I’m working on the front porch this morning, sipping from a hot cup of coffee while the rain beats on the roof above, falling in fat, heavy drops along the drip line in front of me. A hundred yards out, a loon quietly paddles by, immune to the rain cascading down all around it, cocking its head when I move too quickly from the door to the sofa along the house’s outer wall.
The sky and bay are nearly the same color of grey this morning. The demarcation between the two is barely visible along the horizon line, called out by the dark shapes of islands crowned with pine trees and ringed with granite and knotted wrack.
It’s these quiet early morning moments in Maine that I tend to remember most when I’m surrounded by people, planes and tumult over the course of the year, immersed not in the sound of thousands of rain drops hitting leaves and weathered shingles but rather machines and men, their voices raised in anger, happiness, frustration and joy on the course of whatever task or journey that day’s course sets before them.
For now, it’s enough to simply be, disappearing into the words of a past interview, drinking deep of the cool, clean air and thinking of an older world that has long ago disappeared into the annals of a quieter age.
[Editor’s note: these are live, rough notes from my iPad, and should not in any way represent a 100% accurate transcription. I missed far too much. Caveat lector. My comments are in brackets. You can find Dr. @Atul_Gawande‘s bio & writing at the New Yorker. Update: I’ve posted video of Dr. Gawande below.]
GAWANDE: A fascinating part [of the Health Data Palooza]: the idea that we’re putting together people from government, healthcare systems, people from outside who have knowledge about data and tools. This is quite different from the normal models: regulatory or laissez faire.
We have a healthcare system that’s fundamentally broken. The most common complaints from patients seem to be no one you can count on. If you’re paying, you have no sense that there is anyone who can help it costs be under control.
Where to start to fix that? We have recognized that there is enormous variation in cost, depending on whet you go. There is enormous variation in cost, depending on where you go. The two don’t have anything to do with one another. So there’s hope. [Good news.]
Some of the best places to get care are the least expensive. [In healthcare,] positive deviants are the ones that look the most like systems.
Examples from war and lessons within lethality
GAWANDE: Start by looking at performance of doctors in war and their teams. In the war in Iraq/Afghanistan, lethality below 10%. That doesn’t reflect intensity of conflict but improvement in care.
How did we do it? It was the not discovery of new tech that transformed survival but ability to use existing tech far better, in a system that works.
1) Kevlar. Got soldiers to wear it, operationally.
2) Speed to operating table. Improved forward mobile operating theaters.
We achieved the best survival rates in history. How? They changed the way they did surgery. Looked at data, realized needed to stop bleeding, stop contamination, under resource restrictive conditions. No X-rays, needed to learn 19th century techniques for finding fractures by feel.
They adopted “damage control surgery”: Do what you could during 2 hours. Ship and add a note: here’s what I’d did, what’s needed. That helped stimulate development of simple EHR. Average time from wounded on the battlefield, to getting care in the field, Baghdad, in Germany, in us, is less than 3 days. Less than 36 hours for some.
Soldiers can find better care for some conditions in Iraq than in a US city, with fewer resources. How? Alignment of finances, incentives. They weren’t “fee for service soldiers.” Everyone is on the same team: focused on saving life, maintaining health.
Within 48 hours of the wounding or death of soldier, posted on the DoD website. [DCAS: Defense Casualty Analysis System] The public accesses that data, but doctors & nurses access it the most.
One more example: soldiers not wearing protective eyewear. They called them ‘Granny goggles.’ The DoD contracted with a designer, made cool ones. Now wearing. Needed data and research to understand. [Stories matter.]
Affordable Care Organizations (ACOs) have done financial alignment. They’re committing to doing more project at a time. They’re committed to better health within an environment.
To get there, folks in war needed data useful to frontline decision makers. [The same is true at home.]
Open government endures in the nation’s capital. On November 19, the U.S. National Archives and Records Administration (NARA) hosted a meeting between the Archivist of the United States, David Ferriero, senior officials, and representatives of civil society organizations that advocate … Continue reading →
The day after a historic midterm election night brought historic changes to the composition of Congress, state and local governments that more closely reflect the extraordinary diversity of the union, the United States remains a partisan, polarized nation. Despite references … Continue reading →
Silence speaks volumes when it comes to public engagement and announcements about transparency initiatives. That’s a gross understatement in the White House of 2018, but true around the world. As Tajha Chappellet-Lanier reports, an August 31 deadline has come and … Continue reading →
Less than a year after I called for tech companies to publish a a public political ad file as open data online, Facebook has committed to doing so this August, through an API. Working with Congress to draft a law … Continue reading →
As Mark Twain famously blogged, a lie can be tweeted halfway around the world while the truth is still unlocking its smartphone. Misinformation is unintentional. Disinformation is not. A “misinformation virus” infects minds instead of computers, spreading socially across homophilic … Continue reading →
This morning, James Grimaldi reported that Ajit Pai, chairman of the Federal Communications Commission, has told two U.S. Senators that he has proposed “to rebuild and re-engineer” the agency’s online electronic comment system “to institute appropriate safeguards against abusive conduct.” … Continue reading →
When I asked whether when or if it is acceptable for the United States government to charge companies, journalists and the public for government data, citing the example of paywalled immigration data, the chief information officer of the United States … Continue reading →
Last fall, the U.S. government delayed formation of the fourth national action plan after committing to participation with a public consultation – despite historic regressions on open government across federal agencies under the Trump administration. This May, the White House quietly … Continue reading →
On May 29, senior officials from the White House Office of Management and Budget and the State Department confirmed that the United States will develop a new National Action Plan for Open Government for the Open Government Partnership this spring … Continue reading →
This past week, Facebook launched a new political ad transparency website. Facebook believes that “shining a light on ads” will increase transparency, which in turn “will lead to increased accountability & responsibility over time – not just for Facebook but … Continue reading →
RT @bjlefebvre: Zinke to step down at the end of the year after being the subject of multiple ethics investigations - including one over th… 1 hour ago
RT @ewong: President Trump’s comments politicizing Huawei case — mixing Meng Wanzhou arrest with trade — could undermine future enforcement… 1 hour ago
“Concern about legal costs & scrutiny of his travel, political activity & potential conflicts of interest were fact… twitter.com/i/web/status/1…1 hour ago
RT @zittrain: Fascinating buckling to a single jurisdiction: The New York Times isn’t covering a major Australian criminal trial in any onl… 12 hours ago
You could spend a long day listing all of the organizations or individuals who are putting government data online, from Carl Malamud to open government activists in Brazil, Africa or Canada.
Putting a dollar value on clean water, stable markets, the quality of schooling or access to the judiciary is no easy task. Each of these elements of society, however, are to some extent related to and enabled by open government. If we think about how the fundamental democratic principles established centuries ago extend today purely […]
In an age where setting up a livestream to the Web and the rest of the networked world is as easy as holding up a smartphone and making a few taps, the United States Supreme Court appears more uniformly opposed to adding cameras in the courtroom than ever.
On January 10th, 2013, the OpenGov Hub officially launched in Washington, DC. The OpenGov Hub has similarities to incubators and accelerators, in terms of physically housing different organizations in one location, but focuses on scaling open government and building community, as opposed to scaling a startup and building a business. Samantha Power, special a […]
