Wednesday, December 10, 2008

Why Not The Best? A New Web Site for Quality Improvement Professionals

Over the past six years I've been building consumer-oriented report health care cards pretty much non-stop. The field is young and short on evidence, but it's interesting work with noticeable impact. However, the truth is that the largest portion of readers of these report cards are not consumers, but providers.

To that end, I have long been wanting to build a report card for providers, not only to report their data but also to link directly to freely available improvement tools and knowledge directly from the report. My goal being, not only identify poor performance but right there, in the data, link to relevant interventions to impact that data in a positive way.

Well, it's done.

I met with the Commonwealth Fund earlier this year and they were looking to build something around their Why Not The Best? National Scorecard on U.S. Health System Performance. The Fund was looking for a vehicle to deliver their high performer cases studies, wherein hospitals identified as being high performers in a given set of measures were interviewed and the resultant wisdom distilled into case studies for other hospitals to learn from.

After many, many sleepless nights, I'm hugely proud to announce the launch of - a quality improvement resource for providers from the Commonwealth Fund. A ton of very talented people have been working on this and we are all very, very excited to see how the site is received.

The site includes all clinical quality and patient satisfaction data ever released on CMS' Hospital Compare. This means 24 clinical measures and 10 satisfaction measures. In addition, we created 5 summary scores, 4 being topical and one overall composite quality measure.

Users can register for a profile that will remember all their choices for the next visit. This is important as there are many ways to personalise this site.

Profiles are a basic three step process, you choose hospitals that you wish to compare yourself to, then choose measures you wish to track, then choose benchmarks of care you wish to compare against.

We have every hospital in the US that bills Medicare. This is about 4500 hospitals. We have collected the quality and satisfaction data since the launch of the public dataset.

Using this data, we can calculate state and national averages, as well as top percentiles. Commonwealth then asked us to identify just those hospitals that reported all measures and had at least 30 patients in each of four topics, and using that subset we further stratified the population to ascertain the high performing hospitals.

This means that for any measure, you can load the current top 1% of hospitals for each measure.

Choosing A Hospital

You can choose a hospital to add to your profile in three ways. First, you can simply start typing a name and the database will let you know if we have a match.

Another interesting way to build a group of hospitals would be to find facilities that are like your own. Users can choose from a variety of characteristics to whittle down the list to a useful set of comparator hospitals. In the example below I've asked for all teaching hospitals in New York with 400 or more beds.

Finally, users can simply browse a map and grab hospitals of interest.

We don't limit the number of hospitals you can save to your profile, but if you add more than 50 the site will start to look a bit busy. Theoretically, you could store all hospitals in the country, but don't call me when it takes half an hour to load.

You can then choose any or all of the measures and benchmarks, these will then be available to you in any charts you choose to generate, and this is where things get interesting.

User-Generated Charts

We have implemented a dynamic charting application that will build charts on the fly based on your choices and your profile.

This means that for any chart you choose to load, it will populate dynamically based on the hospitals, measures and benchmarks you selected.

Here are a few examples:

Pretty nifty huh?

You can see in the example that we even calculated each hospital's rank in the nation for a given measure.

Each chart is followed by an array of options:

Among other things, you can download a comma separated file of the data used to create the chart, save the chart as an image to use in Powerpoint or similar, and click through to browse related case studies and intervention tools.

There are a wealth of additional features, please stop by and kick the tires! The site is - enjoy! And please feel free to leave me your comments.
Full story...

Monday, December 1, 2008

Change Dot Gov - Copyright 2008

Although most of my posts on this blog are health care-oriented, it also covers Internet technology, freedom of information and related matters from time to time. Today is one of those days.

I was surprised to see Senator Obama standing behind a podium adorned with the Great Seal of the United States of America this morning, and further surprised to learn of the apparent existence of the Office of the President Elect. For one thing, he's not the President Elect. Yet.

You Did Not Vote For President

The Electoral College, which lives at (National Archives), meets on the first Monday after the second Wednesday in December. This year that will be December 15th. On that day, the electors (most of whom were elected on November 4th in a political party election process that most people think is a presidential vote) - on that day, December 15th, the electors will elect the President.

This is basic US Constitutional stuff. The country votes for electors, electors meet a month later and vote for President. These electors are not legally bound to follow the popular vote. In the USA, the People popularly elect members of Congress, the Executive are elected through indirect election.

One more time, to be clear:

On November 4th, the US people elected a slate of electors.

On December 15th, these electors will meet and vote for President and Vice President. After this vote, one can say that there is a President elect.

On January 6th, Congress assembles and counts those votes in the House of Representatives. If a majority winner (270 of the 538 votes) is found the President and Vice President are declared and the Senators leave the House Chamber. If there is no majority winner the House votes for President and the Senate votes for VP.

