During our lunch, Charlie had an interesting reaction to CLOUD, describing it as the “logical model for the semantic web.”  That lunch conversation, plus my reading of his and Liv Watson’s excellent book, “XBRL for Dummies,” have sparked some interesting thoughts about ways in which CLOUD and XBRL might interact in practical ways.

With all the discussion over transparency, open government and “government” data, it seemed like an interesting example could be culled from current places in which XBRL is already being used: public filings.  Of course, the very fact that a verb like “filed” is used to describe the process tells me that even without CLOUD, XBRL is not meeting its full potential.  If I understand the process for SEC filings in XBRL correctly, a public company still “sends” or “files” their XBRL Instance to the SEC, so as to meet their filing requirements.  In the world of the Internet, this makes no sense to me at all.  If we had to “send” HTML documents around the Internet, the Web would never have taken off!

That being said, I will move on…  The example that follows will highlight how XBRL-wrapped data, further empowered by a contextual set of CLOUD tags, could create a more dynamic and secure process.  Before doing that, though, it is useful to think about ways in which we already interact with government and “tag” those relationships.  [To better understand these concepts, it would be useful to watch CLOUD and the Power of WHO and Connecting WHO and WHAT in the CLOUD at our homepage or on our channel "ANewCLOUD" at YouTube.]

Current “Tagging” By Government

As citizens and businesses, we already have “tagged” information, provided by our government.  Our drivers license or social security card is a government “tag.”   Of course, these particular tags are physically delivered, so we all accumulate a lot of different cards to manage our physical tag infrastructure with the government. Beyond our drivers license or social security card, there are passports, military ids and a whole myriad of other bits of plastic or paper we must carry around.  In most cases, to receive one of these various tags, we must fill out duplicate information on multiple forms to resubmit data that is already maintained in numerous databases, scattered across government silos and agencies.  You get the idea.

Reconceiving the Relationship Between People and Data

Everyone wants to open the government data stores, and that is certainly one step to transparency, but the mess of data behind the store windows may only complicate transparency, not improve it.  The reality is that we must focus on people, and not just the data.  Our data-centric approach drives this deeper architectural problem.  By starting with data and then associating individuals with that data, it is simply impossible for this problem to go away or best case, incredibly hard to fix with current approaches.

However, starting with people and associating their data with them, changes the whole construct of the problem.  For example, my birthday (a data point) doesn’t change, but it is replicated in multiple data silos, from my insurance provider to my doctor’s office to my bank account and to all of the government “tags” I’ve already enumerated.

It doesn’t have to be this way.  As Paul and I discussed in our article Set the Default to Open published in Volume 14, Issue 1 of the Texas Review of Law and Politics, we need to move beyond eGovernment to meGovernment.  As we explored in Section 8 of that piece, meGovernment has implications for both delivery of government services and regulation.

XBRL SEC Filings in a CLOUD-enabled World

The Set the Default to Open article explores a number of examples of meGovernment in healthcare and education settings.  I will focus here on the filing of XBRL reports by public companies with the SEC.

If you think about the discrete, as well as aggregated data, that makes up a filing, the only difference amongst the data is who has “rights” to it.  Currently, we package the data in different worksheets or databases to handle these access issues.  Rather than recreating the data in multiple silos to handle the issue of visibility, a CLOUD-enabled Internet looks at the problem differently.  With a language for people, the cross-tags to the data would handle how this information is seen by different people.  In the CLOUD world, XBRL would be considered a type of WHAT tag.  Each of the discrete bits of company data could be “wrapped” in not only XBRL but also “wrapped” by WHO tags.

So, an analyst at Company X, may only have rights to see and validate certain discrete data, while a controller or CFO at the same company, would have rights to not only see a wider array of discrete data but also see that data aggregated.  When the SEC looked at the data, they would want to know which data at Company X had been cross-tagged with the CFO and CEO’s WHO tags, so as to ensure that the data met the necessary filing requirements.  Rather than sending an instance, the XBRL data could simply stay on company servers, while being protected by the new rights structure envisioned by CLOUD and the many intersections between WHO and WHAT.

