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Pandemic Exercise with Bloggers

We routinely hold readiness exercises at HHS on various emergency scenarios. Typically, people from various parts of the emergency management community sit around a square table, and a moderator paints a picture of a disaster unfolding. It is like a reader’s theater. As events are described, each actor assumes their part, describing what they are thinking and doing to respond.

Slowly, the moderator heightens the stakes and intensifies the nature of the problems, throwing out more complicated circumstances, and challenging the reasoning various players use. It is an excellent way to learn and refine emergency protocols.

Monday, we had another exercise on pandemic influenza. Included in the exercise was a group of journalists, including bloggers. Not amateur bloggers like me. Real pros, people who have built reputations with their readers for innovation and speed.

We invite journalists to participate in our exercises because managing their needs for information is a part of crisis management. We need to learn more about how bloggers would react and interact.

Television reporter Forrest Sawyer was the moderator. He has done several of our exercises and he’s very good. He laid out a set of facts that represent routine health news from around the world and laced it with a few interesting tidbits that could attract the interest of people following the flu world.

Turning to public health officials at the table, Mr. Sawyer asked if they found any of the news that day interesting or concerning. He did the same with the journalists, asking what they would do to get more information and how big a story they thought it was. As the facts became more concerning, several observations came to me.

I found it reassuring how important accuracy was to those that attended our session. They were willing to report rumors but made a point of distinguishing them as such. Many of them said they had separate sections of the page for rumors.

The blogs represented at our session tended to be rather specialized and the bloggers knew a lot about the subject matter. It made them better at challenging the facts they were given. I suspect in a major emergency we would be dealing with a broader range of understanding than in our exercise. These people knew their stuff.

I was surprised how much interaction there is between online communities. They seem to share information, monitoring one another’s sites.

More than one of the blogs talked about the way they use traditional news sources but provide added value. One example is translating foreign news articles into English.

I enjoyed watching the interaction between traditional media and blogs. It’s clear television, major radio and newspapers are monitoring blogs all the time. It is also evident most of them are starting to use blogs to supplement their own reporting. The unlimited supply of space and time is appealing to traditional journalists.

The exercise went most of the day. I was only able to stay until noon, but it was a morning full of learning.

The bottom line for me: Government needs to understand the blog world better, and factor it into the way we interact with people. A growing part of the world relies on bloggers for unvarnished information; something they are not sure they always get from us in government.

Thoughts On Your Comments

I’m sitting at my desk with a  bowl of soup for lunch.  I have 30  minutes and I’m thinking this might be a good time to respond to a few comments  you have sent. 

First, let me say, I do read the  comments. I just have a hard time finding the time to respond and make new  postings too.  So, I tend to concentrate  on new postings.

Comment on Guatemala  Inauguration
On January 18,  Science Teacher wrote:
Can you tell us whether the topic of H5N1 came up  with any of the representatives of Latin American countries? Is there concern?

Response:
I was  in Central America about a year ago working on  Pandemic issues with the health Ministers.   We have helped them build lab capacity and actually trained more than  200 people from Central America on pandemic  related issues.  It is not a top of mind  issue there, and they still have a ways to go on public health infrastructure.  Gratefully, we haven’t seen any H5N1 positive birds in that part of the world.

Comment on Guatemala  Inauguration
On  January 22, David A. Haley wrote:
Instead of talking about "safe" topics such as India or Guatemala, why don't you address  meaningful topics to the American people, such as what efforts you and the  Administration are undertaking to fix our healthcare system? Hello. Is anyone  home in Washington?

Response:
David, you are right in saying my writings have been fairly  heavily oriented to international work lately. I think if you look back in past  postings I have written about many different topics that fit the criteria you  lay out.  The concentration of recent  writings on international work reflects the fact that I traveled fairly heavily  while Congress was out of session.   International work is an important part of my work and it has a direct  reflection on the health of the Americas.  The safety  of imports is an example. Most of my time in India was focused on products  Americans consume. 

I should also confess that I use this blog as a way to keep track  of what I learn on these trips as a journal of sorts. 

I encourage you to keep reading as there will be lots of meaty  issues to discuss.

Comment on Day 5 in India
On January 17m Robins Tomar wrote:
It would be great if you could write one more post about your  overall experience, changes in feelings before and after your visit and some  recommendations from your experience.

