October 23, 2014

Health disparities and Electronic Medical Records

I have been thinking in my personal life about electronic medical records (EMR.) A number of friends are doctors who service multiple hospitals, and they sometimes encounter different systems at each hospital (if the hospitals even have electronic medical records.)

As a privacy advocate, it might be weird for me to be advocating electronic medical records because of the potential hazards, but as a patient, it is much, much easier to have continuity of care with EMR. I don’t have to drag a paper printout of my test results with me to each new doctor. When I was insured via Kaiser, it literally took minutes from the time I walked from my doctor down to the pharmacy below for my prescription to be filled. The doctor had ordered the Rx while I was with her, and sent it electronically. It was truly a beautiful streamlined feat that I still wonder at. Like pressing the Staples “Easy” button.

Not being a medical professional, I don’t have to worry if I’m repeating back the precise medical jargon that was fed to me before. For patients who have limited English proficiency (LEP), it is easier than having family members serve as sometimes imperfect translators each and every visit. This doesn’t negate the need for each doctor or specialist to ask questions, but it can be helpful for establishing and cross-checking prior medical history. And it’s important for EMRs to be tailored to specific communities – recommendations for best practices are outlined by HHS and Partnership for Women and Families.

Obviously, having a nationwide EMR system exposes a ridiculous amount of HIPAA data to hackers, and there would have to be the most stringent measures taken to protect patient safety. However, there are already certain nationwide EMR systems such as the one used by the Department of Veterans’ Affairs, which was one of the early adopters of EMR. Despite some of the ways in which the VA is currently broken, the agency deserves kudos on this count. Doctors actually point to the VA EMR system as a model of efficiency even compared to systems at top university hospitals. (That the VA system and the Department of Defense systems don’t talk to each other is a whole other story.)

The same way that I can get a prescription filled in different cities because my information and insurance is in the system, it would be great if not only veterans, but all Americans, could see healthcare practitioners who understand their medical histories without having to wait for the home institution or doctor’s office to fax over information.

I could even see a system that has translations of diseases, causes, symptoms, and treatments that a patient could look over. This isn’t perfect because not all patients are necessarily literate in their native languages, but it could help to overcome some of the barriers. Obviously we still want more culturally and linguistically competent providers and translators at hospitals, but this is a way of bridging the divide. We can make tech work to increase voter participation and allow people to cast ballots in their native languages, why not to improve health outcomes?

–Caroline

Lyft Helps AAA-Fund in DC

Editor’s Note: This unsolicited offer to the AAA-Fund is with our neither endorsement or confirmation.

Lyft provides ridesharing with background-checks, driver interviews & Lyft-issued insurance. It’s a cheaper, safer & more reliable alternativs. Lyft just launched in DC & offers AAA-Fund members free rides ($20 credit). Download the app (Android, iOS) at Lyft.me, go to Settings, enter code “DCNP” for $20 credit (expires Sept 1 for first 500 AAA-Fund Blog readers).

The Meaning of Patriotism: Edward Snowden

Is Edward Snowden a patriot or a traitor?  It’s only fitting to bring this up over the July 4 weekend.

As for myself, I’m not sold that he’s in either category.  On the one hand, it takes guts to reveal that our government (specifically, the NSA) has been illegally spying on us.  On the other hand, why did Snowden reveal some embarrassing information that had nothing to do with our civil liberties?  What good did it accomplish to reveal that our country has spied on both our competitors and allies?

Personally, I wish Snowden would return to the US to stand trial.  Given that a lot of people have already volunteered to fund his defense, he would receive a fair hearing.

What do you think about Edward Snowden?

— Gautam Dutta

Question of the Week: Gun Control

If we need to pass a “background check” to get on a plane, why shouldn’t we have background checks for people who are buying ammo for a gun?

— Gautam Dutta

Question of the Week: Silicon Valley

Asian Americans make up over 50 percent of all high-tech employees in Silicon Valley.  So why do only 12 percent of Asian Americans have executive positions at those same companies?

— Gautam Dutta

Penn Loh: Alternatives to Walmart?

