TECHNOLOGY AND THE BUSINESS OF GOVERNMENT

Engineers, scientists and at least one lawmaker are pushing like never before to resuscitate a legislative agency that once provided Congress with technological expertise.

In an era of supposed government transparency, with allegations that even scientists are attempting to cover up research on global warming, an objective, authoritative Office of Technology Assessment is of utmost importance, advocates say.

Several lawmakers, particularly House member and physicist Rush Holt, D-N.J., have repeatedly rallied for appropriations to revive the office that Congress dismantled to save money in 1995. The counterargument against funding has always been that other agencies, such as the Government Accountability Office or Congressional Research Services, could provide the same services.

Now that belief may be changing, says Francesca Grifo, scientific integrity program director at the Union of Concerned Scientists, who will testify on Wednesday before the House Legislative Branch Appropriations Subcommittee. Holt also will testify in support of restored funding.

"We've decided to make it a priority issue," Grifo said in an interview with Nextgov on Tuesday. Her group is releasing a letter of encouragement signed by 30 organizations, including the American Civil Liberties Union and the United Auto Workers. "It seems a little counterintuitive but, if you look at our current fiscal situation, OTA saves money," she said, explaining that if lawmakers have sound technical advice when they make policy decisions, "you'll waste less money."

Established in the early 1970s, the office was responsible for providing Congress with early evaluations of the potential costs and benefits of new technologies and new applications of existing technologies.

Grifo's organization estimates that the office cost Congress about $20 million annually but, since its extinction, the federal government has squandered billions of dollars on failed systems, including virtual fences to guard the U.S-Mexico border and baggage screening equipment.

A sample of reports produced shortly before its demise shows that the office already was on top of many innovations at the forefront of today's legislative agenda.

One 1995 report referenced the potential for tracking the efficacy of medical treatments with electronic health data - a controversial issue in the ongoing debate over healthcare reform. "Because large amounts of electronic data now can be collected and manipulated, there has been increased emphasis on using existing data, often in the form of insurance claims databases, to evaluate health care technologies," the research stated. "Data gathered from events occurring in a wide range of practice settings have become viewed as a tool for looking at effectiveness-- average outcomes achieved by average doctors and patients."

In a report entitled "Bringing Health Care Online: The Role of Information Technologies," the office found that electronic patient records, portable computers, automated data capture and computer networks "can potentially improve the quality of health care" by "enhancing clinical decision support and by improving data for assessing the effectiveness of health services and the performance of health care providers and insurance plans."

Another 1995 report probed the ramifications of electronic surveillance, concluding, "If major problems arise in meeting the needs of law enforcement, they will likely arise as a result of institutional difficulties in dealing with a diverse, highly entrepreneurial industry made up of a large number of telecommunications companies offering many new innovations and features, with the number of players steadily increasing."

Do you know a federal manager who recently took risks to push through a bold idea, policy or program that uses technology to make government work better or improve public services? If so, we'd like to hear your story by nominating your colleague for a Nextgov Award.

The Nextgov Award program, developed in partnership with O'Reilly Media Inc. and TechWeb, will recognize government executives who stepped outside their comfortable confines to think and manage differently. They acted boldly to push through an innovative program, policy or new management practice that relied on technology to move government in a new direction, to challenge employees to think and work differently, and that ultimately improved the lives of citizens.

We know there are many managers who have done just that, and we want you to tell us about them by nominating them for a Nextgov Award. The deadline is March 12, but we suggest you don't wait. Visit the nomination page and spend just a few minutes filling out the form. We'll tell the stories of the winners later this spring on Nextgov.

A panel of respected judges will make choose the winners, who will be honored at a luncheon on May 27 at the Gov 2.0 Expo at the Washington Convention Center in Washington, D.C. The expo is co-sponsored by O'Reilly Media Inc. and TechWeb, and Nextgov is the premier media sponsor.

The Xbox 360, Microsoft's powerful video game console, may soon be good for more than just virtual basketball games and war simulations. Company researchers currently are looking to adapt the device to various health care needs, including the transfer and display of electronic medical records.

