Wednesday, June 22, 2005

Values

*** DRAFT ***



This is not a statement of values, but a statement about values, on which the Values Committee is agreed.

People ought to have the right, the capacity, and the courage to live their values, whatever they are.

We have the right to live without fear, to live without censure, to feel and be safe in our communities and our homes, to have and to hold to our values, in both a public and private space, together and as individuals, in an inclusive and sharing environment, and with respect for and celebration of our diversity.

But there is a difference in society, between the way people believe they ought to live, and the direction their society takes them.

We believe that our society belongs to all of us, without reservation, that each person is of inherent value to our society. To turn our back on some people, to leave them to live in a state of poverty, of sickness, of want and desperation, is in turn our back on the idea that values have any place in our society.

There is such a divide between what we believe, what we value, and how our leadership conducts public policy. We are desperately seeking a return to a society that is life-affirming, supportive of community, and respectful to the environment.

This requires a fundamental change in how we govern ourselves.

We believe that there ought to be a means of expressing, and living by, what we believe. We need public spaces, like arenas and community centres, libraries and coffee shops, parks and markets, open and accessible to all, where we may engage in common discourse.

Our press and media, relevision and radio, ought not to be a voice to speak to the people, but rather, the voice of the people, a marketplace of ideas in which we all share.

We need a responsive form of government, one that is accessible to all, one that respects the decisions we make as a community, and which gives us freedom each of us to live according to our own good, in our own way, as individuals.

We need a system of education, culture and media, open and accessible to all, that fosters and encourages the development and expression of our own capacities.

Our leaders, corporations and institutions have an obligation, a responsibility, not only to hear the voices of the people, but to be guided by them, as the expression of a free people governing ourselves.

Real leadership does not come from family background, from position or patronage, by appointment or preference or privilege. It comes from the heart, from knowing who we are and where we want to go, what we want to be. And it lives in all of us.

Monday, June 13, 2005

Infoway

Infoway has released a reference implementation on SourceForge:

"IRIS (Infoway Reference Implementation Suite) is a demonstration of Electronic Health Record (EHR) interoperability messaging created by Canada Health Infoway. The project demonstrates and proves Patient Registry interoperability messaging using HL7 v3."

Coverage


This appears to be an otherwise unpublicized reversal of a previous position.


Documentation of the reference implementation.


Open Source, sort of

The code is licensed under the Academic Free License (AFL), which is a SourceForge-approved open source license. Details.

This license is pretty similar to LGPL in that it allows both commercial and noncommercial use, but it reserves ownership (and possible future enforcement of?) patents contained in the source distribution.

Infoway itself is a non-profit organization constituted by Canadian federal and provincial deputy health ministers. It describes itself as a 'strategic investor' and has a budget of $1.1 billion to invest in electronic health care record initiatives ($125 million have been invested already). Partners are public health care institutions (such as hospitals) as well as (unnamed) provate sector investors. Infoway has been running a series of seminars advising the private sector on business opportunities arising from this initiative.

Standards Based Approach

The major strength of this initiative; will ensure interoperability across the system.

Question: how far does Infoway take us down the road to the privatization of health care?

"Infoway is focused on strategic alliances with the private sector. The private sector is key to ensuring that any proposed standards solutions are appropriate and feasible and the effective implementation of any standards-based solution depends on collaboration with the private sector." Link.

The standards group has significant private sector involvement. Link. More.

Private sector information presentation.

Privacy, Security?

There is no suggestion that Canadian citizens own their own data, but there are assertions of privacy. "
Respect for privacy is fundamental to this vision."

There is a conflict of interest policy, but with terms so weak ("disciplinary action up to and including termination of his or her employment or other relationship with Infoway.") that conflict of interest is inevitable. The limitation period (ie., the space between being a board member or employee and receiving contracts) is only 90 days, which is effectively useless.

There is also an intellectual property policy, the gist of which is that private agencies obtain and keep IP developed out of this initiative, subject to certain performance conditions ("The Corporation will require the Participants to take effective steps within a reasonable period of time to commercialize, exploit or otherwise bring to the point of practical application, as applicable, any Investment Derived IP"). However, the enforcement is no more than a "recommendation": ("The Corporation shall encourage the publication and disclosure in a timely manner of all Investment Derived IP while respecting applicable law...").