Taking this example another step, it would also be possible for company shareholders to view this corporate information differently than those that don’t own shares.  There is another WHAT tag, known as the CUSIP, that would enable this variation in visibility.  CUSIP is the 9-character alphanumeric code that identifies any North American security for the purposes of facilitating clearing and settlement of trades.  Everyone that owns a share of a company could connect their WHO profile to this WHAT tag, thus giving them a different “window” into the XBRL-wrapped data from companies that they own shares in.

Within the new fabric of the Internet enabled by CLOUD, the relationships between WHAT tags are also woven together, connecting the appropriate XBRL-wrapped data to the necessary CUSIP WHAT tags.  CLOUD has modeled a use case and rudimentary screenshots for this idea with SWIFT around their corporate actions project with XBRL and DTCC.

Now that we have walked through the intricacies of linking WHO and WHAT and WHAT and WHAT, the last link in the puzzle is to understand how WHO and WHO connect.  (WHO profiles can exist not just for individuals but for entities as well, like a company, government, school or agency.)  Employees at a company could tag their individual WHO profiles to Company X and thus be cross-tagged with Company X’s institutional WHO profile.  That cross-tag would confer certain added and unique rights to their individual profiles.

The SEC would also have its institutional WHO profile, which could be cross-tagged to its agency employees.  The resulting intersection of these WHOs and WHATs would determine what information would be made visible where.  One set of data could be visible to one SEC employee but not another.

Evolution of Tagging by Government

So, by making data “smart,” it is possible for information to be transformed and made accessible in unique and different ways, without having to ship it around the Internet as if the Internet were nothing more than a 21st century courier service.  The same data in a CLOUD-enabled world can be “viewed” by analyst, CFO, shareholder and securities alike without scattering the same data in multiple databases.  However, those “views” are unique and built around the individual.

This example should not only highlight how CLOUD and XBRL might interact in the case of public filings with the SEC but spark some ideas on how our government tagging could move into the 21st Century as well.  I simply don’t need another card to carry in my digital wallet.

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In a weird twist of political philosophy on privacy and liberty, I agree and disagree with them both.  However, I disagree not because Nicholas and Jim are wrong, but because I do not believe that we must accept the assumptions behind their arguments.  Their assumptions with respect to online privacy are rooted in the idea that the World Wide Web is a static state of affairs, that privacy can only be managed through settings at various websites.  As CLOUD has written and tweeted extensively over the past year, the World Wide Web is but one “view” into the Internet.  True privacy and security of the sort that tackles Facebook’s continued bouts with privacy problems and the challenges with patient data from EHRs will depend on a new language for the Internet, one built around people and not web pages.

One sentence in particular from Mr. Carr’s article jumped out at me.  ”Most of us view personalization and privacy as desirable things, and we understand that enjoying more of one means giving up some of the other.”  Based on the current paradigm of the web, that is true, but what if privacy were architected into the Internet?  Current mechanisms for “logging into” web sites or submitting data force this sort of false trade-off.  CLOUD believes that transparency and privacy can co-exist, but it requires a new perspective.  That perspective is ME 1.0, rather than just Web 2.0.  Quoting from Mr. Carr again, “This tradeoff has always been part of our lives as consumers and citizens. But now, thanks to the Net, we’re losing our ability to understand and control those tradeoffs.”  CLOUD’s goal through it contextual markup language (CTML) is make those tradeoffs clear and put control back in the hands of individuals.

The idea of ME 1.0 is described on our homepage.  This concept and the idea of separating WHO I Am and WHAT I Am are at the foundation of a new Internet.  The language that CLOUD is building is why I can agree and disagree with both Nicholas and Jim.  I agree with Nicholas that as individuals we must secure our privacy to secure our liberties, and I agree with Jim that we should “get smart and learn how to control personal information.”  CLOUD believes, however, that that control should be in our hands and not just at the mercy of others on the Web, be they Facebook, Google, your doctor or the government.