This is just a request if you get time from your busy schedule.  Anyway I will be following your blog to know your opinions about what is  happening around us.

Response:
I would say one of the most of the most important changes in my  feelings were the kind of things that come when one actually sees a place  rather than reflecting what you have heard or read.

Here are just a couple of examples:

  • It is hard to adequately explain the challenges of population as large as India’s and how it impacts every public policy issue.         
  • I’m attracted to the people of India.  I have lots of friends in the U.S. of Indian heritage and seeing India created a new context for our relationship.
    In Utah there  is a community of people with roots in India.  They have become prominent in academic and  financial circles.  As governor, I was  often invited to attend their celebrations and events.  I always admired the way they worked to  preserve their connection to an ancestral home even though many of them have  become major successes in the U.S.  Now that I have seen that home, it is easier for me to understand their view of America and India.   
  • I found particularly helpful the understanding I gained of the small farmers in India and their political influence.  I wrote some about this in one of my postings.
  • The number and size of the drug and vaccine manufacturing facilities in India requiring FDA attention was an important actualization.
  • The intellectual connection between the U.S. and India came as a pleasant surprise.  I knew it       existed but didn’t have a sense of scale.

I could go on and on, but this will give you a small sense of what the trip did for me.


Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
The US  government/we the people already own an excellent EHR - the VA's VistA system. It is fast, simple to use, incredibly  stable and a large portion of the work needed to make it viable in private  practice is already done. Two organizations have taken it,  "de-veteranized" it and gotten it CCHIT certified. With a small  fraction of that cost, the system could be fully upgraded and modified to meet  all of the needs of the commercial market-place and fully implement the quality  measures and disease registries necessary to adopt pay for performance and  improve the quality and lower the cost of healthcare

Response:
I am a big admirer of VISTA and  the Veterans Administration.  In fact, I  borrowed the National Coordinator of HIT from the VA, Dr. Rob Kolodner.  The problem comes in creating compatibility  between other systems and the VA because most patients, even in the VA system, deal  with multiple providers outside their system.   We need to achieve interoperability.   As you point out, there are some providers who are using the VA system  as a foundation to develop smaller systems and we welcome that.  This answer is short but in the press of  time, I’ll leave it at that.

Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
It is very easy for the Sec of HHS to say that Electronic records  are the answer to rising Medicare costs. It is very short-sighted to ignore the  reality that the numbers of the Medicare-eligible are increasing every month.  Besides, with increased litigiousness of society, has the HHS conducted an  objective study of what percentage of procedures physicians carry out are just  to protect themselves against frivolous law suits?

Response:
There are a number of studies that document the practice of defensive  medicine.  I would support reforms that would  minimize the practice or perceived need.   Many believe that the development of best practice quality measures will  provide some protection.

Comment on Electronic Medical Records  and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
While agreeing that the current formula is an utter failure, I  would like to point out that Physicians are now working at 2005 reimbursement  levels (far from keeping pace with inflation). The moral of this horror story  is that if professionals are paid their legitimate dues, they will not abuse  the system. It is useful to remember that neither the gas nor electricity  prices; employee salaries nor office rent; neither liability premiums nor cost  of EMRs have stayed at 2005 levels - unlike Medicare payments under this  convoluted SGR formula. I have yet to see any effort by Medicare or any other payee  to actually interact with practices that have had extensive experience with EMRs  to identify real world solutions to real world problems. Until that happens, it  will be unreasonable for Mr. Leavitt to expect physician practices to  voluntarily adopt Electronic records. So if HHS would like to push this idea,  let there be a level playing field and objectivity in assessment of its impact.

Response:
I stand by my belief that the system doesn’t work well.  You would be amazed at the amount of work  Medicare does to estimate what things cost for doctors and therefore what the  reimbursements should be.  The truth is, command  and control regulator systems rarely get it right.  A well informed marketplace where consumers  have information on quality and price will both make the relationship between  doctor cost and charges far fairer.

In a previous entry, I talked about walking through a grocery  warehouse with 50,000 items and asked the manager what would happen if the  government started setting prices on every item.  His answer was right, in my view: “fewer  products, higher cost, and continual arguments.”  I told him, he had just described Medicare  reimbursement.