Editor’s Note: The below is a reposting of “Alternatives to Walmart?” from our friend Penn Loh. Read more of his work at pennloh.wordpress.com.

walmart map

Having harvested rural and suburban retail markets, Walmart is now ploughing new ground in cities with their smaller urban groceries. From Los Angeles to Chicago and now in Boston, communities are debating over Walmart. On the one hand, residents of economically struggling neighborhoods (often also food deserts) want jobs and access to affordable groceries. On the other, Walmart has become identified with everything that’s wrong with the global economy: workers exploited, environment trashed, local businesses destroyed, and governments paid off.

Walmart’s entry into cities raises vexing questions for community revitalization and development. If you think Walmart will eventually come, then how do you fight for a better deal for workers and the community? If you just say no, then what are other development possibilities? This latter question is the one that a community-university partnership recently started exploring. This article shares some of the learning from the spring 2012 Practical Visionaries Workshop, which brought together 20 organizers from Boston area community groups and graduate students from the Tufts Department of Urban & Environmental Policy and Planning.

We took on this bigger question because it’s the one that rarely gets asked in the heat of battle. But it is the question that must be addressed if, in the longer term, we are to move towards a more just and sustainable economy. Many of the community partners were equivocal about waging intensive campaigns against Walmart, though some are involved in the ChangeWalmartMA coalition. If Walmart ultimately prevails, then the best prospect after several years of struggle would be slightly higher wages and perhaps a package of other community and environmental benefits. If Walmart is defeated, then the community is still left no better off than it was before. Worse yet, if you successfully keep Walmart out of one location, it still may end up in the neighborhood next door. (Though Walmart recently abandoned plans for stores in Somerville and Watertown, it still is looking for sites in Greater Boston.)

Thus, we felt that it was time to begin answering the question of alternatives to Walmart. Unfortunately, despite best efforts, there are not many examples of community economic development that have significantly reversed the tide against lower income communities. What are touted as best cases are often not much different from a Walmart or other big box store: mixed-use commercial developments with an anchor tenant, often a national chain (think Stop and Shop or Target). Some of these developments have been vital additions to communities. But are they creating good jobs? Are they generating shared wealth that recirculates locally? Are they leading to transformation of an unjust and unsustainable global economy?

Envisioning a New Community Economy

As we began exploring these questions, we found that we lacked the language to even talk about other models. In part, this difficulty stems from the dominance of free-market ideology (often called neo-liberalism outside the US). In part, we had trouble because we have put our own community organizing work into a box of civic engagement; we rarely think of local organizing as shaping “the economy”, which we perceive to flow down from the national and global levels.

Therefore, our first step was to better understand the existing (or “old”) economy. By looking at the 60 years since World War II, we started to grasp that there is a relationship between how the economy works (and who it works for) and public policy and politics. What we have today is not inevitable due to technological progress or “natural” market forces.

While we are told in fairy tale style that capitalism has triumphed over all alternatives, we felt the need for new stories about the economy, as we are not all living happily ever after. These new narratives are also frameworks to help us understand the differences and similarities between development models. What makes Walmart better or worse than another national grocery chain, from the perspective of workers, the community, and the global economy? Perhaps one pays better wages and benefits, helping stabilize families and community. But perhaps both still suck profits out of the neighborhood back to corporate headquarters and shareholders.

We found that we are searching for the same things as many others across the globe that some are calling a new economy movement. The Occupy movement helped open up more space to imagine life beyond the current economy. In Latin America, Canada, and Europe, there are already well developed networks and emerging governmental strategies to support the social or solidarity economy – one that doesn’t operate solely for private profit, but based on cooperation, mutual support, equity, and sustainability.

The new economy is not a singular and top-down vision, but a set of diverse but interlinked practices that can sustain us materially and spiritually. The economy is not just what’s sold in the marketplace, but also the gifts that we give, the caring for family and friends, and the food we grow for ourselves. It’s not just about having a job, but a livelihood. It’s not just making more things more cheaply while exhausting our Earth’s resources and causing climate chaos; it’s about bringing economy and ecology into one circle. It’s not just about choosing an alternative lifestyle, but doing what’s necessary to survive and thrive.