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Dr. Seidman started his Health 2.0 Show webinar with a similar comment to his other addresses to eHealth groups, “it is not about technology but about transforming healthcare.”  He is right, and this is the heart of the meaningful use discussion.  It is also a perspective that should inform our reaction to the letter to CMS from earlier this week.  Slowing things down until 2017 or speeding them up will not matter unless we are approaching the problem in the right way.  With over $200M in beacon grants announced this week, we must ask ourselves:

Are EHRs a data-source or a presentation layer? If we are simply replicating paper-based medical documents in electronic form, are we really advancing the state of the art?  What parts of these data challenges should be handled in federal rules and which parts should be tackled by new open standards to re-architect the very plumbing of the Internet?

CLOUD is a non-profit technology standards consortia advocating, promoting and developing a language for people on the Internet.  This language, like HTML, is not focused on any particular domain, health or otherwise.  As a result, we are not advocating a specific approach to EHRs or final rules from ONC at HHS.  A thorough background on CLOUD’s impact and perspective can be found in Gary Thompson’s comment at the FACA blog on “Creating a Vision for Engaging Patients and Families Through the Meaningful Use of Health IT.” Since there is some concern that CLOUD’s post to the FACA blog is “advocating a product,” it is also posted here in the CLOUD Health section of our site.  As I mentioned to Dr. Seidman via an email exchange, CLOUD is not advocating a product but instead pushing forward a paradigm change and one that is vital.  We are not seeking permission for this new approach but actively engaging appropriate communities from health to finance to education and beyond to ensure that this new approach meets the needs of individuals and in the case of health, this individual could be a patient, physician or other healthcare provider.

The bottomline is that by 2014 it is highly likely that CLOUD’s contextual markup language (CTML) will be in either active use or aggressive adoption and as a result, it will have significant implications for the way in which our information is used and how that information is made both more private and more secure throughout the Internet.  CLOUD will be posting 4 web vignettes shortly to the What is CLOUD? section of its site that walks through CLOUD’s view of the Internet, the idea of ME 1.0 as opposed to Web 2.0, the power of Who I Am, and the impact of separating Who I Am from What I Am to make privacy and security a part of the architecture of the Internet.

As I listen to today’s discussion, I can’t help be struck by a key assumption in the discussion of an EHR.  This assumption is that an electronic health record is simply a digital version of the previously created paper versions of the same record.  This discussion is not dissimilar to the debate several years ago at the Securities and Exchange Commission as they moved to mandate XBRL (eXtensible Business Reporting Language) for the reporting of financial data by public companies in the United States.  XBRL represents a move towards a data-centric model from a document-centric one in financial reporting, and this type of thinking is a vital one in our ongoing health debate.  The EHR in many ways is simply a “container” by which to view health information.  If a clinical trial investigator were looking at the same information, their “container” for viewing the information might be entirely different.  Architecting around the data, rather than the document, is a vital step.  Ensuring that data is also architected around the individual is equally vital.

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Over the past several months, I’ve had the pleasure of attending a number of intriguing conferences on the issue of healthcare.  From Health 2.0 in San Francisco last October and the same event in Paris in early April to the eHealth Initiative program where Dr. Seidman spoke in late January, every event at some point has touched on the elephant in the room, meaningful use and by extension, the EHR.  With the very astute minds at ONC and HITPC, I am not going to argue that a particular direction be pursued or attempt to answer particular questions from the panels on the subject of meaningful use but instead lay out some completely new ideas.

WHY CLOUD, INC.