Well, the soup is gone and my time is up so I’ll conclude and post.

 

Meeting China's 'Netizens'

In a compact Beijing studio on Monday, Li Xing, the International News Editor of China Daily had questions for me. She asked me about meeting a little girl in western China who had contracted the H5N1 avian influenza virus. We then talked about import-safety agreements with the Chinese governments and the availability of health insurance to U.S. citizens. The questions she asked for more than a half-hour were not just her curiosities, but rather questions e-mailed from China Daily’s online readers whom she refer to as netizens.

I like the concept of netizens. I have to admit, I hadn’t thought much about the term until Li Xing used it. We are citizens of nations but also find ourselves members of global communities connected not by geographic boundaries but our collective interests and passions. When I saw a stream of questions filling Li Xing’s computer screen from some of the estimated 10 million China Daily-reading netizens located all over the world, the term was abruptly given more meaning.

As we talked, two studio-quality digital video cameras streamed our conversation over the Web. Our words were simultaneously transcribed into text. The next day China Daily’s print edition published an article summarizing our interview. That is a combination of digital mediums with serious reach and the capacity to interactively engage people.

I’ve become a novice blogger. I started a few months ago. My first effort was a blog related to pandemic flu. The input we received from netizens (though we didn’t refer to them as such) was remarkably good and persuaded me to spend more time exploring different combinations of media as public policy tools.

In the space of an hour, my encounter with Li Xing and her colleagues at China Daily elevated my thinking some. It seems possible I should be embarrassed not to have realized this before. I suspect there are 26-year-old netizens reading this saying, “Where has this guy been?” Well, despite what most would call a pretty good technology pedigree, the term netizen and its sociologic potential just eluded me.

During our conversation I told Li Xing about my blogging adventure. She volunteered to tell China Daily’s netizens about it. I hope she will because I want to continue the discussion I started with Li Xing and her ten million friends. I have a lot to learn about good netizenship.

For those who linked here through China Daily, it might be helpful for me to tell you about my blog.

First, I am committed to write it myself. For better or worse, what you get are my words, not the product of my staff. They manage the blog and occasionally clean up the postings some but I write the content. I also attempt to read the comments. Time simply doesn’t permit me to regularly respond to the comments. However, once in a while I’m inspired or agitated enough to respond. But time is a real issue. I was the first U.S. Cabinet Secretary to use a blog. So far, I’ve enjoyed it and I find it helpful in hearing different points.

I aspire to write a couple times a week. Lately it’s been more like once a week. Most of the posts are written on my laptop while I’m sitting on an airplane or in a hotel room. Tonight, as I write, I’m on an airplane winging my way back from Beijing.

I’m learning about the blog culture as I go. So, occasionally I make errors, but readers have been good-natured in pointing out my mistakes. For example, when I get on a roll and I tend to be too long. A couple of readers pointed out it would be better to break it up some with subheadings or even individual posts. I’m working on that.

My blog also serves as a combination journal and sounding board. However, I confess to being a little bit circumspect at times given the nature of my responsibilities.

I hope you enjoy occasionally reading my thoughts. I’ll look forward to hearing the reaction of my fellow netizens.

Continuing the SCHIP Debate

I’m falling into a pattern of posting once a week. I have ambitions to do better than that. The reality, however, is if I’m going to keep the commitment I made to write the postings myself, I’m likely to be imperfect in my regularity. I suspect one solution is to write shorter, more frequent postings; something a few readers have properly suggested.

My week has been focused on the reauthorization of SCHIP. This is playing out about the way I expected it would thus far. Some months ago, the Democratic leadership in Congress made clear they were going to send the President an SCHIP bill he would have to veto. Likewise, the President made clear he would veto any bill that didn’t focus on poor children as the primary priority, or that motivated middle income people with private insurance to cancel it to get on a government program. The bill Congress passed violates both principles. So, the President did exactly as he said he would and vetoed it.

Now, the leadership of Congress has decided to put the override vote off for two weeks. During that period we will hear a lot of political rhetoric but in the end the veto will be sustained. When that occurs we can get down to the business of solving this problem. Demagoguery is a politic ritual in situations like this that just has to be endured.

