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Institute of Regulatory Excellence The Use of Technology in Regulatory Reform and Public Policy Initiatives Mark Majek Director, Operations Texas Board.

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Presentation on theme: "Institute of Regulatory Excellence The Use of Technology in Regulatory Reform and Public Policy Initiatives Mark Majek Director, Operations Texas Board."— Presentation transcript:

1 Institute of Regulatory Excellence The Use of Technology in Regulatory Reform and Public Policy Initiatives Mark Majek Director, Operations Texas Board of Nursing

2 Or………… Boldly going where no regulator has gone!

3 Ray Kurzweil Futurist – Inventor - Author The Law of Accelerating Returns: The impact on Healthcare and Medicine

4 The Law of Accelerating Returns The price-performance, capacity and bandwidth of information technologies progresses exponentially through multiple paradigm shifts

5 Linear Projections are accurate for short term projections, i.e. state strategic plans Linear Projections are accurate for short term projections, i.e. state strategic plans Technological change is exponential due to the pace of change Technological change is exponential due to the pace of change Moores Law describes a shrinking of the size of features on an integrated circuit and is associated with the exponential growth of computer technology. Moores Law describes a shrinking of the size of features on an integrated circuit and is associated with the exponential growth of computer technology.

6 Paradigm Shift Thomas Kuhn wrote The Structure of Scientific Revolution and defined and popularized the concept of paradigm shift. Thomas Kuhn wrote The Structure of Scientific Revolution and defined and popularized the concept of paradigm shift. Kuhn argues that scientific advancement is not evolutionary, but rather is a series of peaceful interludes punctuated by intellectually violent revolutions, and in those revolutions one conceptual world view is replaced by another. Kuhn argues that scientific advancement is not evolutionary, but rather is a series of peaceful interludes punctuated by intellectually violent revolutions, and in those revolutions one conceptual world view is replaced by another.

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8 The Paradigm Shift Rate is now doubling every decade

9 Doubling (or Halving) times Dynamic RAM Memory Half Pitch Feature Size5.4 years Dynamic RAM Memory Half Pitch Feature Size5.4 years Dynamic RAM Memory (bits per dollar)1.5 years Dynamic RAM Memory (bits per dollar)1.5 years Average Transistor Price1.6 years Average Transistor Price1.6 years Microprocessor Cost per Transistor Cycle1.1 years Microprocessor Cost per Transistor Cycle1.1 years Total Bits Shipped1.1 years Total Bits Shipped1.1 years Processor Performance in MIPS1.8 years Processor Performance in MIPS1.8 years Transistors in Intel Microprocessors2.0 years Transistors in Intel Microprocessors2.0 years Microprocessor Clock Speed2.7 years Microprocessor Clock Speed2.7 years

10 Information Technologies (of all kinds) double their power (price performance, capacity, bandwidth) every year

11 Measure MITs IBM 7094 Notebook Circa 2003 Year Processor Speed (MIPS) Main Memory (K Bytes) Approximate Cost (2003 $) 1967 0.25 144 $11,000,000 2003 1,000 256,000 $2,000 24 Doublings of Price-Performance in 36 years, doubling time: 18 months not including vastly greater RAM memory, disk storage, instruction set, etc. A Personal Experience

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13 Article in the Austin American Statesman IBM aims to wire chips with light pulses IBM aims to wire chips with light pulses Technology could mean bring supercomputing power to business, home, research applications. Technology could mean bring supercomputing power to business, home, research applications. By David Ho NEW YORK BUREAU Friday, December 07, 2007 By David Ho NEW YORK BUREAU Friday, December 07, 2007

14 The Biotechnology revolution: the intersection of biology with information technology

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16 Every form of communications technology is doubling price-performance, bandwidth, capacity every 12 months

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20 Miniaturization: another exponential trend

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22 Respirocyte (an artificial red blood cell) Copyright Vik Olliver, vik@asi.org.

23 Respirocytes with Red Cells Copyright Vik Olliver, vik@asi.org.

24 The Future

25 2010: Computers disappear Images written directly to our retinas Images written directly to our retinas Ubiquitous high bandwidth connection to the Internet at all times Ubiquitous high bandwidth connection to the Internet at all times Electronics so tiny its embedded in the environment, our clothing, our eyeglasses Electronics so tiny its embedded in the environment, our clothing, our eyeglasses Full immersion visual-auditory virtual reality Full immersion visual-auditory virtual reality Augmented real reality Augmented real reality Interaction with virtual personalities as a primary interface Interaction with virtual personalities as a primary interface Effective language technologies Effective language technologies

26 Other examples By 2015, you will witness three dimensional self organizing molecular computing. This means, once the law of accelerating returns kicks in, you will be able email a shirt or any three dimensional object. By 2015, you will witness three dimensional self organizing molecular computing. This means, once the law of accelerating returns kicks in, you will be able email a shirt or any three dimensional object. By 2020, the key features on the integrated circuit will be about four nanometers. Theyre now at 65 nanometers! By 2020, the key features on the integrated circuit will be about four nanometers. Theyre now at 65 nanometers!