A year ago I founded CLOUD, Inc. for two reasons.  The first was because Facebook in March 2009 had raised the issue of privacy and ownership with a change in their terms of service.  With so many privacy issues over the last year with Facebook, it is important to note that this particular firestorm was unleashed when they changed their terms of service to say that even if you delete your account, we own your profile.  People realized that this notion of ownership on the Web was not just troublesome with Facebook, but with all their data.  The second reason for founding CLOUD was far more personal.  My wife and I were driving from Austin to Houston to visit the MD Anderson Cancer Center in Houston with a very fancy PET/CT scan of her tumor on a DVD.  Having been involved in technology for a long time, I said that there has to be another way to move data around in healthcare.  In the words of ePatient Dave from the eHI event in January, it was my “now I care” moment.

INFORMATION ABOUT CLOUD, INC.

CLOUD is the Consortium for the Local Ownership and Use of Data.  To understand the goals of the Consortium for Local Ownership and Use of Data and its potential impact on EHRs, PHRs and beyond, we need to look under the hood of the Internet.  The Internet isn’t working at its full potential. Some might even say the Internet is broken.  40 years ago, when Vint Cerf and Bob Kahn developed TCP/IP — the open standard that is the basic plumbing for today’s Internet — their goal was to connect people and networks. Make no mistake: That’s been an enormous success.

A little more than 15 years ago, there was another breakthrough — an open standard for text on the Internet called HTML. And HTML is a big success too. It revolutionized free speech and brought billions to the Internet. However, HTML’s revolutionary success has led to an unfortunate side effect. What’s the problem? Well, HTML has been so successful that it’s spawned confusion between exactly what the Internet is and what the Web is. And that’s a fundamental fact to grasp if you want to understand CLOUD: The Internet and the Web are not the same things. As wonderful as it is, remember: the Web is just one window through which you can see the Internet’s connections.

This is perhaps today’s biggest challenge in the entire field of human communications: the same technology that creates windows into the Internet; the same technology that empowers us to communicate visually via Web pages and related tools; this technology also creates window frames and walls that separate us. The problem is, what I enter in one web site isn’t visible anywhere else. My personal information is replicated in dozens, if not hundreds of different websites. That made sense when primitive Internet tools didn’t give us any alternatives about how to control our personal information. But those days are long gone. Today, the technology exists to empower people to control how anyone else might see, use, or republish our personal information. What’s needed is an open standard building on TCP/IP, HTML, and a variety of other standards to make our vision — local ownership and use of data — a reality for the 21st century.

INFORMATION ABOUT CLOUD HEALTH

This is why CLOUD believes that the next revolution of the Internet is not Web 3.0 or Web 4.0 but instead ME 1.0.  CLOUD’s new language for people is being designed to make the Internet about connections — not walls.  To get a quick glimpse of how this type of thinking impacts the PHR versus PHR conversation, these two posts from www.cloudinc.org are useful and point out why an “interop model” that is limited to healthcare, while intriguing, doesn’t go far enough:

Health 2.0 Europe:  A Personal Health Record (PHR) by Any Other Name…

Digital Debacle for EHRs in Britain: The Challenge of Using 19th Century Thinking to Solve 21st Century Problems

As I also commented on David Kibbe’s post at The Health Care Blog, “EHRs for a Small Planet,” earlier this year, resolving the data silo problem by focusing on the data in the silos will simply perpetuate the EHR problem. Moving data from analog (i.e. paper) filing cabinets to digital filing cabinets simply relocates the problem. Securing user data scattered among countless web silos is complex and consumes huge amounts of time. New identity standards or fancy new EHRs, alone, aren’t going to fix things.

A full paradigm shift is needed, a shift that focuses on patients in health care — and on people in every domain in which making data more useful can improve outcomes.”  ’Exporting data’ or moving information from one record to another is a 19th century view of information.  The Internet liberates us from the constraints of documents, records or paper.  Similar to XBRL in the financial space and the mandate for its use by the Securities and Exchange Commission, we need to shift to a data-centric, rather than document-centric view of medical information… or any information for that matter.

