|
11.08
Protecting the Health
Care & Public Health Critical Infrastructure:
IEEE EMBS Magazine Focuses on
Interoperability Imperatives
By BArton Reppert
The November/December 2008 issue
of IEEE Engineering in Medicine and Biology
Society Magazine, due out later this month,
examines the need for greater interoperability
among government agencies, academia and the
private sector to protect the nation's health
care and public health critical infrastructure.
In special comments for the EMBS
publication, Dr.
Robert Kolodner, National Coordinator for Health
IT with the Department of Health and Human
Services, and Dr. Charles Friedman, his deputy,
said, “To monitor and protect the health and security
of communities, aggregated health information
must link with a variety of other data sources
that affect health — food, water, environmental
— while respecting and protecting the privacy of
individuals.”
Kolodner and Friedman added:
“While we have much work ahead of us, the United
States is making significant progress towards an
infrastructure supporting the secure exchange of
interoperable health information. Infrastructure
and interoperability require standards for
information representation and exchange...we encourage the readers of
these papers to think nationally, and even
globally, as they consider the importance of
information infrastructure and
interoperability.”
Dr. Luis Kun, a member of
IEEE-USA's Medical Technology Policy Committee (MTPC)
and a member and founding chair of IEEE-USA's Critical
Infrastructure Protection Committee (CIPC), was guest editor of
the special EMBS issue. This issue fulfills
one of the goals the CIPC had set for itself
during its inaugural year in 2007: to
publish a special IEEE magazine issue on CIP in
2007 or 2008.
Kun, who is research professor
of homeland security at the National Defense
University (NDU) in Washington, D.C., recently discussed
interoperability — and the deleterious effects
of uniteroperability — as an invited
speaker at the the American Institute for
Medical and Biological Engineering’s (AIMBE) 3rd Annual Federal Symposium,
held 15-16 September in Washington, D.C. The
symposium's main theme was:
Policy for Healthier Lives Through Medical
and Biological Engineering. While focusing on the protection
of our health care and public health
infrastructure and key assets, Kun's presentation
connected global sustainability with global
health and global security through
interoperability.
According to Kun, entrenched
stove-pipe mentalities — where the left hand
doesn't always know what the right hand is doing
— prevent integration within and among key
organizations, resulting in uninteroperability
among the very entities that must work together
to solve the most pressing national and global
health care challenges.
Says Kun, “One of the things
that we try to advocate [in the EMBS special
issue] is the need to think
holistically, to try to look at the big picture,
to see how everything is connected — and not
react after the fact, but look at those
connections before something happens, so that
you can better prepare to respond. Part of the
problem of interoperability surfaces when you
try to paint the big picture; in other words, it
is impossible to “connect the dots” if you
are not even aware that certain dots exist.”
“We made a conscious decision to
address areas that most people don’t address,”
Kun noted, with regard to the selection of paper
topics, as well as the
selection of authors.
CIP Background
High-level concern about
critical infrastructure protection (CIP) goes
back to May 1998, when President Bill Clinton
issued Presidential Directive PDD-63. This
directive recognized certain parts of the
national infrastructure as critical to the
national and economic security of the United
States and the well-being of its citizenry, and
required steps to be taken to protect it.
Clinton’s directive was updated
on 17 December 2003 by President Bush through
the Homeland Security Presidential Directive
HSPD-7 for Critical Infrastructure
Identification, Prioritization and Protection.
The directive broadened the definition of
infrastructure in accordance with the Patriot
Act, as the physical and virtual systems
that are “so vital to the United States that the
incapacity or destruction of such systems and
assets would have a debilitating impact on
security, national economic security, [and]
national public health or safety.”
Gathering the Right People
To provide a range of
contributions for the collection of articles in
the forthcoming EMBS publication, Kun
assembled an international team of some 35 people,
including members of IEEE-USA's CIPC and MTPC,
members of other professional societies, as well
as representatives from private industry,
academia and government at the local, state and
federal levels. Professions represented include:
government officials (members of the U.S. Senate
and members of the Executive Branch); biomedical
engineers; civil engineers; physicians (internal
medicine, surgeons, plastic surgeons,
epidemiologists and public health specialists);
geographers; water and food specialists; complex
systems specialists, enterprise architecture
specialists and others.
In one of the issue's noteworthy
papers, former U.S. Surgeon General C. Everett
Koop et. al. call for a distributed,
network-based health care system that would
decentralize medical care from large hospitals,
to a model where care is provided locally in
neighborhoods and individual homes, by using
computer technologies like telemedicine to link
patients and primary care providers to tertiary
medical providers.
And in special comments for this
issue, Senator Susan Collins (R-Maine) and
Senator
Sheldon Whitehouse (D-R.I.), as well as Dr.
Kolodner and Dr. Friedman provide a balanced
perspective from key policy-makers.
“It is crucial to educate
policy-makers about science and technology, as
well as to educate engineers about public
policy,” said Kun.
