NYC Less Resistant to Change - More Hope for Healthcare Reform

I've decided to emphasize the point about how Americans fear change from my previous post and relate it to my opinion of NYC residents' and their typical behaviors. I think as a whole those residing in NYC are more open to change than those living in the rest of the country. The way I see it, those who experienced 9/11 have witnessed firsthand that following standard procedures and protocols is not always the best option. Stantard procedures and protocols need to constantly be changed to adapt to changes in society and the local environment. Those living in NYC at the time of the chaos can vouch for this need to adapt.

For this reason I think that NYC has a better shot at moving from paper based to electronic based document systems. I am pretty confident that the $105 million awarded in grants for community based health IT projects will not go to waste because of resistance to change. I think that NYC residents crave improvement and healthcare is most definitely an area that needs improvement.

The following graph is from a presentation given at the Improving Health-Care Statistics Through Electronic Medical Records and Health Information Exchange Workshop on May 29-30, 2007:


(Click the image to read the words in each bubble)

Basically, this graph shows that many different entities share the same medical records and thus using electronic based medical records has a big advantage. I think that NYC is likely to adopt to these changes.

IT & Healthcare in NYC

On March 28, $105 million in grants were awarded to 19 leading community-based health IT projects (NY State Gov). New York currently leads the U.S. in their commitment to move from paper based to electronic based systems. Officials would like to see this money used to provide more patient-centered care.

New York, in my own opinion, is by far the leading to state to take advantage of technology and use it to increase efficiency, safety, opportunities, and effectiveness in various applications such as emergency preparedness, public official stationing, and knowledge management. However, health care is an application in which, across the country, cities and states have struggled to incorporate technology and have consistently failed. And New York is not an exception.

One of my family members has worked in various jobs related to health management over the past 5 or 6 years. I have seen him continuously switch jobs, never quite fond of the bureaucratic nature of the the company. Yet this bureaucracy is a major reason why the incorporation of IT continues to fail. People hate change. People love consistency and organization. And someone is always in charge saying,"Why change now?". Well change now, or healthcare will never experience the power that IT has to offer.

I read a crazy statistic: "The U.S. spends twice as much per capita on healthcare as the average of the 10 other richest countries in the world" (Brookings). So what exactly are we spending all of this extra money on then? Wasted IT investments?

And from this same article, I have come across some very interesting points about why IT in healthcare (reform) has consistently failed:

• "Eighty-five percent of Americans are insured and fear change"
• "Large-scale health reform is large-scale income redistribution, and the politics of redistribution is the politics of trench warfare"
• "Healthcare reform involves huge financial stakes" (the $105 million should hopefully make this point obsolete)
• "The U.S. political system is exquisitely structured to frustrate action on large and controversial matters on which there is not overwhelming agreement"
• "Healthcare varies greatly across the United States, making consensus hard to come by"

I now plan to research how IT can actually achieve the healthcare reform, while still taking into consideration the above points. In my next posting, I will provide what I have come up with...

Florida as a Role Model

Florida has successful implemented a tool that could be very useful for public safety in New York City. This tool is called FCIC II System (Florida Crime Information Center). Criminal justice agencies are able to locate and update information electronically about Florida's criminals and criminal activity. For whatever reason, the justice system is a little bit behind on moving from paper-based systems to electronic-based systems. I've come up with a few reasons why this could be true:

• Fear that systems could be hacked and sensitive information compromised
• Lack of funding to implement
• Resistance to change in a bureaucratic environment

I would like to comment on each of these possible reasons I have come up with. First, there is definitely always a chance that electronic systems can be hacked into. However, I would argue that the benefits from moving to an electronically based system far outweighs the chances of data being compromised. This goes back to what I wrote about awhile back. Our country is too reactive. We should implement electronic systems AND put in necessary controls to hopefully eliminate (or at least reduce) the chances of being hacked.

Second, although justice agencies are governmental agencies, private investors are likely willing to invest in implementing electronic based systems. Thus, they can be funded jointly from the government as well as from private investors.

Finally, resistance to change is just something I could argue about for days. Having interned in big corporate environments I've seen how difficult it is to make any changes to solidified practices. This is something that needs to be changed across the board in all large environments, from the government to large public companies. Until resistance is conquered, people will be stuck in their ways eternally. We shouldn't have to wait for the older generation to leave the workforce to implement the tools we already have waiting for us to use at our fingertips. The problem that many of the older generations have with technology is distinguishing the role of technology as a business tool from the role of technology as a form of entertainment. I'm not saying that all businesses should have pages on social networking sites, islands on SecondLife, and replace reports with blogs. I'm simply saying we need to focus on how technology plays a role in business strategy and I think the only way to do this is to emphasize the difference between the two.