The Xbox may be used to feed information onto displays in patient rooms, researchers said during a health care technology forum held last week in Beijing. Microsoft also is looking at automating the display of sensitive information based on conditions such as who is in the room. A sensor would tell the device to filter the records as people enter, and the onscreen display would change accordingly.

In addition to streamlining healthcare delivery, the Xbox would serve its original purpose: entertainment for patients and visitors. The company plans to release its Project Natal system, which allows users to control the device with gestures, later this year.

Nextgov has launched the Nextgov Awards, an inaugural program to recognize federal managers who have shepherded a program, policy or management practice that is not only innovative, but bold and brave.

Yes, we know, there are a lot of awards programs in government. But when we asked federal managers and industry executives what is missing, they told us unanimously: No awards recognize federal employees who took on risks -- personal, political and otherwise -- and boldly acted to see their idea to fruition. Or if their idea died, at least they took on entrenched bureaucratic interests in an attempt to make government better through the use of technology.

We invite you to visit our awards page to learn more and to nominate someone who fits the criteria. The technology isn't the reason for the award, but the bold idea must rely on it in some way. And we encourage you to tell us a story about the individuals you nominate. We want you to wow us because we know there are dozens of stories of federal employees trying to improve government and the lives of citizens, but they are up against big odds. Yet, they have acted bravely and with resolve to bring about change. We want to know about them, the drama they faced and the results they achieved. And, of course, the technology they used.

The winners of the Nextgov Awards will be honored at a luncheon at TechWeb's Gov 2.0 Expo in May. (Nextgov is a TechWeb partner for the event.) We'd love to see you there.

More to come.

The Social Security Administration, bogged down with a backlog of disability claims and oncoming onslaught of baby boomer paperwork, is trying to expedite processing by paying medical providers $15 to submit applicants' records electronically.

"We are experiencing a significant increase in the number of initial claims for disability insurance benefits and Supplemental Security Income payments on the basis of disability, and we expect this trend to continue," states a Jan. 11 Federal Register notice. "The increasing volume of claims, coupled with the backlog of disability cases in the hearings process, underscores our need to process cases more efficiently by using advanced technologies."

The agency usually makes more than 15 million requests a year for patient records from providers to determine the severity of disability applicants' medical conditions. Waiting for the information can take months.

Social Security officials said they determined that $15 is a reasonable reimbursement rate for the cost of transmitting medical records through a secure data exchange system but said they will periodically review and adjust the rate as technologies advance.

"By using health IT, we will be able to request and receive medical information within minutes, rather than the days or months it may take to receive medical evidence by traditional methods," which are largely paper-based, labor-intensive and manual, the notice states.

Federal Chief Technology Officer Aneesh Chopra spoke at the Consumer Electronics Show in Las Vegas, Nevada on Friday and his message was one that should be familiar to Nextgov readers: He spoke abstractly of making government more open to innovation and specifically emphasized the importance of standards in health information technology.

However, the most interesting part of the speech came when Consumer Electronics Association chief Gary Shapiro took a swipe at Chopra and the federal government, implying that the the latter often stands in the way of technology firms attempting to innovate. From the BBC:

"When it comes to innovation there's a lot the government can do, and there's a lot they should not do," said consumer industry head Gary Shapiro.

"The government doesn't spur innovation or entrepreneurship. The government often gets in the way," said Mr Shapiro.

. . . "High taxes and regulatory bureaucracy are barriers."

In response, Mr Chopra said the CEA's criticisms had some weight.

"We don't have to agree on every issue, but we can always say we have room for improvement to spur innovation and entrepreneurship," said Mr. Chopra during a CES press conference.

"We have to eat our own dogfood -- Gary is right about the federal deficit. We are in an economic crisis but we are going to tackle it. We have to get this right," Mr Chopra told journalists.

He said the US government was planning a summit with a number of chief executives from the "most innovative companies in the country to directly advise us to make government more efficient and more effective".

Chopra also said the government's ability to spur the economy is limited:

"We always have room for improvement," Chopra said. "At the end of the day, the private sector is what creates jobs."

