I have some thoughts about this article and the underlying story. Short thread with morning coffee incoming. // Kushner’s team seeks national coronavirus surveillance system https://www.politico.com/news/2020/04/07/kushner-coronavirus-surveillance-174165 via @politico

First: Some distinctions between (1) case-based public health surveillance, (2) syndromic surveillance that uses EHR data, (3) "third space" health data from phones/IoT tech, and (4) other forms of mass surveillance, are becoming much less important, at least re: COVID-19 data.

That has been sort of evident. However, the "how" is starting to take shape.

That POLITICO story does a great job of describing how that process is happening: the sort of health tech actors involved, and how they are trying to translate that into infrastructure and policy.

There are many big and small health IT firms working an angle: they want their COVID intervention to be the one that gets adopted.

In the absence of robust evidence, in health IT policy, actors with the most scalable tool and persuasive argument to sympathetic ears often win.

That is how health IT policy is made. Agencies like ONC did not digitize the healthcare system in 10 years following the 2009 HITECH Act using standards that were all subjected to rigorous and uniform testing at scale.

That work came after the adoption of standards as policy.

That is not just how health IT standards and the digitization of healthcare systems works, that is how standards policy works in general.

Anyway, back to the main point here.

The digitization of the U.S. healthcare system since 2009 has facilitated the de-differentiation of formerly-distinct classes of healthcare data, such as "clinical patient data," "public health data," "research data," "[X] data."

At least at the level of data infrastructure.

That is because the digitization of healthcare has been accompanied by a health IT standards policymaking process that has made these different classes of data interoperable with one another in shared infrastructures, over common exchange networks, and/or using uniform standards.

Here is a graphic from a 2014 "vision" document from the Office of the National Coordinator for Health Information Technology (ONC).

It depicts a desired "nationwide interoperable health IT ecosystem."

The document that that graphic comes from is called “Connecting Health and Care for the Nation: A Ten-Year Vision to Achieve an Interoperable Health IT Infrastructure” (2014). The office that produced it - ONC - is the coordinating entity for U.S. health IT policy.

In some of my talks (and in my diss), I spend a lot of time on that graphic and underlying vision, because it is a representation of the underlying motivation/ideology of most federal health IT policy.

That is: the ideology (always doomed to fail) of One Big Perfect Database!

Those of us in STS are familiar with this story: visions of contemporary governance rooted in totalizing visions of perfect interoperation and "programmability."

Wendy Chun's PROGRAMMED VISIONS (2011) and Alex Galloway's PROTOCOL (2004) are two great books about this phenomenon.

Anyway, while visions of governmentality rooted in totalizing programmed visions are doomed to ever be completely realized, these visions do have real material effects on the constitution of digital infrastructure and the policy apparatuses built to enact digital governance.

Basically: there are real ramifications stemming from the fact that the underlying motivation of U.S. health IT standards policy is to build frameworks that facilitate the connection of as many health IT systems as possible to one another through uniform standards adoption.

Among other things, this means both (A) that different kinds of data can exist in the same infrastructure (e.g. clinical vs. public health vs. phone data), and (B) that infrastructures used to manage different kinds of data can be more easily made to interoperate with each other.

Ease of interoperation in the management of health data and health IT infrastructures makes it easier to ignore or bypass regulatory distinctions between different health data classes, and the regulatory frameworks haven't kept pace with the speed of infrastructural development

In the context of the emergency, where HIPAA and health data exchange rules meant to maintain distinctions between different classes of health data have been loosened (and given robust interoperability) the fast scale-up of tech-driven COVID-19 interventions is a likelihood.

The POLITICO article that started this thread is the best encapsulation I have seen of how that process is taking shape in national policy: how the case is being made for national COVID surveillance in the context of existing infrastructures and their interoperability potential.