CLOUD’s emerging technology standard is that shift, because as ePatient Dave knows, this is a people issue and not just a data issue.  The challenge goes far beyond identity, to empower Internet users to control precisely how their information is used. Think of CLOUD’s evolving standards as privacy and authenticity standards that work — not a confusing Web-based control panel, but standards to let anyone — user or service provider — develop tools that are simultaneously more sophisticated and easier to use. Doing this requires a shift in thinking equivalent to what HTML brought to the Internet 15 years ago: this time, though it is a mark-up language not for text, but for people. It’s a mark-up language that supports Internet connections that transcend the browser paradigm that’s consumed us since the 90s and thus breaks us free of the challenges of data silos in the medical domain.

CLOUD believes the keys to adoption are, one, Local Ownership and Use of Data — hence the name of our Consortium. Two: to break down health, finance, education, and other silos to simply connect people, not industries. Just as people use one main standard to connect text on the Internet, we should use one main standard to connect with each other on the Internet. And three: empowering people to separate their identity from their data in every silo. Thus, privacy is ensured and the economic value of connections among people and their data grows. It’s ME 1.0, not just Web 2.0.

The following white papers show how this new approach not only improves things within health care (using clinical trials as an example):

A New Contextual Language to Improve Treatment and Prevention of Disease

but across domains (using immunizations as an example):

A New Contextual Language to Improve Usefulness of Immunization and Vaccination Records

The immunization white paper makes clear that the issue we are addressing with meaningful use is not just a health record issue.  For anyone with children, the immunization card that we take to school each year for registration is a clear sign of the cross-domain nature of information.  As the white paper highlights, should we track immunizations in health databases or school databases?  Or is that the wrong question?  Right now, we are duplicating the information in both, and that is definitely not the right answer.

CONCLUSION

We hope that individuals and the industry will engage with CLOUD in this transformation of the Internet.  The new foundation and open standards we seek to build should open a whole new world of tools and resources to address EHRs, meaningful use and a host of other goals for information and improved healthcare.

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Following the Health 2.0 Conference on April 6 and 7 and meetings with the innovation leadership at SWIFT on April 8 in Brussels, my wife and I enjoyed some time with her family in Belgium before returning home.  It was during this time with family that an interesting conversation unfolded over a delicious lunch in the countryside west of Brussels that unexpectedly yielded some intriguing historical insights into language and access.

My wife’s aunt lives in a beautiful old farmhouse that has been renovated several times over its life.  One of those renovations is a truly special library (populated with many, many antique books by her now deceased uncle and former justice on the Belgian Court of Appeals).

It was during lunch in the salon close to this library that one of my wife’s other uncles told the story of another old collection of books in the city of Lille, which is now in France (Lille is only an hour or so from Brussels and used to be a part of Belgium.  Like the Alsace-Lorraine with Germany and France, it is one of the places that has gone back and forth in history.).  As my uncle told his story from Lille, I realized that in many ways it is the same challenge we have with languages on the Internet.

What struck me from his story was when he said the following, “many people in Belgium and France can not read the histories of the region because they are in Flemish and not French.”  Think about that statement for a moment.

Without translations, there are stories that are completely missed by entire populations, because they are in a language that others do not use.  In modern terms, this is akin to Google’s scanning of books into digital form. That undertaking is only a small portion of the ultimate benefit of the project.  Google needs to translate them, too. Because, if they are in a language that no one understands or no one uses, then it is as if they were never printed in the first place.

The history of books can inform us in the debate over ABS transparency, and my uncle, who has no knowledge of technology at all, may have hit the nail on the head with his story of the Flemish books in Lille.  If the disclosures are in a language no one uses, then it is as if the information was never disclosed in the first place.