27 2029: An intimate merger $1,000 of computation = 1,000 times the human brain $1,000 of computation = 1,000 times the human brain Reverse engineering of the human brain completed Reverse engineering of the human brain completed Computers pass the Turing test Computers pass the Turing test Nonbiological intelligence combines Nonbiological intelligence combines the subtlety and pattern recognition strength of human intelligence, with the subtlety and pattern recognition strength of human intelligence, with the speed, memory, and knowledge sharing of machine intelligence the speed, memory, and knowledge sharing of machine intelligence Nonbiological intelligence will continue to grow exponentially whereas biological intelligence is effectively fixed Nonbiological intelligence will continue to grow exponentially whereas biological intelligence is effectively fixed

28 What does this have to do with regulation? Everything!

29 Guiding Principles of Nursing Regulation Adopted by 2007 NCSBN Delegate Assembly Evidenced-Based Regulation Nursing regulation uses evidenced-based standards of practice, advances in technology, and demographic and social research in its mission to protect the public.

30 Mark Majek Circa 1987

31 Human evolution speeding up, study says Human evolution speeding up, study says Anthropologists thought evolutionary pressures on humans had eased but found the opposite to be true. Anthropologists thought evolutionary pressures on humans had eased but found the opposite to be true. By Karen Kaplan LOS ANGELES TIMES Tuesday, December 11, 2007 By Karen Kaplan LOS ANGELES TIMES Tuesday, December 11, 2007

32 October 12, 2012 Any significance to this date?

33 The Next Generation Mature 1925 to 1945 Mature 1925 to 1945 Baby Boomers1946 to 1964 Baby Boomers1946 to 1964 Generation X1965 to 1983 Generation X1965 to 1983 Millenials (Y)1984 to present Millenials (Y)1984 to present

34 Bill Felkey, MS Professor, Auburn University Enterprise wide connectivity Enterprise wide connectivity Single electronic medical record Single electronic medical record Replace repetitive and tedious jobs Replace repetitive and tedious jobs High quality evidence-based information High quality evidence-based information Telepractice Telepractice Existing technology exists but not used Existing technology exists but not used

35 The Use of Technology Accept it Accept it Embrace it Embrace it Understand it Understand it Use it Use it Test it Test it Validate it Validate it

36 Kurzweil says: We dont have a real balancing of risks in our society when we talk about regulation. We dont have a real balancing of risks in our society when we talk about regulation. Nothing is risk-free. Nothing is risk-free. If you are a regulator and you approve something that goes wrong, theres hell to pay. If you are a regulator and you approve something that goes wrong, theres hell to pay. But, infrequently there is very little credit given when all is going right. But, infrequently there is very little credit given when all is going right. With the generation of technologies getting shorter and shorter, we must also accelerate our regulatory approval processes. With the generation of technologies getting shorter and shorter, we must also accelerate our regulatory approval processes.

37 Nursing Regulation Paradigm Shifts June, 1978 – Creation of the National Council of State Boards of Nursing (NCSBN) June, 1978 – Creation of the National Council of State Boards of Nursing (NCSBN) 1979 – Directed by the NCSBN Delegate Assembly (DA) to develop a central data bank for the primary purpose of serving the Member Boards needs for statistics and information 1979 – Directed by the NCSBN Delegate Assembly (DA) to develop a central data bank for the primary purpose of serving the Member Boards needs for statistics and information 1980 – Voluntary disciplinary data bank created 1980 – Voluntary disciplinary data bank created 1982 – Directed to install the NCSBNs first computer to serve as a resource for information 1982 – Directed to install the NCSBNs first computer to serve as a resource for information 1984 – an electronic mail system, or e-mail was introduced to the Delegate Assembly 1984 – an electronic mail system, or e-mail was introduced to the Delegate Assembly

