in was physical and impossible to miss. Even if the government did steal your private chart, at least you knew about it.

Which is why Nixon’s lawyer, Egil Krogh, went to prison for 4 months for violating Dr. Fielding’s Fourth Amendment right.

One of the many lessons the government learned was that stealing medical charts needed to get easier. This eventually culminated in Executive Order 13335 (69 FR 24059) which ordered that all Americans must have their medical charts in electronic form.

CBS News Epic: How a company you never heard of handle.

Posted in Uncategorized.

Apple dropped plan for encrypting backups after FBI complained – sources

Joseph Menn:

Apple Inc (AAPL.O) dropped plans to let iPhone users fully encrypt backups of their devices in the company’s iCloud service after the FBI complained that the move would harm investigations, six sources familiar with the matter told Reuters.

FILE PHOTO: A woman uses her Apple iPhone and laptop in a cafe in lower Manhattan in New York City, U.S., May 8, 2019. REUTERS/Mike Segar/File Photo
The tech giant’s reversal, about two years ago, has not previously been reported. It shows how much Apple has been willing to help U.S. law enforcement and intelligence agencies, despite taking a harder line in high-profile legal disputes with the government and casting itself as a defender of its customers’ information.

The long-running tug of war between investigators’ concerns about security and tech companies’ desire for user privacy moved back into the public spotlight last week, as U.S. Attorney General William Barr took the rare step of publicly calling on Apple to unlock two iPhones used by a Saudi Air Force officer who shot dead three Americans at a Pensacola, Florida naval base last month.

U.S. President Donald Trump piled on, accusing Apple on Twitter of refusing to unlock phones used by “killers, drug dealers and other violent criminal elements.” Republican and Democratic senators sounded a similar theme in a December hearing, threatening legislation against end-to-end encryption, citing unrecoverable evidence of crimes against children.

Apple did in fact did turn over the shooter’s iCloud backups in the Pensacola case, and said it rejected the characterization that it “has not provided substantive assistance.”

Behind the scenes, Apple has provided the U.S. Federal Bureau of Investigation with more sweeping help, not related to any specific probe.

An Apple spokesman declined to comment on the company’s handling of the encryption issue or any discussions it has had with the FBI. The FBI did not respond to requests for comment on any discussions with Apple.

More than two years ago, Apple told the FBI that it planned to offer users end-to-end encryption when storing their phone data on iCloud, according to one current and three former FBI officials and one current and one former Apple employee.

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“Thank you for not screaming at me”

Certain boxes,

filled with something delicious

from somewhere fun

did not accompany us upon arrival.

A few boxes

including mostly unessentials,

did arrive simultaneously.

Queue, we did.

numbers and routes were shared.

A new claim number generated.

Home.

Phone calls and website tracking links.

A few days later, two boxes,

filled with something delicious

from somewhere fun

and

dirty clothes

arrived at home.

Still.

One box, filled with something delicious

from somewhere fun

could not be found.

A further day passed.

Nancy’s iPhone rang.

crushed it was

at ORD.

Something delicious,

from somewhere fun.

Memories only.

And, a credit and claim.

“Thank you for not screaming at me”

said the kind airline representative.

It was just wine.

## I have to say that the people who helped track down our boxes were wonderful professionals.

I am sad that one thanked us for not screaming at her, in this, the year of our Lord 2020.





Explore the Douro Valley with amuz

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Merry Christmas

Via the Verse App

Dave Winer:

They’re all gone now, and the bonds didn’t extend into the next generation. So I have a very tiny remnant of a family now. I seek friendships that can take their place, but truth is they can’t. I’d pay a lot if I could buy another weekend with the relatives who are gone, even the ones who drove me crazy, but alas that is not for sale anywhere. #

Monumento Tragedia No Mar commemorates a 1947 Matosinhos storm which cost 152 fisherman their lives – via amuz

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Internet “broadband” availability, redux. “carrier’s lying about coverage”

FCC:

Bridging the digital divide is the Federal Communications Commission’s top priority, and accurate broadband deployment data are critical to this mission. As part of the Commission’s ongoing effort to reform universal service funding of mobile wireless services and focus subsidies on unserved areas rather than on areas that already have service, the Commission unanimously adopted a new data collection of 4G Long-Term Evolution (LTE) mobile broadband coverage maps and a challenge process to determine areas eligible for support in the Mobility Fund Phase II (MF-II) auction. The largest mobile providers supported both this data collection and the challenge process. After mobile providers submitted coverage maps to the Commission and during the challenge process, some parties raised concerns regarding the accuracy of the maps submitted by providers. Based on these parties’ complaints and its own review of the record, staff became concerned that maps submitted by Verizon, U.S. Cellular, and T-Mobile overstated their coverage and thus were not accurate reflections of actual coverage.