Over the weekend, President Bush made a significant point in his radio address. This isn’t about money; it is about the priorities, accountability and focus of the program. He wants to reauthorize SCHIP with its core mission of helping poor children intact. The Children’s Health Insurance Program isn’t a program for adults; it wasn’t instituted to help children in families with middle or upper incomes.

The policy differences between the two sides are real and more complicated than a duel between two competing budget numbers. President Bush made clear when we can find a solution to our policy differences he is willing to work with Congress in finding additional money, if necessary.

I’m asked regularly, “So what’s the President’s SCHIP budget number; how far is he willing to go?” There isn’t an answer to that question yet, because we aren’t even talking to the other side of the debate. They have chosen to proceed as though the President’s opinion isn’t important. They will likely continue to act that way until after the veto is sustained. This is a dance that occurs whenever controls of the legislative and executive branches of government are held by different parties. Each time there is a shift in the power structure of Washington, the resilience has to be measured. Each time the lesson is the same. It takes both the legislative branch and the executive branch to make a law.

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Evaluating after More than a Month

Six Week Evaluation: Your thoughts?

Several readers have made helpful suggestions over the six weeks since I opened this blog. Here are my observations so far:

  • I have written each entry myself, as promised. I’m fairly sure my colleagues who manage the site clean them up some before posting, but it is punctuation and small editing only.
  • Most postings have been written on airplanes or late in hotel rooms during the late evening. Finding the time has been a bigger challenge when I’m in Washington.
  • My postings tend to be too long.
  • I may invite a few people besides me to post an entry occasionally. It will add variety and perhaps stimulate discussion.
  • The comments have been constructive. I think the blog would be better if I could respond to more. It’s simply a time issue.
  • Some comments ask factual questions others could respond to. I’m thinking it would be good to have another HHS person respond to those. I think we’ll try that for a while. They should respond in the comment section not as a blog posting.
  • Readership has been reasonably good. We continue to pick up new links each week. We’re getting close to a hundred. I have no idea if that’s any good. Maybe some of you more experienced bloggers can give me some perspective. We get thousands of visits every week.
  • On a couple of occasions news media have used blog comments to ask questions more appropriately directed through normal channels at HHS. I hope the media will find this interesting enough to read, but if they have questions it would be better to call or email Public Affairs at (202)690-6343.

The bottom line: So far, this has been a positive experience. I will get better at it as we go. I’ve not been as regular as I aspire to be. I’ll keep working on that. I’m still not committing to blog perpetually, but for now I’ll keep writing.

I would invite you to suggest how we could expand readers and improve the blog. Any thoughts?

Wading into Blogdom!

A couple of months ago, we had a successful experiment with our pandemic flu blog. It was done in advance of a conference on preparedness we had in Washington D.C. I found myself engaged in reading the comments and learning from them. So, I’ve decided to wade in a little deeper into blogdom by writing one for the next month or so. I’m going to see how I feel after that time period. I may continue; I may not.

The viability of my capacity to do this longer term, will be determined by time management considerations. I want to write my entries personally, rather than relying on staff. If I can do it justice we will continue; if not—we won’t. I likely won’t write everyday, but I commit to check in most days and will read as many of the comments as time allows. I have no idea how many comments there will be. I may try to reply to comments occasionally, but not always.

I expect some of my entries may only be a paragraph or two punched out on my Blackberry while traveling in a car or waiting in an airport. Anybody who uses a similar device understands the efficiency and the limitations (No spell check, for example).

I will have some help monitoring the comments. Our web management folks feel that is important. They have set some rules about how comments will be handled. I’ll leave management of that to them.

Most of my postings will typically be about something I’ve learned or experienced during the day. What I value most about this job is the remarkable opportunities it provides to learn and gain perspective on problems. I hope I can share a small part of it this way. I may also invite some of my colleagues at HHS to share some of their experiences.

There are an unlimited number of things to write about. This is an intensely demanding period. For example, I’ll be traveling the last two weeks of August in Africa to get a better perspective on our nation’s efforts to battle HIV-AIDS and malaria. I am in the midst of a special assignment President Bush has given me to lead a Cabinet level working group on import safety. The reauthorization of SCHIP must occur before the end of September and I’m focused hard on increasing the velocity of health information technology standards development.

Topics won’t be the rate-limiting factor here; time will. But, let’s give this a try and see what happens. I hope you will add to the value with your comments.