Emerging Models

We found inspiration in the many places outside of the US that have been cultivating a new economy. Launched in 1956, Mondragon in Spain has built a network of more than 100 worker-owned cooperatives employing more than 80,000. In Argentina, we learned about the workers who occupied their factories and took them over when the economy collapsed in 2001. In Quebec, we were inspired by the formation of a social economy network in the late 1990s, which with labor union partnership created its own investment fund to support nonprofit and cooperative businesses. A number of South American countries, such as Brazil and Venezuela, have national-level secretariats for the solidarity economy, providing technical assistance and investment funds.

While the movement outside the US may seem light years ahead, we also discovered that the seeds of a new economy are being sown right here at home. Some of these efforts are more recent and consciously about laying the foundations for a new economy. However, some are decades old, even if they don’t yet see themselves as part of a new economy. Here in Massachusetts, we can point to a number of well established worker cooperatives, such as Equal Exchange, a worker owned fair trade coffee company and Red Sun Press. We also have large numbers of socially-owned housing developments, where tenants have significant level of ownerhip control. In Springfield, the Alliance to Develop Power has leveraged tenant ownership of 4 housing developments to build their community economy. Perhaps the best case from Boston is the community land trust established by Dudley Street Neighborhood Initiative in 1988, where they took control over a swath of vacant land and have since built several hundred units of affordable housing as part of their “urban village”.

The Evergreen Cooperatives in Cleveland have gained much attention for launching several worker-owned cooperatives serving the City’s universities and hospitals. So far, they have launched a green commercial laundry, solar-installation/weatherization company, and commercial greenhouse producing fresh lettuce. With significant support from City and institutional leaders, this initiative is fashioning itself after Mondragon, aspiring to build a network of 10 cooperatives with 500 worker-owners in the next several years.

Evergreen has inspired a number of similar efforts in cities across the US. We had the opportunity to learn directly from two such initiatives – one from Springfield, Massachusetts and one from the Bronx. In Springfield, the Wellspring project has brought together anchor institutions and community partners with University of Massachusetts and the Center for Popular Economics to plan for launching a food hub and green building business in the next year. The Bronx Cooperative Development Initiative has also been in planning mode for more than a year, with key community groups, a labor union, and MIT CoLab anchoring the process.

Then What?
As we were learning and being inspired, we also drilled down into the specific question of how to envision alternatives to Walmart in the Boston area. A group of five masters students completed a major report, guided by our community partners, entitled “If Not Walmart, Then What? Envisioning a Different Paradigm for Local Economic Development in Roxbury and Somerville”. The first half of this report tells the stories (in popular terms) of the local economy with Walmart and with a new community economy. The second half frames out a systems alternative to Walmart and sketches out the possibility of a food cooperative in Somerville and a community-owned organics repurposing facility in Roxbury.

Perhaps the biggest lightbulb moment for our exploration this spring is that an alternative to Walmart is not simply a different development on the same site. Walmart doesn’t just bring a new store, but a whole global supply chain, with goods produced across the country and world. A different paradigm starts with thinking about the regional economy and what can be produced here. Thus, we started to look not just at where food is sold but where it is grown and produced. We also looked at what happens to energy and waste flows. The possibility of turning organic waste into fertilizer and energy inspired the idea of an organics facility in Roxbury. In short, we needed to look more holistically at the system.

This exploration is only a beginning. As inspired as we are by efforts such as Evergreen, we also have major questions about how these models are coordinated with community organizing, policy change, local democracy, and building community power. In the end, we have even more questions than answers. But we know that there will have to be work on a number of fronts, including:

  • Popular education – the work of redefining the economy has to proliferate to the streets. This is tough work, but community organizers are looking for ways to connect short-term campaigns to long-term vision.
  • Assessing assets – we already have a lot to work with, but it often goes unrecognized and synergies left untapped. Mapping of existing businesses, residents’ skills, and community-controlled institutions will be critical.
  • Demonstration and pilot projects – functioning enterprises, even if not perfect, are important for showing that other economies are possible. They are also fertile learning grounds for how to build our own solidarity economy.
  • Public policy and resources – a new economy will need public support in the form of policies and resources. Policies should start to tilt the playing field towards the new economy while curbing the worst practices of the old economy.
  • Coordination – the new economy can bring together many partners who have not traditionally worked together, including community groups, unions, environmentalists, local businesses, social investors, and anchor institutions.