2. Mobile providers are responsible for submitting accurate coverage maps in accordance with the Commission’s rules and orders. In response to these concerns and based upon a preliminary staff review of the challenger data, on December 7, 2018, the Commission launched an investigation into whether one or more major mobile providers violated the requirements of the one-time collection of coverage data. The investigation was led by the Rural Broadband Auctions Task Force in coordination with the Office of Economics and Analytics, Enforcement Bureau, Wireless Telecommunications Bureau, Wireline Competition Bureau, and the Office of Engineering and Technology. Commission staff initially requested information directly from several providers in order to understand providers’ mapping processes, and later issued subpoenas to Verizon and U.S. Cellular.

During the window to file challenges in the MF-II challenge process, 21 challengers submitted 20.8 million speed tests across 37 states.39 Of these submitted tests, the Challenge Portal validated approximately 20.5 million speed tests and these tests were thus considered to be valid challenges.40 Challengers then certified almost 19.8 million valid tests by the close of the challenge window. Approximately 4 million speed tests fell outside of the reported 4G LTE coverage area for the provider tested—leaving approximately 15.9 million tests within areas reported as covered.41

https://www.fcc.gov/mobility-fund-phase-2/#data

$400 Billion broadband scandal.

Taxpayers have repeatedly subsidized telecommunication companies, to no avail.

Thankful

We live in a time of incredible abundance.

The Lord is my shepherd; I shall not want.

2 He maketh me to lie down in green pastures: he leadeth me beside the still waters.

3 He restoreth my soul: he leadeth me in the paths of righteousness for his name’s sake.

4 Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me.

5 Thou preparest a table before me in the presence of mine enemies: thou anointest my head with oil; my cup runneth over.

6 Surely goodness and mercy shall follow me all the days of my life: and I will dwell in the house of the Lord for ever.

Thankful.

Happy Thanksgiving.

Posted in Uncategorized.

Thinking different and light

The curse of imagery knowledge runs deep in my mind. I often look at a scene and consider the capture possibilities. 2019 dwellers are blessed with endless options, from all powerful iPhones, capable of remarkable low light captures:

to traditional digital cameras, some of which feature impressive stabilization and image processing/compositing capabilities:

I was able to capture these images because a few camera manufacturers have invested in smaller, lighter, silent and capable equipment.

I am thankful for that.

The iPhone has not yet eaten telephoto lens applications. That said, I suspect that computational photography will change the market again, in the not too distant future.

Related: Firmware 2.0.

Posted in Uncategorized.

Moses: “Pardon your servant, Lord. Please send someone else.”; Steve Kerr –

Exodus 3 and 4, spoken in a recent church service, is timely:

Now Moses was tending the flock of Jethro his father-in-law, the priest of Midian, and he led the flock to the far side of the wilderness and came to Horeb, the mountain of God. 2 There the angel of the Lord appeared to him in flames of fire from within a bush. Moses saw that though the bush was on fire it did not burn up. 3 So Moses thought, “I will go over and see this strange sight—why the bush does not burn up.”

4 When the Lord saw that he had gone over to look, God called to him from within the bush, “Moses! Moses!”

And Moses said, “Here I am.”

5 “Do not come any closer,” God said. “Take off your sandals, for the place where you are standing is holy ground.” 6 Then he said, “I am the God of your father,[a] the God of Abraham, the God of Isaac and the God of Jacob.” At this, Moses hid his face, because he was afraid to look at God.

7 The Lord said, “I have indeed seen the misery of my people in Egypt. I have heard them crying out because of their slave drivers, and I am concerned about their suffering. 8 So I have come down to rescue them from the hand of the Egyptians and to bring them up out of that land into a good and spacious land, a land flowing with milk and honey—the home of the Canaanites, Hittites, Amorites, Perizzites, Hivites and Jebusites. 9 And now the cry of the Israelites has reached me, and I have seen the way the Egyptians are oppressing them. 10 So now, go. I am sending you to Pharaoh to bring my people the Israelites out of Egypt.”

11 But Moses said to God, “Who am I that I should go to Pharaoh and bring the Israelites out of Egypt?”

…………

Exodus 4:

Moses said to the Lord, “Pardon your servant, Lord. I have never been eloquent, neither in the past nor since you have spoken to your servant. I am slow of speech and tongue.”

