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open government

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

As more and more people become connected using social media, researchers, media and public health officials naturally are increasingly interested in what their updates can tell us about the world. According to the Pew Internet and Life Project, 18% of American adults online are on Twitter with some 200 million active users globally sending out 400 million tweets every day. That amount of data is catnip for researchers interested in everything from sentiment analysis, food security or embryonic pandemics.

sentiment-analysis

When people are sharing what they’re seeing using social media, city managers and public health agencies have increasingly learned to listen to what’s happening in the hopes of responding to fires, floods, odd smells, tornados, crimes or other public emergencies more effectively.

Some of the reported results are genuinely exciting, too: according to David Kirkpatrick, the director of UN Global Pulse, Twitter data accurately predicted the cholera outbreak in Haiti two weeks earlier than official records. Kirkpatrick’s team is now examining the predictive value of millions of tweets sent in Jakarta, Indonesia for assessing food security.

There are caveats to crunching Twitter data as a proxy for what’s happening in a given region or industry. As Pew Research showed in March 2013, what’s happening on Twitter is not necessarily representative of public opinion or a representative sample of a given population.

The perils of polling Twitter are particularly worth noting for media, as New York Times interactive developer Jacob Harris demonstrated this July.

That said, there are an increasing number of projects that are exploring the potential of Twitter for socially networked transparency. In Chicago, health authorities are seeking out Chicagoans who tweet about feeling poorly and ask them to share the restaurants they ate in most recently. Chicago’s health department told the Chicago Tribune that 150 Chicagoans have been contacted since the “Foodborne Chicago” initiative began, triggering 33 restaurant inspections in the first month, some of which found health code violations.

This kind of “high touch, high engagement” human approach requires a lot of humans, however, whose time is hard to scale over an entire city.

Further to the east, a research group at the University of Rochester analyzed millions of tweets in New York City to develop a system to monitor food-poisoning outbreaks at restaurants. The research crunched 3.8 million tweets, traced 23,000 restaurant visitors and found 480 reports of likely food poisoning.

As Henry Kautz highlighted in his column on public health and social data in the New York Times, there’s considerable interest in what can be gleaned from what people are sharing online:

“Groups at Brigham Young University and the University of Iowa have done extensive work on influenza monitoring via Twitter posts. Researchers at Microsoft are helping to identify women who are at risk of severe postpartum depression by analyzing changes in their online behavior. And researchers at Cornell are mining the social media stream to gather data for urban planning and environmental conservation.”

As always, anyone making public policy decisions based upon such data will have to take into account who is represented in the data or who is not.

That’s also true in efforts like Lungisa in South Africa, too, where a project is encouraging residents to hold government accountable using Twitter and Facebook. The issues raised on social media reflect the needs of the connected, not necessarily those of the poor, or of the powerful, who have their own channels to influence policy.


We’re looking for more examples of socially networked transparency, so please keep them coming. There’s already some rich veins for inquiry that some digging is turning up. For instance, in the most recent installment of his “week in civic innovation,” David Sasaki shared two helpful resources, which in turn have many more links to various projects and initiatives:

1) The Crowdsourced International Civic, Democratic and Transparency Website List, maintained by mySociety, has a long list of global efforts.

2) This list of Transparency and Accountability Resources & Initiatives, from the Engine Room, has a more US-centric collection.

If there’s something important happening in your town, state or industry, please let us know.

Cries for increased “transparency” has become a rallying cry across industries and governments, as consumers and citizens look for more information about what they’re eating, buying, breathing, drinking or how they are being governed. What “does transparency” means, and for whom?

Targeting transparency can have unexpected outcomes, particularly as humans and societies adopt and adapt novel technologies to suit their needs or goals. For instance, research at Northwestern found hospital report cards could actually decrease patient welfare. The dynamics of transparency are complex, given that systems for reporting may reveal corruption, fraud or abuse by powerful interests but can also expose people to retribution or discrimination.

[Radiation plumes in Japan]
[Radiation plumes in Japan]

“The challenge is to create and design transparency policies that actually work for people and don’t just waste time or create a bunch of information that’s difficult to understand or make organizations go through the fairly expensive processes of collecting information that nobody then goes on to use,” said professor Archon Fung, in a recent interview. “The policy challenge has to do with designing transparency policies so that they produce information that is actually highly valuable to people and that people can take action on.”

Many of the perils and promise of transparency have been explored at length in “Full Disclosure,” by the directors of the Ash Center’s Transparency Policy Project, from calorie counts to restaurant inspections. As is so often the case, such research raises as many questions as it answers. When and how do consumers respond to new information? What factors influence whether private companies respond to disclosure mandates by reducing the risks posed to consumers or improving practices? Where and when should policy makers apply disclosure versus other policy tools?

