The Progressive Ensign

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Category: Internet

Millennials Demand Virtual Health Services – Upending the Present System

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: meddeviceonline.com

By 2020 there will be 83 million millennials in our country becoming the largest generational group.  As they take ever more powerful positions in our society their demands on the healthcare system will focus on virtual services. They grew up using the Internet, with its culture of immediate access, virtual relationships and convenience.  Millennials expect their healthcare services to provide the same types of services as they regularly use on the Internet – Internet healthcare.  For them the baseline is using technology as the platform for accessing, using and paying for services.

Harris Survey for Salesforce – 2015

The millennial generation want to use as their framework for health services all the Internet services they enjoy now: patient reviews, online appointments (including specialists), using mobile phones for services, use apps to manage their wellness, use wearables for monitoring health, 3D printing of devices ie hearing aids, teleservices like video chat with a doctor, and pills that monitor internal organs that are swallowed.

The present system is organized around a primary care physician (PCP) who is the gatekeeper and co-manager of the patient’s health program. All patient records are with the PCP and the healthcare provider, records are not accessible from anywhere in the ‘cloud’.  The core guiding principle being that all medical services need to be integrated, not disconnected for increased efficiency, effectiveness and safety.

Artificial Intelligence adds another innovation level to delivery of health services. The AI industry is looking to serve the needs of millennials in healthcare by offering ‘neural network’ based medicine of expert databases and access to the ‘right treatments’ at the click of a button or the swipe of a phone app.

Next Steps:

The implications for changing the present PCP, doctor oriented system toward an on-demand patient based system are revolutionary.  One challenge will be how to maintain continuity of care when the patient is using virtual services from multiple providers, while ensuring effective care and safety.  The human body is one complex entity made up of multiple systems, all integrated tightly to work together. If one system is off balance or damaged other systems maybe impacted, which is why the PCP based system was established.  Doctors, not patients are trained to see the interactions of various human body systems, and to know when and how to bring in a specialist to treat a condition.  Yet, how will placing tests, treatments and services at the touch of an app by a patient change the doctor – patient relationship? Will quality of care be maintained?   Will high quality care only go to the technology savvy patient who knows how access all the health services to obtain a complete health solution? Are we going to be comfortable with AI – a physician advisor robot prescribing medications, treatments, surgery? In this virtual world of services who is responsible for maintaining continuity in care?

The virtual world of medicine does offer ways for reducing the cost of healthcare dramatically to thousands of patients. The U.S. spends 41 % more as a percentage of GDP than OECD countries while life expectancy is 4 years less.  Yet how will the present system of layered providers, drug – pharmacy managers and hospitals respond to Internet based healthcare?  Will they just use this myriad of disconnected services to charge even more because it will be difficult for the patient to manage costs the same way a health care provider does today. Do we want to place the patient in the center of healthcare delivery of services?  The economic dislocation of every health care service provider will be profound and huge. How will we make sure that all our citizens are included and not just those with Internet access?  So, what will our health sector plan be?

A few salient points need to be kept in mind in developing a sound policy.  The patient does not have the expertise of a physician who has attended years of training, internship and practice before treating patients.  Replacing the physicians role in the delivery of healthcare needs to be done carefully and in some cases certain conditions are off limits. Ensuring the safety of medicines, treatments and invasive procedures needs to be paramount in any system change.  Patients need to be given options, for example the patient may not want a robo physician advisor and wants a human doctor of his or her choice.

The other major point is our political processes are way behind what technology innovators are creating today, dramatically impacting what our healthcare choices will be tomorrow.  Our political processes need to be brought up to date, and forward looking if we are to have any chance at making intelligent decisions about our healthcare delivery system.  We need to take this opportunity of a shift to Internet based health care to ensure that everyone receives good quality health care, at a reasonable price and will not go bankrupt in the process.

The Press Needs To Help Build the Common Good

 

Image: epceurope.eu

While, it is necessary that all of us be engaged in building the common good – the press establishes the national dialog on major issues.  When the press focuses on reporting problems only, with no solutions, monitoring or follow up we are left with a sense of frustration, desperation and hopelessness.  One way the press can make a difference is to stick up for the people who cannot defend themselves.  Recently, the PBS News Hour, assigned their correspondent to follow a three year old immigrant girl through her process of being reunited with her parents after separation at the border.  PBS by staying on the story, asking the hard questions and continuing to press the administration for her status illuminated the fate of thousands of other children.  A  week ago, The New York Times completed an in depth analysis of the Trump family fortune and how Donald Trump acquired his fortune essentially as a gift from his father paying very little in taxes.

We see these in depth analyses and vigilant reporting as necessary to keep the truth flowing to citizens to help them make good decisions.  Yet, reporting on major topics often winds up being a sound bite of 30 seconds or a few short sentences quoting a Senator or Congressman with very little context.  The text of what the legislator says is scrolled across the bottom of the TV screen in summary form, with no data, context or way to follow up.