In her introductory remarks,
Senator Collins, ranking minority
member on the Senate Homeland Security and
Governmental Affairs Committee, observed that as
a result of an investigation by the committee,
she and Chair Joseph Lieberman (D-Conn.)
introduced the Post-Katrina Emergency
Management Reform Act, which was signed into law in 2006.
“The law established a Chief
Medical Officer within the Department of
Homeland Security to oversee all medical issues
related to disasters, such as stockpiling
medication and medical supplies in advance of
emergencies, planning mass evacuations of people
with medical needs, and coordinating with
federal, state and local health care providers,”
she wrote.
Senator Collins added: “Our
nation has made great progress in preparing for
the health care needs associated with major
disasters. Unfortunately, no disaster is the
same, and our response will need to be flexible
to meet the exigencies of the moment.
In other comments to appear in
the EMBS magazine, Senator Whitehouse noted that
the nation's health care system is in
serious trouble: “Nearly 50 million Americans are
uninsured. Health care costs exceed $2 trillion
a year, and are soon expected to double. We
spend almost 16 percent of our gross domestic
product on health care, which is more than any
other industrialized country and double the
European Union average.”
Whitehouse said that last May,
he introduced three bills to address such
problems, including the National Health
Information Technology and Privacy Advancement
Act of 2007 (S. 1455). According to
Whitehouse, “this bill would create a national,
private, non-profit corporation to plan,
initiate, develop, finance, and manage our
national health IT infrastructure.”
Following are some excerpts from the
abstracts of various papers in the EMBS
publication:
Future Delivery of Health
Care — Cybercare: A Distributed Network-Based
Health Care System; paper by C.
Everett Koop (former U.S. Surgeon General) and
nine co-authors.
This paper proposes health care
system reforms that change the structure of the
current U.S. health care system, from
centralized large hospitals to a distributed,
networked health care system. In our model,
medical care is delivered locally in
neighborhoods and individual homes, using
computer technologies like telemedicine to link
patients and primary care providers to tertiary
medical providers. This decentralization could
reduce costs enough to provide all citizens with
medical insurance coverage; it would benefit
patients and providers; and as a ‘dual use’
system, it would better protect the country’s
resources and citizens in the event of
biological terror or natural disasters.
Enhancing the Healthcare /
Public Health and the Food and Agriculture
Critical Infrastructures Through an Enabling
Food Product Safety Enterprise Architecture;
article by Stan Boddie and Luis Kun.
The Healthcare and Public
Health, as well as the Food and Agriculture
Critical Infrastructures are highly
interdependent. Globalization has created an
environment where every country depends on many
others for a continuous year-round supply chain
of food and related products. . . The United
States does not have a national approach to
protect this critical national infrastructure,
and needs a food product safety management
enterprise architecture to enable food product
safety. . . Without a national food
product safety management enterprise
architecture, the United States will continue to
experience contaminated food product incidents
that threaten global U.S. food product
consumers, and also threatens U.S. financial and
national security.
National Security Strategy
for U.S. Water: Ensuring Interoperability and
Cooperative Engineering in the Water Sector;
article by Robert Mathews and Catherine Spencer.
Undertaking the task of crafting
national strategies, or engaging in policy
discussions without possessing the
prerequisites, can predictably produce a variety
of nationally degrading effects. Those effects
include mounting public costs associated with
irrational policy misadventures, lost
opportunity costs that may not ever be
recoverable, remediation costs, and costs
associated with detrimental impacts on select
demographies, or whole populations. . .
This body of work recounts analytical shortfalls
used to conceive and place into service the U.S.
National Security Strategy for the Water Sector.
Additionally, a reformed and renewed
‘cooperative engineering’ approach orientation
capable of delivering an efficient, effective,
beneficial and complete National Security
Strategy policy framework is proposed, drawn
from the need for tightly coupled
interoperability amongst multiple entities in
the national strategy spaces, policy spaces and
the operational spaces — with strong
consideration of policy historicals.
More on Interoperability and
Uninteroperability
An article by Debra Schiff in
the September 2007 issue of Today’s Engineer,
“Taking
a Wide-Angle View of the U.S. Electric Power
Grid,” interviewed Kun and Robert Mathews,
the authors of the IEEE-USA e-Book,
Interoperability & Critical infrastructure
Protection: A Review of Activities to Ensure the
Reliability of the U.S. Electric Grid.”
See also Kun's Government
Affairs column, "Interoperability: The Cure for
What Ails Us," from the Jan/Feb. 2007 issue of
EMBS Magazine [Vol. 26, No. 1, pp.
87-91].
Barton Reppert is a freelance
science and technology writer specializing in
S&T policy coverage. He previously worked for 18
years as a reporter and editor with The
Associated Press in Washington, New York and
Moscow.
Comments may be submitted to
todaysengineer@ieee.org.
|
E-mail
this page to a friend