The answers to all of these questions are further complicated by the introduction of networked systems for communication and disclosure, particularly the emergence of powerful mobile devices and social media. The Ash Center is actively looking for examples of socially networked transparency systems that reduce risks and provide new tools for citizens and consumers to navigate the world. Examples of networked transparency include:

  • hospital ratings by individuals that may help other patients avoid the risk of medical error or infections
  • Websites like PatientsLikeMe that may provide earlier warning of drug side effects, safety or effectiveness problems
  • Civic media services like Safecast, which leverage citizen science and public data to inform the public about radiation risks
  • Data sources like Google Flu Trends, where the actions of individuals provide tacit information that can augment existing systems for early warning of outbreaks

In each of these examples, the collective actions of many individuals reporting information based on their experience, aggregations of reliable reports, or sensor data is collected and then disseminated in a way that makes the associated risks to the public risk more visible and transparent. Such networked transparency systems can then be adapted and used to inform individual choices or change behaviors of the entities creating the risks, saving lives or reducing harms.

Over the next several months, the Transparency Policy Project will be looking for more examples of networked transparency, from grassroots efforts created by public laboratories to reporting systems created by governments.

As you’d imagine, the people collaborating on the research (including the fellow writing this post) will be looking for tips, feedback, comments and links from you. Please email your ideas or pointers to alexanderbhoward [at] gmail.com, or reply to @digiphile or @sunshinepolicy on Twitter. Each week, we’ll gather together what we’ve learned to date and share a digest at this blog.

Huge and impenetrable government databases – technically public but inaccessible in practice – have long hidden critical health and safety information. Consumers and patients need emerging knowledge about product defects, drug side effects and service flaws to choose safe cars, cribs, doctors, medicines and much else. Government has long collected this kind of information from us: manufacturers, retailers, medical experts and consumers send in millions of stories every year about unexpected problems that cause deaths or injuries. But, despite efforts toward more open government, shoppers and patients often can’t get access to this developing knowledge to make smart choices.

Now software developers are filling the gap – making important clues about health and safety risks hidden in government-gathered information easily available to consumers – and hoping to make a profit, of course. Two examples to watch: AdverseEvents Inc. and Clarimed LLC are firms that translate dense data about unexpected drug side effects and medical device malfunctions into usable information for patients and doctors. Can such transparency save lives and improve product safety? The CEO of Clarimed told Melinda Beck of the Wall Street Journal : “The best way to drive quality improvements is to make things crystal clear and transparent as possible.”

Mary Graham, co-director — Transparency Policy Project

A much talked-about innovation in public policy has been the push to achieve greater transparency and accountability through open government strategies, where the public has access to government information and can participate in co-producing public services. At the Transparency Policy Project we have been investigating the dynamics behind one of the most successful implementations of open government: the disclosure of data by public transit agencies in the United States. In just a few years, a rich community has developed around this data, with visionary champions for disclosure inside transit agencies collaborating with eager software developers to deliver multiple ways for riders to access real-time information about transit.

Transit agencies have long used intelligent systems for scheduling and monitoring the location of their vehicles. However, this real-time information had previously been available only to engineers inside agencies, leaving riders with printed timetables and maps, that, at best, represent the stated intentions of an complex system that can be disturbed by traffic, weather, personnel issues and even riders themselves.

Recognizing the need to be able to access this information on-the-go and in digital format, Bibiana McHugh of Portland’s TriMet agency worked with Google in 2006 to integrate timetable data into Google Maps, eventually becoming Google Transit. McHugh went further, publicly releasing TriMet’s operations data: first the static timetables, and eventually real-time, dynamic data feeds of vehicle locations and arrival predictions. Local programmers have responded with great ingenuity, building 44 different consumer-facing applications for the TriMet system, at no cost to the agency.

Transit Apps and Ridership by City

Other transit agencies have adopted this open data approach with varying outcomes. The most successful agencies work closely with local programmers to understand which data is in demand, troubleshoot and improve the quality of the data feeds. Programmers also make the link between end users and transit agencies by filtering up comments from apps users. This iterative feedback loop relies on a champion within the agency to build strong relationships with the local developer community. Of the five transit agencies we studied, Portland’s TriMet and Boston’s MBTA exemplify this approach and have generated the highest ratio of apps per transit rider (see table). Meanwhile, the most reluctant agency to adopt open data, Washington DC’s WMATA, only has eleven applications serving its customers.

The number of apps built by independent developers is important, indicating the variety of options riders have in selecting which interfaces (mobile, desktop, map-based, text, audio) and platforms best fit their needs to access transit information. As we have learned from our research on what makes transparency effective, simply providing information is not enough. Format and content matter, and should address the needs of a targeted audience. What we have seen in our study of transit transparency is that local programmers have been the critical intermediaries, taking raw data and generating a variety of information tools that transit agencies could not have imagined on their own. For other open government initiatives to spark this level of innovation and public benefit, they must identify their audience of information intermediaries and foster those relationships.

Francisca Rojas, research director – Transparency Policy Project
Original post on Google’s Policy by the Numbers blog (January 27, 2012)