The internet makes available a wide variety of reliable research sources such as local, state and federal government agencies, non-partisan research groups and universities. Corporations have finely tuned their decision processes around a simple approach – gather data from all sides of an issue or topic both qualitative and quantitative, analyze the data, look into various solutions, present multiple solutions to decision makers, then decide.

The public today has major issues that need to be addressed by government agencies and their leaders – we need high quality reviews and analysis available to everyone to make good voting decisions.  The old style of journalism focused on a lead to grab attention and then fill in the details later through the body of the story or at the end needs to be examined in the Internet age.  Front page news can continue to present headline stories, yet they should be placed into context, with qualitative and quantitative data, presented graphically for easy viewing, with expert analysis from 360 degree points of view.

The fact there are only a few national newspapers, which fewer people are reading does not help the situation toward building the Common Good. We need Internet providers like Facebook, Google and Twitter to be the next generation of journalists, instead of feeding the fragmentation and opinion masquerading as news.  A quick reading structure to the story, using multimedia maybe thought of as the ‘teaser’, graphics and charts with expert analysis from multiple points of view.  Every story needs to go the next step and focus on how to solve  the problem presented.  Often, only problems are published leaving the reader with no way to take action.  Some stories, do leave Internet links or ways to contribute to a family who had a fire and needs shelter.  Yet, the major stories of our time: climate change, opioid epidemic, workers being left out of the economic mainstream, loss of hope in ghetto areas, or escalating health costs are not covered in an action enabling format. In this blog we have taken a building toward the common good and action approach by starting with a basic issues, providing a graphic of data from a non-partisan source, then follow up alternatives and action to solve the.problem.

The press needs to take responsibility for the fractionalization happening when a constant drone of problems are broadcast to people with no follow up, no facts for building a common understanding, presentation of alternatives and next steps for action to solve the problem.  We need to become a problem solving society and the press in how they communicate issues to us can take us a long way toward a common good building nation.

Resetting the Web’s Balance of Power

Internet pioneer, Tim Berners-Lee has an audacious yet powerful goal for his latest startup Inrupt.  He wants to “reset the balance of power on the web and reignite its true potential.” Building work with other Internet activists at MIT he is developing a decentralized personal web based platform called Solid.  He is introducing a ‘Netscape’ browser front end that gives the user control of all his own content. During a demo he shows a fundamental set of tabs with a To-Do List, Calendar, Chat Address Book and eMail.  Yet, this screen hides from the user one basic difference, all his data is stored in a POD or Personal Online Data store. All the content he creates or uses is stored in a POD, not some corporate server like Google, or Facebook.

Source: Tim Berners-Lee – 9/29/18

Users of the Inrupt browser and applications are given a Solid identity and access key to personalize security. Berners-Lee envisions an Alexa like persona assistant, he calls Charlie where a user can be comfortable accessing health records, financial accounts and personal memos in POD storage not a Amazon cloud server. He sees global web developers writing appls for Solid and Inrupt to take back the Internet, provide the security and safety of personal identity management and reduce the need for government regulation.

We are excited about the opportunity to finally end the corporate control of user created content which we have always believed is the user’s property not the Internet application provider.  Google, Facebook and Apple have the idea that they own our content, can do anything they want with it, including selling it to partners without our permission.

Solid and Inrupt are revolutionary in scope, technology and return the Internet to its original vision – to empower users and link them together on a peer to peer basis.  Not, a corporate behemoth holding all the content power to a weak end user.  Maybe with technology like Solid we can finally get back to a democracy of entrepreneurs, small business and users controlling their content, its use and distribution!

Our Internet Purchases Are Private, Let’s Keep It That Way

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: scienceprogress.org

A year ago, Mastercard sold consumer store transaction data to Google, who sells the store transaction information and correlates it to searches for the same product or service to advertisers.  Advertisers can see patterns in consumer behavior from the ads that are run and whether a prospective buyer went to the store to buy the item or online (online tracking databases). This strategy by Google is focused on Amazon’s business, and their recent moves into in store retail to dominate emerging sectors.

Google is dominant in digital advertising:

Sources: eMarker, Recode – 2018

In digital advertising Google has 2 times the share of its next largest competitor – Facebook.  In mobile advertising, Google has a 1.5 times greater share of the advertising business. In short, Google is the digital advertising player for most advertisers to work with, and Google is interested in maintaining that dominant position versus possible competitors like Amazon. Amazon now has 50 % of the eCommerce business in the U.S. The eCommerce behemoth is in a position to both track consumer behavior and offer point of decision purchase capabilities.

