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accountability

6127243966_e9189f1099_zLast week, fourteen groups filed a public comment asking the Centers for Medicare & Medicaid Services (CMS), to disclose Medicare payments to providers. Should the recommendation be implemented, it will add more transparency for health care costs to a system that needs it.

“We urge CMS to uphold its stated commitment to transparency and adopt a policy to promptly disclose, in an open format, payment data, with as much detail as practicable while protecting patient privacy,” recommended the organizations.

The Medicare provider charge data for hospitals showed a significant variation within communities and across the country for the same procedures. Providing more transparency into Medicare payments could help fight fraud and strengthen Medicare itself, argues Gavin Baker, an open government policy analyst at the Center for Effective Government, which signed the public comment.

The public has a fundamental right to know how government spends public funds. Medicare’s tremendous size and impact – $555 billion in expenditures, covering 49 million beneficiaries – make it a prime target for increased transparency. In fact, just the improper payments from Medicare are estimated at a whopping $44 billion – which is more than the entire budget for the Justice Department.

Releasing payment data would allow members of the public, including journalists and watchdogs, to help detect fraud or improper payments. That increased scrutiny could deter fraudsters– as happened with spending under the 2009 Recovery Act. This in turn could strengthen Medicare and help ensure its ability to continue playing its vital role in securing health care for America’s seniors.

The signatories to the public comment are a roll call of good government advocates, journalism organizations, think tanks and media outlets in the United States, demonstrating widespread interest in the data and a hint of the organizations that stand ready to make use of it.

Such a data release has a recent precedent: in May, the  United States Department of Health and Human Services released open data that compares the billing for the 100 most common treatments and procedures performed at more than 3000 hospital in the U.S. No patient privacy violations related to this release have been reported or demonstrated to date.

Should CMS choose to publish Medicare payments to providers, it would make 2013 a watershed year for increased data-driven transparency into health care costs.

Image Credit: Images of Money

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A recent update on how the Safecast project is tracking radiation remediation in Japan in the aftermath of the nuclear disaster in Fukushima got Ethan Zuckerman thinking.

After trying his hand at radiation monitoring himself, the director of MIT’s Center for Civic Media connected citizen science and data collection with civic participation in a long essay at his blog:

“If the straightforward motivation for citizen science and citizen monitoring is the hope of making a great discovery, maybe we need to think about how to make these activities routine, an ongoing civic ritual that’s as much a public duty as voting.”

Stepping back from the specific instance, the big idea here — citizens monitoring infrastructure — is not a novel one, at least in the world of development, where people have tried to apply information, communication technology (ICT) for years. It just hasn’t been particularly well executed in many places yet.

Ethan points to “Shovelwatch,” a collaborative effort by ProPublica and WNYC to track federal stimulus projects in the United States.

While the (now defunct) Recovery tracker enabled people to query data, there’s no section for people sharing pictures of progress on reports like the one below.
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New opportunities afforded by the increasing penetration of mobile devices, Internet connectivity and sensors are balanced with challenges to them working well, from data quality to cultural contexts.

First, citizen engagement matters for transparency initiatives, as Lee Drutman observed at the Sunlight Foundation this summer. People won’t become involved in monitoring infrastructure or projects unless they knew such a need or opportunity exists.

Second, the incentive structure matters. Why should people contribute pictures or data? Are there monetary rewards? A lottery ticket? Public recognition for participation by government or media organizations?

Third, who participates matters, in terms of project design. Leveraging “citizens as sensors,” doesn’t work as well in places where the men have the cellphones and the women get the water. Pilots that asked people to send text messages about whether water pumps were working haven’t done well in Africa.

Fourth, there needs to be a low barrier to participation. If people are going to be involved, bandwidth constraints and user-centric software design matter.

Those considerations don’t inherently mean that mobile monitoring projects like the USAID-funded mWater won’t work, but they’re worth watching closely as case studies.

All of those factors have led to increased interest in the development of inexpensive sensors that automatically collect data, as opposed to depending upon people to monitor.

Beyond Safecast, which is now developing the capacity to do air quality monitoring in Los Angeles, there are a growing number of projects focused upon environmental data collection.

For instance, the WaterwiseWater Canary” uses inexpensive hardware to help monitor contamination in water supplies.

A new nonprofit, WellDone, is pursuing a similar approach to water pump monitoring, combining open source hardware, software and mobile messaging. A prototype of their monitor is pictured below:
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A new generation of data-driven journalists are also working “sensoring the news.

Although there’s a long way to go before sensor journalism experiments go mainstream, the success of the Associated Press independently measuring the air quality in Beijing during the 2008 Olympics shows how data collection has already provided an alternative narrative to government reports.

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Earlier this year, computer science professor David Culler created a prototype for “conscious clothing”, winning a one hundred thousand dollar grant from the National Institutes of Health, the Office of the National Coordinator for Health IT, and the Environmental Protection Agency.

These wearable air quality sensors could be an important clinical tool for physicians and researchers to analyze changes in environmental conditions.

In the photo below, taken at the 2013 Health Datapalooza in Washington, DC, Culler shows off the prototype to Bryan Sivak, chief technology officer at the Department of Health and Human Services.sivak-culler-datapalooza

If you have other examples to share of projects that are collecting or creating data that’s used to hold government or corporations accountable, please share them in the comments or let us know on Twitter or email.

The Transparency Policy Project’s dual role as an organizer and participant at the Bridging Transparency and Technology workshop in Glen Cove, New York gave us an opportunity to reflect on this emerging field at many different levels.