Look here for future posts related to the new community economy and our partner efforts here in the Boston area.

Have You Voted Yet?

Have you voted yet?  A record number of Americans will be voting in this Presidential election by mail (though not online, but that’s an entirely different subject).  I just got my mail ballot a couple days ago, and will probably shoot it out by next weekend.

Like it or not, vote-by-mail is here to stay.  On the plus side, voting by mail saves cities and states a lot of money, and is quite convenient:  you don’t have to deal with lines, and you study up on the issues and candidates at home.  On the minus side, if you make a mistake, your vote might not be counted.  In contract, many voting machines these day “spit out” ballots if a voter has made a mistake.

How will vote-by-mail affect the Presidential election?  It all depends.  It looks like the Obama campaign’s on the ball, but we’ll only know for sure on November 6.

Meanwhile, go vote!

— Gautam Dutta

This Could Destroy Everything

This could destroy everything. Yeah. Imagine Don Draper’s saying such with the devil voice he used for the internal-to-SCDP Sno Ball pitch.

This could destroy everything. No, I’m not referring to the Christian Taliban’s dawning realization that eroding the separation of church and state can lead to funding of Islamic schools as exemplified by Louisiana state Rep. Valarie Hodges and Colorado state Sen. Kevin Grantham, respectively

I liked the idea of giving parents the option of sending their children to a public school or a Christian school. Unfortunately it will not be limited to the Founders’ religion. We need to insure that it does not open the door to fund radical Islam schools.

Mosques are not churches like we would think of churches. They think of mosques more as a foothold into a society, as a foothold into a community, more in the cultural and in the nationalistic sense. Our churches — we don’t feel that way, they’re places of worship, and mosques are simply not that, and we need to take that into account when approving construction of those.

Perhaps it would shatter the minds of the Christian Taliban that the founding fathers didn’t roll that way.

This could destroy everything. Still, no. I’m not referring to the mysterious missing mass of The International Prototype Kilogram and its resulting implications for many other measurements.

This could destroy everything. Ron and Rand Paul intend to turn their focus to “internet freedom,” which, like many other uses of “freedom” is code for “no regulation upon the monied interests to the detriment of the people.” Essentially, they want to kill net neutrality. This isn’t a Pirate Party movement with properly operated Tor networks and bitcoins for everyone. No. Not one bit(coin).

Much like how Republicans shouted “GOVERNMENT DEATH PANELS!!!!!!” when ignoring the inconvenient and unfortunate facts that we already have death panels in the form of health insurance companies and the Affordable Care Act actually reduces the opportunities the health insurance companies have to act as death panels, net neutrality prevents internet service providers from deciding what data will be transmitted quickly, slowly, or at all. Internet access is a human right. If the Pauls succeed in their quest, your ability to access this blog could be greatly diminished. If that doesn’t concern you, worry about your Hulu, your Netflix, your Skype chats, your pornography — human, food, house, what have you — just Google whatever you enjoy. If none of those concern you, worry about your precious, precious cat videos.

With the internet so radically altered would we continue to have access to such incredible international television clips?

– Justin Gillenwater

Internet Access – A Human Right

The United Nations Human Rights Council has backed internet access as a human right. Unanimously.

The UN HRC has members across the rights-upholding spectrum including China, which is a well-known internet censor. Recently, China even censored an article shedding light on the riches of its likely next leader.

Do you think internet access is a human right? A necessity? A privilege? Do you think this means access to this blog or amusing cat photos and videos is thus a human right? Let us know in the comments.

– Justin Gillenwater

Question of the Week

Would you feel better if you were stuck in a traffic jam — but everyone was driving emissions-free (as opposed to fume-belching) cars?

— Gautam Dutta