So, what does this mean for us as users and our privacy?  Google is no longer a company just setting up a partnering relationship with Mastercard, they are controlling the retail market and manipulating data to put us under constant surveillance. We did not give our permission to Google to constantly put us under surveillance.  It is dangerous to our private lives to have a big corporation or partners knowing everything we are doing and buying.  What happens if hackers break into these databases and begin to use the data to find us or siphon off our purchases or find out our transaction information or credit card data?

Next Steps:

First principle is that we own our data, and we own the patterns of our searches that is our propriety information because it is our behavior and is not owned by the company. When users search on Google, they are looking for an idea, a product or a service or a person – not to be spied on.  Recently, Google was still keeping user location even when the user turned off  location services.  A couple of years ago Google tracked words in user email messages and sold the information to advertisers, so if a user mentioned their child’s bike, all the sudden bike ads were showing up in the side bar – they finally ended this practice after a lot of complaints it was just too spooky.

Second, Google and Internet companies can’t build trust with users if they are constantly telling us one thing and doing something else to their benefit and not ours. The U.S. should look at implementation of a policy like the EU General Data Protection Regulation (GDPR) plan which could be widened to include schemes like the Google – Mastercard deal. The GDPR provides users with control over their personal data and how or if it may be transmitted outside of the country. The GDPR policy particularly focuses on personally identifiable information and how this information is to be handled in a confidential manner, not disclosed to third parties and the information made anonymous to outsiders.  In a provision we particularly like the information processor (ie Google) must enable users to be able to erase their information on the system.

We need to take a stand as a user community that user rights come first. User’s own their data not the processors.  Users should have control over any processing of that data and who has access to their personal data. Otherwise, we are opening our citizens to corporate spying for any reason, and targeting of the linked Mastercard – Google profile data to hackers.

The Internet Connects Us All in Common

 

Image:  Your Little Planet

We all enjoy the connectivity the Internet provides us today with instant messaging, email, hyperlinking, websites and news.  It was built by the Defense Advanced Research Projects Agency (DARPA) contracting with universities and research centers to build a powerful internetworking protocol and network for the Department of Defense beginning in 1969.  The network evolved with more research centers and government organizations using the system for communication and joint projects.  By the mid 1990s the Internet was opened to the public primarily for email, though soon websites and messaging systems were established.  Commercial common carriers were offered government contracts to provide more communication network support and services.  In 1993 the Internet provided 1 % of all two way communications, by 2000 51 % of all communications were over the Internet, then growth exploded to 97 % of all telecommunications information in 2007.

Built by taxpayer money by DARPA  for military communications,  next universities and research centers, then open to the public and commercial enterprises. So, why do companies like AT & T, Verizon, and Comcast think they should control how Internet is offered to our people?  We paid for it, as it evolved the Internet was envisioned as a wonderful new way to engage citizens in the political process and to level the playing field for new companies.

We certainly, have seen how innovation with a plethora of new services has emerged in the last 20 years, yet now a few giants run the content side: Google, Facebook, Netflix, Disney and the network side run by AT &T, Verizon, and Comcast.  As the content companies merge with networking companies we have huge companies deciding how to make more money from a network entity that is actually a public trust built by taxpayer money.

One way we see inequality growing is access to the Internet for many in poor, or rural  regions of the country is limited in speed and services.  Without Internet speedy Internet access or innovative services for universities, hospitals, and companies in these regions it is difficult for the working class to gain the skills to get a better job, or companies to compete with their high speed competitors.  Investment is declining in some regions of the Midwest and South due to poor Internet infrastructure which means fewer jobs for people living in the area.

The Internet is really a Common Good. It is a utility, not a platform for companies to make profits and not take responsibility for equity in access, speed and content which was the original purpose in designing the Internet as a peer to peer protocol rather than hierarchical.

The present GOP administration installed a company lobbyist as chair of the FCC who immediately decided that the network neutrality doctrine of the Obama administration should be overturned, giving control to for profit entities to charge whatever they wanted for speedy access or content. It is as if we turned the interstate system of freeways over to GM, so GM could give special lanes to GM cars and the others would have to go in slower lanes.

No, we don’t see the Common Good being protected by a for profit doctrine, it just can’t do the job.  Recently, when firefighters in the California Mendocino fire went over their mobile data plan limit, Verizon throttled their data transmission to 1/200 of the speed.  After the outrage over such predatory practices Verizon relented and will now offer all western state first responders standard data plans without throttling.  Why should they even be able to throttle?  If a user needs more data then just charge more over a certain limit – but throttling their network speed is coercive.

Network neutrality for all content, all websites, all messaging is the just doctrine for a Common Good like the Internet built with public funds. The fact that corporations think they should be able to do whatever they want shows once again that The Elite has control and power over the public interest.  Their position needs to shift to supporting the public interest as priority one, not profits. We need to have the common carriers see they have a public trust, and social responsibility in operating a public Internet utility.

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