Health information technology advocates say new federal requirements for hospitals to become eligible to receive electronic health record incentives set the bar too high.

Many hospitals are only about half-way toward meeting the criteria for acceptable use of health IT to qualify for federal incentive payments by 2011, according to a new survey from CSC, a technology vendor that sells health IT systems.

"Many hospitals report they have the required capabilities but they are not in active use," state the findings that were released this week. "Readiness is highest in the areas of privacy and security protection."

Meanwhile, some physicians who have analyzed most of the 556-page proposal say the timeframe for the government's goals is probably unrealistic.

On the penultimate day of 2009, the Health and Human Services Department issued preliminary guidelines dictating what hospitals and medical professionals must do by 2011 to receive part of the nearly $20 billion in stimulus funding allocated to encourage the use of e-health records.

This fall, before the official guidelines were out, CSC asked executives at 58 hospitals nationwide to describe their readiness for the basic criteria, including deployment of a certified product, routine use, standards adoption, quality of care reporting and privacy and security protection.

The survey found large holes in hospitals' electronic quality of care reporting and noted that most hospitals do not routinely use e-health records. Health IT is supposed to increase the ease and accuracy of measuring outcomes by allowing hospitals to pull results from records automatically, in real-time and without transcription errors.

A proposed rule announced Dec. 30 defines meaningful use as complying with specific procedures -- including the reliance on certified technologies -- in ways that enhance the coordination of care, engage patients and families, and ensure privacy. A typical 275-bed hospital that makes meaningful use of certified electronic health records, as defined by the department, could be eligible for up to $6 million in bonus payments during the next five years.

The conditions for meaningful use of e-health records will become more specific and stringent during the next few years. The first stage requires providers to electronically capture health information in a coded format to track medical conditions, exchange that data with other professionals to coordinate care and report quality of care statistics. In 2011, participants must report the results of their efforts, including quality of care measurements, to the Centers for Medicare and Medicaid Services.

The Health and Human Services Department on Wednesday set preliminary terms dictating who will and will not get billions of dollars in stimulus funds for buying electronic health records systems.

One proposed rule outlines criteria for the e-health records incentive program, including the core concept of "meaningful use" of e-records technology. Medical professionals who make "meaningful use" of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments spread out over five years.

The proposal would define "meaningful EHR user" as a medical professional or hospital that complies with specific measures, including the use of a certified technology in ways that improve the quality and safety of health care delivery, reduce health care disparities, engage patients and families, enhance care coordination, improve public health and ensure privacy and security protections.

The rule would phase in the specific measures, based on the present state of technological capabilities and providers' practice experience. HHS officials will demand stricter and more extensive criteria for demonstrating meaningful use over time, as technologies and providers' expertise advance.

The 2009 American Recovery and Reinvestment Act allocated about $20 billion to encourage doctors and hospitals to install e-records systems by 2014. The definition of meaningful use and certification standards have sparked controversy, especially among innovative companies, including Microsoft and Google, who contend that the government's strategy won't work because funding is tied to the adoption of electronic health records, not to management of data by clinicians.

A top Google official argued the administration's plan will result in hospitals and physicians using outmoded databases in the increasingly Web-focused world.

HHS Office of the National Coordinator for Health Information Technology (ONC) also released an interim final rule that sets initial standards, implementation specifications and certification criteria for e-records technology.

Both sets of proposals are open to public comment for 60 days.

Under the Recovery Act, HHS must adopt an initial set of standards for electronic health records by Dec. 31. So, the interim final rule will actually go into effect next month, before the period for comment and refinement is over. A final rule will be issued in 2010.

"These regulations are closely linked," Charlene Frizzera, acting administrator at the Centers for Medicare & Medicare Services, stated in a press release. "CMS's proposed regulation would define and specify how to demonstrate 'meaningful use' of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC's regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology."

