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I swear, I am not usually a person who looks up medical conditions online. I lived without health insurance long enough that I am far more likely to try to sleep off anything short of decapitation.

Give us an idea of…” Noya Baram rubs her temples. “Oh, well.” Augie begins to stroll around again. “The examples are limitless. Small examples: elevators stop working. Grocery-store scanners. Train and bus passes. Televisions. Phones. Radios. Traffic lights. Credit-card scanners. Home alarm systems. Laptop computers will lose all their software, all files, everything erased. Your computer will be nothing but a keyboard and a blank screen. “Electricity would be severely compromised. Which means refrigerators. In some cases, heat. Water—well, we have already seen the effect on water-purification plants. Clean water in America will quickly become a scarcity. “That means health problems on a massive scale. Who will care for the sick? Hospitals? Will they have the necessary resources to treat you? Surgical operations these days are highly computerized. And they will not have access to any of your prior medical records online. “For that matter, will they treat you at all? Do you have health insurance? Says who? A card in your pocket? They won’t be able to look you up and confirm it. Nor will they be able to seek reimbursement from the insurer. And even if they could get in contact with the insurance company, the insurance company won’t know whether you’re its customer. Does it have handwritten lists of its policyholders? No. It’s all on computers. Computers that have been erased. Will the hospitals work for free? “No websites, of course. No e-commerce. Conveyor belts. Sophisticated machinery inside manufacturing plants. Payroll records. “Planes will be grounded. Even trains may not operate in most places. Cars, at least any built since, oh, 2010 or so, will be affected. “Legal records. Welfare records. Law enforcement databases. The ability of local police to identify criminals, to coordinate with other states and the federal government through databases—no more. “Bank records. You think you have ten thousand dollars in your savings account? Fifty thousand dollars in a retirement account? You think you have a pension that allows you to receive a fixed payment every month?” He shakes his head. “Not if computer files and their backups are erased. Do banks have a large wad of cash, wrapped in a rubber band with your name on it, sitting in a vault somewhere? Of course not. It’s all data.” “Mother of God,” says Chancellor Richter, wiping his face with a handkerchief.

The US traded its manufacturing sector’s health for its entertainment industry, hoping that Police Academy sequels could take the place of the rustbelt. The US bet wrong. But like a losing gambler who keeps on doubling down, the US doesn’t know when to quit. It keeps meeting with its entertainment giants, asking how US foreign and domestic policy can preserve its business-model. Criminalize 70 million American file-sharers? Check. Turn the world’s copyright laws upside down? Check. Cream the IT industry by criminalizing attempted infringement? Check. It’ll never work. It can never work. There will always be an entertainment industry, but not one based on excluding access to published digital works. Once it’s in the world, it’ll be copied. This is why I give away digital copies of my books and make money on the printed editions: I’m not going to stop people from copying the electronic editions, so I might as well treat them as an enticement to buy the printed objects. But there is an information economy. You don’t even need a computer to participate. My barber, an avowed technophobe who rebuilds antique motorcycles and doesn’t own a PC, benefited from the information economy when I found him by googling for barbershops in my neighborhood. Teachers benefit from the information economy when they share lesson plans with their colleagues around the world by email. Doctors benefit from the information economy when they move their patient files to efficient digital formats. Insurance companies benefit from the information economy through better access to fresh data used in the preparation of actuarial tables. Marinas benefit from the information economy when office-slaves look up the weekend’s weather online and decide to skip out on Friday for a weekend’s sailing. Families of migrant workers benefit from the information economy when their sons and daughters wire cash home from a convenience store Western Union terminal. This stuff generates wealth for those who practice it. It enriches the country and improves our lives. And it can peacefully co-exist with movies, music and microcode, but not if Hollywood gets to call the shots. Where IT managers are expected to police their networks and systems for unauthorized copying – no matter what that does to productivity – they cannot co-exist. Where our operating systems are rendered inoperable by “copy protection,” they cannot co-exist. Where our educational institutions are turned into conscript enforcers for the record industry, they cannot co-exist. The information economy is all around us. The countries that embrace it will emerge as global economic superpowers. The countries that stubbornly hold to the simplistic idea that the information economy is about selling information will end up at the bottom of the pile. What country do you want to live in?

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Fiscal Numbers (the latter uniquely identifies a particular hospitalization for patients who might have been admitted multiple times), which allowed us to merge information from many different hospital sources. The data were finally organized into a comprehensive relational database. More information on database merger, in particular, how database integrity was ensured, is available at the MIMIC-II web site [1]. The database user guide is also online [2]. An additional task was to convert the patient waveform data from Philips’ proprietary format into an open-source format. With assistance from the medical equipment vendor, the waveforms, trends, and alarms were translated into WFDB, an open data format that is used for publicly available databases on the National Institutes of Health-sponsored PhysioNet web site [3]. All data that were integrated into the MIMIC-II database were de-identified in compliance with Health Insurance Portability and Accountability Act standards to facilitate public access to MIMIC-II. Deletion of protected health information from structured data sources was straightforward (e.g., database fields that provide the patient name, date of birth, etc.). We also removed protected health information from the discharge summaries, diagnostic reports, and the approximately 700,000 free-text nursing and respiratory notes in MIMIC-II using an automated algorithm that has been shown to have superior performance in comparison to clinicians in detecting protected health information [4]. This algorithm accommodates the broad spectrum of writing styles in our data set, including personal variations in syntax, abbreviations, and spelling. We have posted the algorithm in open-source form as a general tool to be used by others for de-identification of free-text notes [5].

Since 2000, no important technology innovation in the United States has been scaled up to create millions of manufacturing, marketing, and engineering jobs here, as personal computers and related industries did. While selling online and social networking are clearly transformational movements that have created entrepreneurial opportunities, fewer than fifty thousand traditional jobs—those with full-time hours, benefits, and health insurance—have been created.

Nearly half a million people chose health plans through HealthCare.gov during the first week of the new open-enrollment period in the online insurance marketplace, federal health officials announced Wednesday.

Wellness programs offer important benefits, but these data policies underscore the less visible and more dangerous privacy risks they pose.82 Most are exempt from traditional health data privacy regulations. The Health Insurance Portability and Accountability Act of 1996 (known as HIPAA), for example, protects individuals’ identifiable health information in the United States. But it doesn’t apply when employers offer workplace wellness programs directly rather than in connection with their group health plans. Without laws preventing them from using the data collected through wellness programs, employers can mine the data they collect, which many do with abandon.83 Employers learn everything that employees share in the questionnaires and online surveys they complete as part of these programs, from what prescription drugs they use to whether they voted and when they stopped filling their birth control prescriptions.84 And employers are using that data in increasingly more intrusive ways.