Of course, language is only one piece of the equation.  Even before books and printing, language flourished, although it wasn’t widely disseminated because the cost of distribution (i.e. scribes) was very high. The invention of the printing press didn’t change language, but it did change the speed, volume and dissemination of information. More people could read because we suddenly lowered the cost of books through the use of technology. The printing press was a major achievement because it removed the human capital limitation of scribes on the amount of information available.

So, language and printing are both vital to the dissemination and access to information.  The SEC must, therefore, not only pick the right language but pick the right process to ensure that information is democratized and markets function.

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Unfortunately, watching Roni Zeigler show off Google Health, it is clear that there is not even a real data utility layer for health.  This is not to say that Google Health is not breaking important new ground, but the idea that I have to import information from the Cleveland Clinic or any other source is what gives me that feeling of deja vu.  For all the prowess of Google, this is just a Web 2.0 version of the old EDI approach to moving information.  Once I click that import button, I now have data in two places, Google Health and the Cleveland Clinic.  Once data is replicated, new challenges develop around which data source is authoritative, and the data runs the risk of being out of sync.

So as not to simply target Google’s approach, it is equally clear that Microsoft has the same perspective.  Their announcement with Siemens is an excellent accomplishment, however, as I just tweeted from @ANewCLOUD and @CLOUDHealth, “Can the PHR be a ‘platform’ like the Internet when Microsoft & Google announce partners/customers? I don’t license the Internet.”

At an intuitive level, a true date utility layer for the Internet can not just exist within one domain.  If it did, it would be like having different flavors of HTML for finance, education, government or health. As we all know, HTML is a presentation layer that like the printing press can print whatever “words” we feed into it.  We don’t have different printing presses for different topics, and so, we can’t have a separate data utility layer for different topics, either.

The ultimate implications of a true data utility layer in health (or any domain) means that any player in the value chain: doctor, payor, patient or any one else, does not need to know if your PHR is in Google Health or Microsoft HealthVault.  Like HTML, I can view a web page in Internet Explorer, Safari, Firefox or Opera, and I do not need to know how the website I am visiting was created.  Until we reach this same point with a data utility layer for the Internet, we will remain trapped in the world of EDI and keep have a strong sense of deja vu.

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One of the questions that was raised by the moderators and by the audience is can these communities translate across geographies?  This question was not raised in the context of language translation but instead from the perspective of broader community engagement.  That same question was also tweeted by @andrewspong in the context of the intersection of these communities between physicians and patients.  That tweet is an excellent one and got me to thinking about how a CLOUD-enabled Internet might change some of the context around how communities are formed and engaged.As CLOUD points out on its welcome page, part of the challenge for any of these patient or physician communities or for that matter, Facebook, or any community site is the fact that the Internet has been segregated by web pages.  The Internet at its core is a large global community.  It is only when you engage the power of HTML for its wonderful presentation capacity that you begin to create silos and separation.  On that note, the Health 2.0 moderator just asked the question of how many online communities doctors will join.  47% of the audience thinks doctors will only join two sites or communities, and one of the panelists commented that doctors want to keep their Facebook and professional lives very separate.  But from a CLOUD perspective, we don’t think one should have to choose.

On my personal blog at The End of Linearity, I point out that “there is no there on the Internet.”  This is a fundamental shift in thinking.  One of the biggest challenges for a Facebook or PatientsLikeMe is the fact that they spend large amounts of time aggregating users at their sites or destinations.  If I’m at Facebook, then I’m not at PatientsLikeMe and vice versa.  At a certain point, users are only going to engage so many communities, so what if that one “patient like me” doesn’t end up at PatientsLikeMe?  What if instead, PatientsLikeMe was a viewer of connections on the Internet and not a destination?  What if Medting didn’t need to aggregate doctors at all but could focus all of their energy on tools, resources and services rather than attracting doctors?  What if patients with a certain disease could bring together in one viewer (notice I didn’t say website) the great content from the first panel at Health 2.0, fellow patients from the second panel and appropriate physicians from anywhere in the world from the third panel?