David Blumenthal, HHS national coordinator for health IT, said in an e-mail update to the public, "Great care was taken in the development of these criteria, with input from the public and federal advisory committees every step of the way." The resulting standards and certification criteria are organized into four categories:

• Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents);
• Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies);
• Transport Standards (i.e., standards used to establish the communication protocol between systems); and
• Privacy and Security Standards (e.g., authentication, access control, transmission security/encryption) which relate to and span across all of the other types of standards. "

As technology observers we're often quick to highlight when the government lags behind the private sector. That's why it's important to take note when the public sector does something better, which seems to be the case when it comes to providing electronic health information.

According to a new survey from ForeSee Results, the federal government's health care Web sites are leading their private sector counterparts in terms of user satisfaction. From the Wall Street Journal:

On the benchmark's 100-point scale, government health care Web sites had an aggregate score of 79, while pharmaceutical Web sites came in second at 78, hospital Web sites dropped a point from last year to 73, and health insurance Web sites also fell a point year-over-year, coming in last at 64.

A score of 80 or higher is generally considered excellent on the benchmark's 100-point scale.

"Health insurance companies have the most room for improvement and also the most to gain from focusing on the customer experience, because improvements can directly and quickly impact their bottom line," said Larry Freed, president and CEO of ForeSee Results. "Meanwhile, because of a long and focused effort on online satisfaction over nearly a decade, government-run health care Web sites are leading the pack and provide a positive example of how focusing on the customer experience has tangible results."

Disseminating health information via the Web has been an area in which the government has excelled for some time now. Web sites operated by the Health and Human Services Department and the National Institutes of Health routinely top ForeSee's customer satisfaction ranking for federal Web sites. The government's success in this sector has made it difficult going for private sector companies such as Revolution Health or WebMD, which offer similar services. Likewise, the Center for Disease Control and Prevention and the Food and Drug Administation have seen a very positive response to their initial attempts at using social media to spread public health information.

Agencies that regularly interact with the public should take note: For important topics like health care, the government is still the most trusted source of information.The lesson here is that federal agencies have the most success on the Web when they use it as a natural outgrowth of their existing missions. Making your Web site easy to navigate and digest will make your agency that much more likely to be the place where citizens turn when they need the facts on a particular issue. At the end of the day, you want your agency to be where people turn when they are looking for help or guidance in your field.

An industry group representing pharmaceutical companies is proposing that the Food and Drug Administration require a FDA-certified emblem -- akin to the Good Housekeeping seal -- on Web content that contains medication information.

The so-called universal safety symbol, perhaps an FDA logo that links to more comprehensive information, would assure Internet users that the page they are viewing contains accurate drug risk data. Such a symbol could easily fit into Web services that limit word length, such as search results or the blog-broadcasting tool Twitter, says the Pharmaceutical Research and Manufacturers of America (PhRMA).

PhRMA is presenting the concept to FDA at a Thursday and Friday hearing on ideas for regulating the promotion of prescription products using the Internet. Currently, there are no specific rules on prescription advertisements or descriptions that post to the Internet. But all promotional materials for FDA-regulated products, wherever they may appear, are still regulated.

"Social media tools offer an unprecedented opportunity for third parties to speak about a sponsor's products without the knowledge or control of the product sponsor," says Jeffrey K. Francer, PhRMA assistant general counsel.

The association argues that manufacturers only should be accountable for pages that it controls, not sites like Wikipedia, an online encyclopedia that anyone can edit. The site includes many entries describing marketed drugs with information on the history of the treatment, FDA-approved uses, press coverage and investigational research.

"While some of the entry's content may repeat the sponsor's own labeling or advertising, Wikipedia users can alter this content and post additional information," Francer says. "As a result, the final Wikipedia page may - through no fault of the sponsor - fail to comply with FDA advertising and labeling rules were the page attributed to the sponsor."

Jay Walsh, a spokesman for the nonprofit Wikimedia Foundation, which operates Wikipedia, said in an interview that experienced editors remove content that is not attributed to existing research. For example, Internet users will notice and delete side effects in an entry that are stated as fact without a citation.

"One of the basic principles of Wikipedia is that we don't permit introduction of original research," he said. "Most Wikipedians default to a reductive editing process rather than an additive one."