11 The Lord said to him, “Who gave human beings their mouths? Who makes them deaf or mute? Who gives them sight or makes them blind? Is it not I, the Lord? 12 Now go; I will help you speak and will teach you what to say.”

13 But Moses said, “Pardon your servant, Lord. Please send someone else.”

14 Then the Lord’s anger burned against Moses and he said, “What about your brother, Aaron the Levite? I know he can speak well. He is already on his way to meet you, and he will be glad to see you. 15 You shall speak to him and put words in his mouth; I will help both of you speak and will teach you what to do. 16 He will speak to the people for you, and it will be as if he were your mouth and as if you were God to him. 17 But take this staff in your hand so you can perform the signs with it.”

Can Steve Kerr and the NBA do better on China?

Ethan Strauss:

China, estimated to account for 15 percent of league revenue, which corresponds directly to player salaries. China, where the superstars annually flock to in the offseason for extensive sneaker sale tours. China, which hosts annual NBA preseason games, whether they televise them or not. China, where the last FIBA championship was held last month. Nobody in the NBA knows a thing about the place, somehow. It’s like all anyone affiliated with league remembers about China is how to cash its checks.

……

Many people, mostly on the political right, are having fun with the predicament Kerr now finds himself in, given past statements like the one above. They do have a point, even if many of the people jeering care more about scoring that point than making it. Kerr has said that free speech is important, but cannot bring himself to defend Morey’s? He won’t get deeply into why he refuses, even though we can guess. Is this hypocritical? Probably. It’s perhaps understandable hypocrisy under the circumstances. Maybe he wants to ensure the safety of the players returning from China. Maybe it’s about protecting the Warriors’ interests.

Let’s say it is hypocrisy. Now what? A lot of social media discussion feeds off the hunt of hypocrisy as an end game. The way it’s played is that you capture your out-group’s hypocrisy for the pleasure of your in-group. The unstated goal of the hunt is to rob your foe of moral authority, in hopes that nobody will ever listen to them ever again.

Nobody really wins the hypocrisy game, other than clout seekers. Kerr will continue to speak and if people agree with what he’s saying, they’re likely to resonate to it. Merely mocking Kerr and the other NBA figures for their silence doesn’t often convey a sense of how certain matters should be handled.

On this, I have some ideas. Of course, I’m just some guy, not a high-level international diplomat, and not an NBA accountant who grasps the true impact of what happens when and if the $1.5 billion Tencent contract gets ripped to shreds.

My personal preference is for the NBA to break from its relationship with China and end an immense moral compromise that has seeped into the domestic sphere. That’s not exactly realistic, though, so I’ll try my best at making some productive suggestions within the current parameters. I mostly make them because I’m disappointed in how people within the NBA, people whom I have respect and admiration for, are handling this admittedly difficult situation.

Epic Electronic Medical Record Implementation: $100,000,000 for Stanford Hospital in 2005

Marc Andreessen and Jorge Conde podcast 25 minutes:

I don’t remember exactly probably a hundred (million) to Epic or something like that. And then I’d say 300 we went out for integration bids. And this is where I almost started crying. It was Perot systems, Ross Perot systems, which was the follow-up (to EDS). Ross Perot’s company, which is now owned by Dell.

And so yes, it’s a 400 million dollar project, Perot systems. I remember this was 2005. I think we started the Epic implementation and they were very excited. They’re starting the demo and I was very excited because I was like, wow, this is like a new house, probably to (garbled) be mobile.

This is when smartphones are starting to take off. This is mobile. And this sensor is like all this stuff that’s going to be great and it was like they were super excited because they had just moved to the Windows 95 UI. Right in 2005. It was like the big upgrade from Windows 3.1 and I was like, oh my God.

And so but you know, as you know, like is 20, which is 2019 and it’s still right. It’s obviously still it’s still the same thing, right? Yeah, we have an incredibly entertaining thing about epic is that they are so; you know out here it’s like out here there’s a big focus on software interoperability.

And so it’s like can one piece of software work with another this whole concept….. There’s entire companies now, they’re called API companies that build basically software building blocks you plug together, there’s open source and so out here, it’s just this constant process of everybody building on everybody else’s creativity and kind of the the whole thing rises except for epic which has an absolute prohibition on third-party integration.

(Epic) does not tolerate it. (They) will sue you if you attempt to integrate with it.

Taxpayers have spent nearly $40B (!) in backdoor electronic medical record subsidies since 2011. One of the goals of our extravagant taxpayer expenditures, part of the Obama era “stimulus”, was interoperability.

Airdrop trumps $40B emr subsidies.

Madison’s property tax base growth since 2011.