May 2011

Last week, Comcast announced that it is creating a new position in the company called “Executive Director of Diversity and Inclusion” and appointed Maria G. Arias to take on its responsibilities. Arias will “direct, manage, and organize Comcast’s diversity program strategy,” which includes important issues such as minority recruitment, career development, suppliers, and programming. Named one of the “100 Most Influential Minorities in Cable” in 2010, Arias is well positioned to serve as a role model for minorities considering careers in the telecommunications and high-tech sectors.

Comcast and other broadband service providers have long been leaders in developing minority workforces. This recent announcement is great news for minority communities that are yearning for increased minority-focused content and general inclusion in the digital media sector. But more work needs to be done across other parts of this emerging ecosystem, including the high-tech sector. The San Jose Mercury News published an article last year disclosing figures that revealed just how few minorities are employed by firms operating in Silicon Valley, our nation’s leading hub for innovation. As previously discussed on BBSJ, these findings are highly discouraging.

Nevertheless, minority employment in high-tech appears to be improving, albeit slowly. Following the lead of companies like Comcast, a growing number of high-tech firms are promoting tech-based educational programs and embracing in-house diversity initiatives. The Information Technology Industry Council, for example, has reported that Cisco has deployed a number of educational projects focused on building “tomorrow’s workforce,” many of which target minority students enrolled in science, technology, engineering, and mathematics (STEM) programs.

[Commentary] American presidents have always reached out to the public. From the beginning, our presidency was created to be something distinct from the monarchs of Europe. Here, the door was always open. Literally, in the case of Andrew Jackson, who opened the White House to any and all. Americans took advantage of the invitation, coming to Pennsylvania Avenue and leaving food, gifts and messages. This stream of visitors formed a curious and colorful line through the Jackson presidency, and they were not all citizens — one official reported finding a goat wandering the halls. The modern world has placed limits on this openness. A president’s exposure to the public was restricted after the assassination of President John F. Kennedy, and tightened further after President Ronald Reagan was shot. The terrorist attacks of September 11, 2001, brought fundamental changes. Walls went up, security was hired, and the guardians of official Washington began to see the public itself as a threat. The president’s access, what little remained at that time, evaporated. It took the freshest of modern technology — Facebook and broadband access — to carry our politics back through the open door. Obama’s use of Facebook was a new form of political communication, and we will see more of it in the future. The fact that millions of Americans will be left out because they don't have a Web connection gives new urgency to the One Economy campaign and its work to extend opportunities for broadband Internet access to every household.

In their recent book, "The Death and Life of American Journalism," Robert McChesney and John Nichols tracked the number of people working in journalism since 1980 and compared it to the numbers for public relations.

Using data from the U.S. Bureau of Labor Statistics, they found that the number of journalists has fallen drastically while public relations people have multiplied at an even faster rate. In 1980, there were about .45 PR workers per 100,000 population compared with .36 journalists. In 2008, there were .90 PR people per 100,000 compared to .25 journalists. That's a ratio of more than three-to-one, better equipped, better financed. The dangers are clear. As PR becomes ascendant, private and government interests become more able to generate, filter, distort, and dominate the public debate, and to do so without the public knowing it. "What we are seeing now is the demise of journalism at the same time we have an increasing level of public relations and propaganda," McChesney said. "We are entering a zone that has never been seen before in this country."

Recently, colleagues have raised questions about pending state legislation related to electronic prescribing (e-prescribing) and in particular the concept of electronic prior authorization (ePA) for medications.

We thought it would be helpful to discuss what we know about the current state of e-prescribing and ePA. E-prescribing provides significant advantages in contrast to its paper analog. Coupled with other complementary technologies, such as drug-drug interaction checking, e-prescribing can improve patient safety, increase prescribing accuracy and efficiency, and lower costs by notifying providers of generic or preferred drug list alternatives.

Over the past three years, Congress has signaled its support for e-prescribing by promoting its use in two major laws: Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act covers certain eligible professionals seeking to become meaningful users of certified electronic health record (EHR) technology in the Medicare and Medicaid EHR Incentive Programs. Below are a few points that address some of the questions raised by our state colleagues as they consider e-prescribing related legislation.

It is useful to keep apprised of the technical requirements (capabilities and technical standards) that are currently part of Federal health IT programs to ensure consistency and avoid potential conflicts.

While ONC requires as a condition of certification (for the purposes of meaningful use) that EHR technology be capable of generating and transmitting electronic prescriptions, certification does not require that EHR technology also be capable of performing electronic prior authorization.

We are not aware of a widely adopted, common, industry transaction standard that has been demonstrated to support real-time ePA, nor are we aware of a common or universal electronic format that has been demonstrated to facilitate distribution of prior authorization forms. We are aware of work that has been done by the National Council for Prescription Drug Programs (NCPDP) to create an XML-based ePA messaging standard and a real-time eligibility check messaging standard. We understand that these are draft standards that have not yet been tested in pilots and have not been fully “balloted” (voted on) through NCPDP’s process or been finalized as American National Standards Institute (ANSI)-accredited standards.

There is a lack of established and fully vetted standards to support ePA and the current lack of capability to support ePA in implemented EHR systems. Therefore, requiring real-time electronic prior authorization as a prerequisite technical capability before health care providers could e-prescribe and/or access drug formulary information may be difficult to implement, and could otherwise prevent providers from being able to e-prescribe. If such requirements prevent providers from being able to e-prescribe, it could also keep them from being able to participate in the incentive programs noted above.