Prior to the workshop, our conversations with the NGOs that participated revealed that their organizations were wrestling with similar tensions in their advocacy work. Common themes included:

  • Sustaining public interest in tech-transparency projects beyond the novelty of a first website visit.
  • Targeting tech-transparency projects to citizens, but finding that the media and other NGOs were the primary consumers of information.
  • Weighing the strategic advantages of open data approaches versus embargoing information to generate maximum accountability outcomes.
  • Linking online transparency efforts with offline accountability effects.
  • Finding the right metrics to capture the impact of their work.

These themes helped us shape the “arc” of the Glen Cove event. As Allen Gunn of Aspiration Tech noted in How we are designing the agenda for our Bridging Sessions, we aimed to “match needs to knowledge”.

At the workshop we saw a lot of cross-pollination take place between the advocacy strategies of groups working in natural resources governance and the extractives industries, and all the amazing tech tools that already exist for collecting, displaying and disseminating information. We were inspired by the passion, skill and ingenuity everyone brought to the table, and we are motivated by the potential harbored in proposed collaborations between NGOs and technologists that emerged at the workshop.

Based on workshop discussions and post-event conversations with participants, we put forth three lessons to inform the Bridging effort going forward:

  1. Articulate your strategy. Advocacy groups and technologists alike gained an understanding of the challenges and opportunities that exist in the growing technology for transparency space. A desire remains to delve deeper into deconstructing different types of strategies for transparency advocacy, and understanding how technology can be a lever in achieving accountability.
  2. Context matters. A lot. Discussions reinforced the importance of understanding the political environment and context within which technology approaches are implemented and advocacy groups operate. A greater diversity of perspectives – particularly from the developing world – would enrich this discussion and help in evaluating the impact of technology for transparency.
  3. The data exists, so hack! The hands-on opportunity to “hack” transparency projects and demonstrate how existing technology tools and approaches can be implemented quickly and effectively was a valuable experience for participants. Interactions between technologists and NGOs that lead to concrete projects and outcomes must be supported and sustained.

As we move forward with the Bridging initiative, the Transparency Policy Project will engage the Glen Cove groups in reflecting together on how to implement transparency and accountability projects. We are also keen to develop more innovative, and tailored approaches to measuring the impact that this work is having in advancing transparency and accountability. By articulating strategies, understanding context, and hacking projects, we hope to sharpen our collective understanding of how to best leverage technology tools in improving outcomes for arguably some of the most wicked problems on this planet.

Francisca Rojas, research director, Transparency Policy Project (original post)

Pedro Daire is in charge of technology for Chile’s Fundación Ciudadano Inteligente (“Smart Citizen”), a leader in employing technology for transparency in Latin America. Notable projects include Vota Inteligente to monitor the Chilean parliament, the Freedom of Information portal Acceso Inteligente, and most recently, a conflict of interest tracker that shines a light on parliamentarians, the legislation they support, and their personal investments. I spoke with Pedro via Skype on December 16, 2011 to capture his reflections on the Bridging Transparency and Technology (TABridge) workshop (which TPP participated in as well) held in Glen Cove, New York in early December. Pedro’s answers to my questions were so insightful on the matter of bridging tech and transparency that I decided to share a condensed version of our interview through this blog post.

Francisca: What was most valuable about participating in the TABridge event to the work you are doing and want to do in the future?

Pedro:    The most useful insight from the event was learning from the experiences of Kert Davies of Greenpeace and Heather White from the Environmental Working Group (EWG). They have been working with information to advance their advocacy work since before technology became such a powerful tool, and a result, they really know how to use information in strategic ways. They use technology as an amplifier, as a tool, and not and end in itself. In contrast, for younger people like me, technology is content, something in and of itself.

That insight, combined with the imperative to have an explicit theory of change behind our projects, an idea which Archon Fung guided us through at the workshop, is very useful for us. We are planning to analyze every project we do through the theory of change framework to guide our strategy and planning.

Did the event give you new ideas as to the role of technology in transparency efforts?

We have a very creative and innovative team at Ciudadano Inteligente, which means that we often have too many creative ideas! Our challenge is implementing those ideas and thinking about the impact chain of each project. We are very adept at developing tools for transparency, but don’t think about how that tool will be used to change or promote our end goals. We are too often focused on the tool and assume people will react to the information in impactful ways. But that’s not true. What I learned in the event is to attach a cause behind each tool.

We try to actively engage people with the information we provide, but we haven’t made a point to teach them what the next step is for them in terms of mobilizing around the information. With the conflict of interest tool for example, we should have considered incorporating an element to mobilize people to hold their legislators accountable from the beginning, but instead, we improvised a last-minute online petition when we realized this could be useful. I’ve come to see that facilitating these interactions is very important because otherwise, we have this citizen, but she’s only a spectator of the information. Only the most motivated people will react to the information. We need to say “hey, you’ve seen the info, now you should share this with five people,” and that’s much more than what we’ve done so far.

What should the TABridge program focus on as we work to support this network of practice?

The group that gathered at Glen Cove is like a ‘dream team’ of NGOs! Everyone who was there is very capable, enthusiastic and smart. The shared sense of purpose that we felt there – knowing that we are all concerned about the same issues and looking for the best ways to impact change – is very powerful. But there is risk that we’ll forget that we’ve been together thinking about how to use tech for transparency in strategic ways.

We need the organizers to keep reminding us that we have common issues, challenges and problems. I don’t think they should be helping me to implement projects, however. I didn’t expect to return to Chile from the workshop with solutions. Rather, I expected to come home with doubts. We have already been successful with our work here in Chile, but it’s risky for us to keep holding those minor successes as triumphs. The main value of TABridge is to help us reflect on our work.

Francisca Rojas, research director – Transparency Policy Project (original post)