So back to the public safety side...if we could only get past these roadblocks (the fear of being hacked and resistance to change), I argue we could have much safer streets in New York City. And if not, well at least we can increase the efficiency of our justice systems and improve the quality of life (and work balance) of those working in the justice system.

Unrelated, but interesting...

This is unrelated to tech in NYC, but its an interesting article and relates to a thesis I am writing for another class...

How Should I.S.P.’s Tell You if They Want to Track Your Surfing?

Thoughts?? (Any thoughts would be helpful for my paper...)

RFID & Taxi Cabs

Lately there has been an increasing popularity for finding new applications for RFID technology. One new application I have found for RFID that is potentially beneficial to safety in NYC is the convergence of RFID and mobile devices to determine the safety of taxi cabs. This technology and application is based on the service that is currently offered in Korea, called "Green Taxi, which enables pasengers to get information on the taxi by scanning an RFID tag embedded within the cab's seats" (MobileMentalism.com).


For additional security, the information received from the scanner can be sent to friends or family, allowing them to track the location of the cab from their own mobile device. Although Korea has been quick to introduce new applications of RFID in convergence with mobile devices, the United States has been slower to pick up on this trend. I think this application would be extremely important in a city like NYC where public transporation systems are a major part of the city's culture. This technology could also be applied to the other types of public transportation in NYC such as buses and subways. As someone who is moving to New York, I would be very interested in this technology!

>>UPDATE: Samsung has actually developed a single chip RFID reader that can be plugged into standard mobile phones. Although it has yet to be released, this new technology could provide the United States with the available tool to implement RFID chips in all of its taxi cabs.

Sometimes Dreams Give Me Good Ideas

I want to quickly tell you about the dream I had a few nights ago and then tell you how I think it is relevant.

Dream: In this dream, I was at Disneyland with my roommate and a few other friends. Instead of walking around the park, everyone had a transportation vehicle that flew. Everyone's vehicle was difficult--mine was shaped like a spaceship. Okay, now here's where the dream gets a little weird. If you didn't hold on to your transportation vehicle it flew up into the sky like a balloon does if you let go of the string. As you probably guessed, I accidentally let go of the spaceship and it flew into the sky. What goes up must come down, right? So after a few minutes the spaceship came plummeting back down and hit Disneyland. An announcement was made over a loud speaker that Disneyland was hit by a nuclear bomb and everyone needed to immediately follow evacuation procedures. No procedures were followed. CHAOS took place.

My Point: In the dream, I tried really hard to explain to security officials what had happened. It was not a nuclear bomb, just my spaceship transportation vehicle! Each security official that I sold slowly began to understand and believe me. However, Disneyland is a very large place with many security officials and the amount of time that simply relaying a message "through the grapevine" to all of the security officials across the park was completely inefficient. I consider Disneyland in my dream to be a microcosm for NYC. The procedures that could have been followed are similar to that of officials in NYC during a citywide disaster such as 9/11.

Handheld devices, as I have been speaking about in many previous posts, could have eliminated the hysteria. A simple officer wide text message via the handheld devices could have easily explained the situation and then calmed down the people. Although at Disneyland, the visitors have not signed up for a text message service, many residents of NYC do. If the first round of text messages went to public officials until they could validate the "all-clear" and then the second round of text messages went to all subscribers, CHAOS could be avoided (or at least limited).

So many dreams really do have meaning...?

Telematics & National 9-1-1 Education Month

Telematics: The integrated use of telecommunications and informatics, also known as ICT (Information and Communications Technology). More specifically it is the science of sending, receiving and storing information via telecommunication devices (Wikipedia.org)

Telematics is the key technology being used in the many of the initiatives I spoke about in my last posting. According to a letter from the National Emergency Number Association and COMCARE Emergency Response Alliance to the Department of Homeland Security, "telematics is the one area of this kind where a longstanding, multi-profession initiative has resulted in a current XML specification which is a de facto standard now being used by OnStar to share emergency data". Within the last couple of months the DHS has been incorporating telematics into its information systems used for security purposes in big cities such as New York City. The letter speaks mainly about the importance of standardizing emergency data so that it can be shared with all 911 emergency response centers. Types of data range from vehicle telematics to personal information including medical information.

911 Education Awareness Month: The COMCARE Emergency Response Alliance announced on March 10, 2008 that the month of April would be deemed as the National 911 Education Month. According to the public announcement: "They are calling upon public safety officials, schools, government officials, and industry leaders to engage in a national effort to educate children, seniors, and the general public about the importance of, and appropriate use of, 9-1-1". I think its really important that the general public be aware of the use of 911 especially in large cities such as NYC. Its important in cities where wireless communications can become congested that everyone know when the appropriate time to use 911 services. The education awareness month is seeking to educate the public of these times and uses.