But, I digress.

When is .gov not .gov? is a Web site that appears to represent an official government entity. Dot gov addresses are hard to come by, and are strictly regulated. It is with concern and curiosity then that I see to proclaim itself to be the Web site of the official-sounding Office of the President Elect.

However, this entity is in fact a private 501c(4) organisation, not a government office. I heartily salute Senator Obama's evident direction to bring greater transparency to the government through the use of Internet technologies, and I also look forward to the inclusivity promised through the use of blogs and similar modern concepts. However, what I do not ever want to see is a copyright notice on a dot gov Web site.

The Obama campaign's attempt to communicate it's freedom-loving principles are exhibited through the use of a Copyleft statement, the copyright notice on this Web site references a Creative Commons license.

I use the Creative Commons license myself wherever and whenever I can, it freely allows people to use and copy certain content with limited restrictions. It's a great tool.

But not for government. See, the government can't copyright anything. Ever.

The government is us. Well, technically not me as I'm not a citizen, but it is composed entirely of US citizens, for US citizens. Everything the government produces that is not secret is in the public domain. Because it *is* the public domain.

A dot gov Web site with a copyright notice is bad bad bad, unless that copyright notice says something to the effect of "there is no copyright". The government cannot put documents in the public domain via a Creative Commons license.

Here's an example of what a dot gov copyright should say, this one coming from the US Department of State:

"Links to State Department sites are welcomed. Unless a copyright is indicated, information on the State Department’s main website is in the public domain and may be copied and distributed without permission. Citation of the U.S. State Department as source of the information is appreciated.

If a copyright is indicated on a photo, graphic, or other material, permission to copy these materials must be obtained from the original source. For photos without captions or with only partial captions, hold your cursor over the photo to view the "alt tag" for any copyright information. Please note that many photos used on this website are copyrighted."

According to 17 USC § 105, copyright protection
"is not available for any work of the United States Government, but the United States is not precluded from receiving and holding copyrights transferred to it by assignment, bequest, or otherwise".

Further, we've witnessed the dilution of Web domains such as the dot org and the dot net, whose meaning's have now become shrouded in pre-2000 history. But dot gov is supposed to be sacred. I work and have worked on federal and state gov Web sites, the rules are long, complicated and necessary.

They ensure that when you visit a dot gov address, you can trust it. It represents government. It is the word of government. It is accessible, publicly-funded and accountable to the people.

Not a private lobby group.

In fact, the GSA, which administers the .gov domain, explicitly states:

"No Political or Campaign Information: The Gov domain is for the operation of government, not the political, political party, or campaign environment. No campaigning can be done using Gov Internet domains. The Gov Internet domain websites may not be directly linked to or refer to websites created or operated by a campaign or any campaign entity or committee. No political sites or party names or acronyms can be used. Separate webites and e-mail on other top-level domains (TLDs), such as .org, will have to be used for political activity."

(See Dot Gov Eligibility)

Obama's transition team is funded by appropriations from government, true. But it is also funded by donors. Private donors. This is not a government entity. The one link on this Web site that leads to a truly governmental source is the link below the copyright to the GSA, you'll notice a "leaving the Web site" notice as well as no copyright notice on the actual government Web site you end up at.

The Obama transition team is budgeted at 12 million dollars, 5.2 million of which comes from public coffers. The rest is private donations (under $5,000 each).

Presidential Transition services are an accepted part of the General Services Administration function. That's why the GSA has a transition Web site.

Regarding the use of the Great Seal (which of course is not the same as the Presidential Seal he will get to use soon...)

Use of U.S. State Department Seal (the U.S. Great Seal) and Other Official Insignia
U.S. State Department seals (the U.S. Great Seal), logos and other official insignia may not be used or reproduced without written permission. Use of the Great Seal of the United States is governed by Public Law 91-651, Title 18 of the United States Code. This is a criminal statute with penal provisions, prohibiting certain uses of the Great Seal that would convey or reasonably be calculated to convey a false impression of sponsorship or approval by the Government of the United States or any department, agency, or instrumentality thereof."

Senator Obama is doing himself, and the Web, a disservice by misappropriating the dot gov domain and the Great Seal while he awaits his turn in office. He holds no federal power, he represents no executive office, and he should wait his turn.


Having looked at the privacy policy, I'm now even more curious. If this is a dot gov site, why is there a COPPA notice? Further, this site actively solicits contributed content from readers via "Your Story" and other similar links, are these readers sending information to the government or to a private organisation? If the former, there a re serious privacy issues to be considered. If the latter, I think it is vital and fair for these individuals to fully understand they are dealing with a private, non-governmental Web site.‎ Full story...

Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.