Patient Health Records and HIPAA

The Obama administration is all for electronic health records. Here's a Federal Computer Week article on the topic. It makes sense to me--I'm in Kaiser Permanente which does have its own system, which is much better than the records systems I've run into in my contacts with non-Kaiser setups. (Though that may change when I'm hospitalized.)

One of the aspects I haven't seen discussed is the issue of the caregiver. We're all getting older and we are caring for relatives who are even older and possibly more senile. But under HIPAA, access to someone else's records is severely limited. Essentially, even if you're next of kin you need a health care proxy to access records, including on-line records. I wonder how well computerized systems will handle that issue, because they tend to be designed and built with the idea of the patient handling his/her own data. And the problem is, even the best of us, like me, shy away from either executing his own health care proxy or asking older relatives for theirs. Just one more thing to worry about, and procrastinate on.

Rock Snot Is Spreading

That's the word in a NYTimes science article--apparently fishermen spread it on their waders, even including to New Zealand. The lede:

The Esopus Creek, a legendary Catskill Mountain fly fishing stream that is an integral part of New York City’s vast upstate drinking water system, is one of the latest bodies of water to be infected with Didymosphenia geminata, a fast-spreading single-cell algae that is better known to fishermen and biologists around the world as rock snot

Maybe as I get old and senile I get more enjoyment out of names: first karnal bunt, now rock snot?

Lies

Just caught our President in a lie--Lehrer Newshour was excerpting his remarks to the AMA, the part where he says he, Michelle, and the daughters are like the rest of America, just doing what the doctors tell them to.

What's the lie? He didn't follow doctor's orders to stop smoking. (I had a 2-3 pack a day habit, but I quit before I reached the big 4-0.)

Indian Agriculture

The greens love to cite India as a place where traditional farmers are under siege, where the green revolution has failed, and where unrest is common. For those with time I recommend some of the articles at this site, which give a somewhat different perspective on the state of Indian agriculture. This lead from February is noteworthy:

Mounting stockpiles may prompt the govt to lift a 3-year ban on exports of wheat, likely weighing on prices that have declined 52% the past year in Chicago

Funniest Regulation Title

"Records Governing Off-the-Record Communications. "

(The Federal Energy Regulatory Commission is basically saying any communication on a regulatory matter has to be put on the record, even if it's oral and "off-the-record".)

Recession and Locavores

Mr. Wells in the NYTimes Magazine writes about adapting his family's food buying in light of the recession's impacts:

Until recently, whenever we went to the farmers’ market, we would lug home $50 pork roasts and $14 gallons of milk. We would spend over $100 on food that might not last more than three days. Sometimes we’d shop on Saturday morning and have nothing to make for dinner on Monday. I shrugged this off as one of those oddities of New York life, like getting a ticket because your neighbor put out his trash on the wrong day. But the $35 chicken made me reconsider. Buying sustainably raised beef and sustainably squeezed milk and sustainably hatched poultry is a way of life that, these days, I just can’t sustain.

Personal Information

Back in the day, when the Privacy Act was first enacted, we notified all program participants their information was personal and protected from disclosure. Then, in the early 1990's, the Environmental Working Group took ASCS/USDA to court, saying that farm and program information was not personal. They won, at least at the circuit court level, and DOJ decided not to appeal to the Supreme Court. So our IT folks had to figure out how to provide the data to EWG, while masking the social security number (which was the primary key to a number of the files).

They did, and EWG put it online. I've used this data as an example of the problems of providing governmental transparency.

Meanwhile, FSA has been dealing with the current rules and issued an interesting notice AS-2179. Looking at the list of data which is protected, I'm not sure I see a clear line between what FSA is providing to EWG and what FSA has to protect. The notice doesn't provide a rationale for the division. But it's another example of the complexity the administration will run into as they push for open government.

The Decline of Intermediaries?

Yesterday I commented on a OSTP blog post asking about how to improve "public" participation in rulemaking. It's part of a bigger effort by the Obama administration to be open and elicit input on various e-government issues. It stimulated a chain of thought on intermediary institutions.

Today newspapers are in trouble. Consider them as intermediaries which gather news, vet and authenticate it, and provide it to individuals. Along with the news comes ads, which pay the freight. But now the Internet is allowing individuals to get their own news more directly and newspapers suffer.

Consider "interest groups", people like the Farm Bureau, the Corn Growers, the Sustainable Agriculture people, groups large and small. One way to look at them is as intermediaries: they search out news, they identify concerns of their members, they carry the concerns to Congress and the executive branch, they give news to their members. Suppose Obama (or his successors) succeed in adapting Web 2.0 to make strong connections between the public, or subsets of the public with their own hot issues, and the government, or subsets of the government concerned with writing laws and implementing them. What happens to the intermediaries?

Do we possibly have an arms race, a competition between private interest groups and public institutions to serve citizens?

Consider IRS. Back in the day tax returns were simple. As they grew more complicated people like H&R Block developed into intermediaries between taxpayer and IRS. As PC's came along we started getting software packages which allow the individual to do tax returns. And now IRS has its own software to do returns.

Farmers Can Be Optimistic, But Doubling in 5 Years?

From Chris Clayton's post on House Ag hearings:

Rep. Stephanie Herseth-Sandlin, D-S.D., also highlighted that technology is expected to continue boosting farmer yields for corn dramatically in the next five years. Secretary of Agriculture Tom Vilsack reiterated this perhaps a dozen times in his testimony. So if technology is going to allow corn yields to soar, perhaps come close to doubling, then why do we need an arbitrary 15-billion cap on corn-based ethanol in the Renewable Fuels Standard?

Of course, I may be misunderstanding this. But if corn yields are at 150 bushels or more, it's taken about 35 years for them to go from 100 to 150.

I know I'm old and have my head in a dark place (as Tom von G used to say) but when I hear of corn being used for ethanol I've just the beginnings of the same qualms I have when I hear of good farmland growing houses. Corn is for food. Yes, I know better, but that's my upbringing.

A Tale of Two Michaels: Pollan and Roberts

Professor Michael Roberts reviews Michael Pollan's "In Defense of Food" (after commenting on Kindle) and comes out about the same place I do (although at longer length and more politely).

An excerpt (once Roberts has gotten past praising Pollan):

So this is the tone that grates. Pollan writes as if the nutrition scientists are conspiring in a sinister plot with the food business to make us all fat and unhealthy. He doesn't actually say that but it is implied. And, well, that's just silly. The reality is that food companies exaggerate findings from food science to market their goods. But this is neither new nor surprising nor in anyway unique to food. It's absolutely ubiquitous. That doesn't make it right, but the problem surely isn't science. And by misrepresenting the problem it becomes more difficult to articulate reasonable solutions.

And, now, the real rub. Did I mention prices?

Go to Greed, Green, and Grain to read it all.