For this to happen, the Internet must not only move away from its web-centric view of the past fifteen years, but it also must move away from concepts of identity like OpenID that simply makes it easier to log in to these same websites.  We need to move towards a context-centric view of the Internet and bring together people not webpages.  By making it about WHO I Am™, then wherever I am on the Internet, I can be everywhere I need to be.

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With the program commencing at 1pm today, I decided to join my wife on a walk of the Seine this morning and a visit to the Musée d’Orsay.  With a limited time at the Musée d’Orsay, I felt compelled to visit the impressionist and postimpressionist works.  They are my favorites.  As we looked at some Monets, I noticed something very intriguing about each of his works and for that matter all of the painted works in the Orsay’s collection. As important as the works themselves, it was equally important to the artist to put their WHO and WHEN tag on their works.   Monet and others not only signed their names to their art but also indicated the date of their painting.  Of course, Monet’s painting of the Arguenteil Bridge or the Houses of Parliament tells you WHERE it is by the subject matter of his painting.

What does Monet have to do with the Internet, though.  In today’s world of the Internet, we have a new canvas on which to paint our works of art.  Unlike Monet, we do not need to be skilled with a brush, colors and a sense of how to combine them to use the Internet.  We do, however, still use tags like Monet.  When we are on Facebook, we tag WHO we are to connect with our friends.  When we are on Flickr, we tag WHERE we are by sharing photos of our experiences and WHEN they were taken.  This whole notion of WHO I Am™, WHEN I Am™ and WHERE I Am™ is part of our DNA, and CLOUD intends to bring this language for people on the Internet to life.

Of course WHERE I Am matters, and in order to connect with leading European artists in Health 2.0, I have come to Paris.  By being in Paris at the Cité Internationale Universitaire, I can not only see great art from the past but also see the great art of the future.

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The following quote is at the very heart of the privacy issue:

The “summary” records contain basic medical information including illnesses, vaccination history, and could include medication patients have been given. Ages and addresses are also included. (emphasis added)

The issue with privacy on the Internet today is that the data silos into which our records are poured not only include What I Am™ but Who I Am™.  The combination of critical health information, in this case, along with personally identifying information is at the heart of the privacy issue.  If one can separate Who I Am™ from What I Am™, then the privacy issue begins to change, since the NHS database may have the What, but it won’t have the Who.  The patient, along with their doctor, are in charge of connecting Who to What.  No opting out… simply better control… and putting the ownership of the data into its rightful place, the individual.

Approaches, like OpenID, regretfully, are only a part of the solution to this EHR ownership issue. By facilitating “logging in” to web pages and making it  possible to more quickly take all of my information and put it into yet another web and data silo, they don’t change the privacy problem.  They accelerate it.  Their home page states this very clearly, “Log into 50,000 websites with a single username.” Even the OpenID Foundation accepts the world of web sites as a given: “OpenID is a safe, faster and easier way to log into websites.”  OpenID’s challenge is that it accepts the browser and web paradigm of the past 15 years and does not go to the heart of the Internet that was ushered in by Vint Cerf and Bob Kahn 40 years ago.

Katherine Murphy, of the Patients Association, quoted in the article, says it best: “The Health Service should not put in place bureaucratic obstacles to patient choice because they are worried about what patients might choose to do.”

CLOUD seeks to fix a broken Internet, so that patients can have that choice.

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Although Google Buzz has fixed its highly visible privacy flaw that occurred at launch, this episode is another indication that privacy must be woven into the fabric of the Internet, rather than a term of service by vendors.  The challenge ahead of us is not just a technological one but a philosophical one.  At its heart, the question is “who owns ME?”  CLOUD’s goal is to build the technology architecture that makes it possible for us to have “Local Ownership and Use of Data.”

Peter at SWIFT does a brilliant job of explaining how and why this is different than the eID movement and how CLOUD can propel all of these efforts forward by ushering in a new era of ME 1.0.

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