38 Paradigm Shifts Continued 1985 – NCSBN Board of Directors (BOD) participate in computerized clinical simulation testing 1985 – NCSBN Board of Directors (BOD) participate in computerized clinical simulation testing 1986 – NCSBN Board of Directors direct staff to prepare a proposal for funding computerized adaptive testing (CAT) 1986 – NCSBN Board of Directors direct staff to prepare a proposal for funding computerized adaptive testing (CAT) BOD appoints committee to explore the implementation of a national license database system BOD appoints committee to explore the implementation of a national license database system 1991 – Delegate Assembly voted to implement CAT for NCLEX 1991 – Delegate Assembly voted to implement CAT for NCLEX 1995 – DA directed a committee to be appointed to study telecommunication practices across jurisdictional lines 1995 – DA directed a committee to be appointed to study telecommunication practices across jurisdictional lines

39 Paradigm Shifts Continued 1996 – DA directed to continue full development of an electronic licensure verification system 1996 – DA directed to continue full development of an electronic licensure verification system 1997 – DA adopted mutual recognition model of nursing (Nurse Licensure Compact) 1997 – DA adopted mutual recognition model of nursing (Nurse Licensure Compact) 1998 and 1999 – Nursys adopted as the NCSBN license verification system 1998 and 1999 – Nursys adopted as the NCSBN license verification system Next shift ????????????? Next shift ?????????????

40 Next Paradigm Shift Kurzweil – specific paradigms do not run out of steam. Kurzweil – specific paradigms do not run out of steam. The fading of one paradigm creates research pressure to create the next. The fading of one paradigm creates research pressure to create the next. We find that another paradigm kicks in around the time that another runs out of steam. We find that another paradigm kicks in around the time that another runs out of steam.

41 Regulatory Reform Regulation directly affects the innovative process Regulation directly affects the innovative process Technical changes has significant impact on regulation Technical changes has significant impact on regulation Regulatory reform is directed to making sure that regulations are fully responsive to changes in the economic, social and technical conditions around them Regulatory reform is directed to making sure that regulations are fully responsive to changes in the economic, social and technical conditions around them Regulatory Reforms include de-regulation, re- regulation, simplification and institution building Regulatory Reforms include de-regulation, re- regulation, simplification and institution building

42 What is Regulatory Reform? Security – Legal Security and predictable enforcement Security – Legal Security and predictable enforcement Transparency – clear and simple rules, openness through policy process, less discretion and less corruption Transparency – clear and simple rules, openness through policy process, less discretion and less corruption Legitimacy – protecting safety, health and consumer and public interests Legitimacy – protecting safety, health and consumer and public interests Efficiency – low-cost rules, orderly and timely decisions, responsiveness to market needs Efficiency – low-cost rules, orderly and timely decisions, responsiveness to market needs Expertise – good regulatory skills and understanding of complex practice and technologies Expertise – good regulatory skills and understanding of complex practice and technologies World Bank Institute

43 Regulatory Reform/Innovation Interface Understand regulation/technology linkages. Understand regulation/technology linkages. Introduce competition. Introduce competition. Streamline regulations. Streamline regulations. Use technology-driving approaches. Use technology-driving approaches. Harmonize internationally. Harmonize internationally.

44 Use of Technology Internal Use Enforcement Enforcement Case Reviews Case Reviews Fact finding Fact finding Nursing School Approval Process Nursing School Approval Process Educational Standards Educational Standards Technology adaptation Technology adaptation Licensing Licensing Paperless Applications Paperless Applications Paperless Reviews Paperless Reviews No more paper anything! No more paper anything! Smart Card Smart Card Operations Operations Financial Transactions Financial Transactions Customer Service Customer Service Board Meetings Board Meetings

45 Use of Technology External Use Nurses Nurses Scope of Practice Scope of Practice Ongoing Education Ongoing Education Nursing Schools Nursing Schools Test Adaptation Test Adaptation Student Requirements Student Requirements Nursing Employers Nursing Employers Legislatures Legislatures Strategic Plan Strategic Plan Legislation Legislation Public Policy Public Policy Other Boards of Nursing Other Boards of Nursing National Council of State Boards of Nursing National Council of State Boards of Nursing International Customers International Customers Nurses Nurses Patients Patients

46 In Between Paradigm Shifts Information overload Information overload Saturation of technology Saturation of technology Allows for long-term strategic planning Allows for long-term strategic planning Assess areas of technological weaknesses Assess areas of technological weaknesses Allows for collaboration on a national basis Allows for collaboration on a national basis allows us to train staff in our areas of technological knowledge deficits allows us to train staff in our areas of technological knowledge deficits

47 Possible Solutions Continued collaboration with the NCSBN and other state boards of nursing Continued collaboration with the NCSBN and other state boards of nursing Resolution for Uniform Regulation Through Technology Resolution for Uniform Regulation Through Technology Regulatory E-Regulation Conference Regulatory E-Regulation Conference NCSBN Technology Committee NCSBN Technology Committee


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