There is no privacy policy extant on the website.

Not So Open...

There is an EHRS "blueprint" available on the website, however, it is necessary to register to view it.

Terms and conditions for this registration (which you must acknowledge having read and agreed to) include: "
Upon submission, you irrevocably assign all your moral rights in such submission to Infoway and agree to grant Infoway a royalty-free, perpetual, irrevocable, world-wide non-exclusive licence to use, reproduce, create derivate works from, publish, edit, translate, distribute, perform and display such submission in any manner and form."

Overall...

The good news is that this project exists, is at least partially open source, and is based on open standards. It has the potential to save billions of dollars in our health care system.

But...

- there is a significant level of private sector involvement, enough to suggest an inextricable linkage and thus significant privatization of the health care records system
- there are few, if any, contraints on conflict of interest, misuse of records, or other breaches of privacy and security

From what I can see Infoway is a fait accompli - other initiatives will have to conform to it or be frozen out. That said, recent events have shown that our governments are in the process of privatizing health care. This is happening despite the wishes of the vast majority of Canadians. Infoway is demonstrating a significant degree of private investment, enough to suggest that the process of privatization extends into health care records. This is something to be concerned about.

Friday, June 03, 2005

The Vision

Posted in response to this poll at the Walrus:

If the federal government sought to implement a defining vision for the country, which nation would you want us to be?
· The Peacekeeping Nation
· The Environment Nation
· The Immigration Nation
· The Foreign Aid Nation
· The Poverty-Free Nation
· The "No Separation" Nation
· The Boldly Visionless Nation

It seems to me that the selections offered are pretty unimaginative - each will probably gain a certain measure of support, all are aspects of the vision we see for Canada.

But the sort of vision that would capture our imagination is one that would capture most if not all of the choices offered. Being 'the environmental nation' is a part of being X. Being the 'poverty-free nation' is a part of being X.

Perhaps Trudeau was closest to this when he articulated his idea of Canada as being the "just society." One wonders whether there couldn't be a 21st century reiteration of something like the same theme.

If it were me, I would want to characterize Canada as "the Open Society." This connotes not only freedom and democracy, but also the sense that we do not lock our knowledge and wealth behind barriers reserved for the wealthy. It also (in its more modern usage) evokes ideas of community and cooperation.

I also think that something like this is a vision being more and more articulately expressed by people like Dave Pollard and Rob Paterson, among many others (including, I hope, myself).

This is a current of thought we rarely see amidst the factionalism and wannabe Americanism ringing through our national press. But it is there, and more expressive of what the people I know feel than any of the old line philosophies.

The people have the grand vision of Canada, even if our leaders and their media do not.

Thursday, June 02, 2005

They Lie

The Wall Street Journal:


Great Moments in Socialized Medicine

"A New Brunswick man who told police that a friendly dog scuttled his plan for a bloody shooting rampage was sentenced Wednesday to a three-year prison term after admitting it was all a ploy to get life-saving surgery while in jail," the
Canadian Press reports from Toronto:

Ontario Court Justice Brent Knazan described James Stanson as a "manipulative, duplicitous, entitled con-man" who headed to east Toronto last June "to hatch a plan that would lead to his detention (and) the medical treatment he needed."

"It is important that I give a sentence that denounces (Stanson's) conduct and deters anyone else from doing the same," Knazan said, rejecting the defence's request for a
sentence of one year, less a day, to be served in the community.

But Stanson's plan worked; he did indeed get the heart operation he needed while he was in custody. Self-righteous Europeans and Canadians love to call America "barbaric" for our private medical system and our refusal to abolish capital
punishment--but at least we don't sentence innocent people to death, as Canada's medical system effectively does.



What the WSJ neglects to mention is that the government of New Brunswick is a conservative government with a policy of shutting down health services with the intent of forcing a privatization of the health care system in this province, that it has the *money* to provide the sort of care the man needed but has *refused* to do so, presumably at the behest of the U.S. health interests that fund its election campaigns.

What it also fails to point out is that, if you're poor and need of the operation in the United States, there is *no* recourse, and that *many* more people die per capita from such aiments in the U.S. than in Canada. To say that the U.S. health care system doesn't sentence people to death is laughable. That people believe this when they read it in the WSJ is tragically sad.

One thing about conservatives - they lie. A lot.