Figure 1. Federal HPCC program organization chart. During the COVID-19 pandemic, society around the entire world was able to do telework, participate in distance education, use telemedicine, purchase items, and/or get entertained through the use of services via the Internet. How did society get there?
The concepts of computer-based patient records and telemedicine have been intertwined with my professional life for about 50 years. Through the years and because of my different jobs, different layers of complexity have been incorporated. At IEEE, I tried to create opportunities that would benefit society, my employer, and IEEE. In 1986, International Business Machines (IBMs) moved me from Healthcare Software Development in Las Colinas, TX, USA, to their Gaithersburg, MD, USA, Health Complex Systems Group, to become the Technical Manager of the Point of Care System for Nurses. At that time, two past Engineering in Medicine and Biology Society (EMBS) presidents (Al Potvin and Joe Bronzino) insisted that I become part of the IEEE USA’s Health Care Engineering Policy Committee (HCEPC) [which about ten years later became the Medical Technology Policy Committee (MTPC)]. I reluctantly accepted their proposition for what would become one of the best and most rewarding moves of my professional life. At the HCEPC, I was the founding chair of the High Performance Computers and Communications (HPCC) and Electronic Health Record (EHR) Working Group (WG). About ten years later, I was offered (by one of the members of the HCEPC, an economist who heard me speak) and accepted an expert appointment as the senior IT advisor for the Center of Information Technology (CIT) of the Agency for Health Care Policy and Research (AHCPR part of the Department of Health and Human Services).
At IEEE, I tried to create opportunities that would benefit society, my employer, and IEEE.
During the years 1996, 1997, and 1998, I became AHCPR representative to the Telehealth Federal Committee as well as the Federal High Performance Computers and Communications (HPCC) Research and Development program (see Figure 1) and worked with members representing the National Coordination Office (NCO), Defense Advanced Research Projects Agency (DARPA), Department of Energy (DOE), Department of Education (ED), Environmental Protection Agency (EPA), National Aeronautics and Space Administration (NASA), National Institutes of Health (NIH), National Institute of Standards and Technology (NIST), National Oceanic and Atmospheric Administration (NOAA), National Security Agency (NSA), National Science Foundation (NSF), Department of Veterans Affairs (VA), Office of Management and Budget (OMB), and Office of Science and Technology Policy (OSTP).
I prepared AHCPR’s program descriptions in three consecutive “Supplement to the President’s Fiscal Years 1997–1998 and 1999 Budgets” and authored the areas of computer-based patient records, clinical decision support systems, and telemedicine. These were published in the President’s HPCC Implementation Plan of the following Committee on Computing, Information and Communication (CCIC) Blue Books: “Advancing the Frontiers of Information Technology”; “Technologies for the 21st Century,” and “Networked Computing for the 21st Century” (see Figure 2), NSTC/Executive Office of the President (97, 98, and 99). In addition to AHCPR’s topics, the privilege of working closely with members of all these other federal agencies/departments provided me with a unique opportunity to learn and get a holistic understanding of how we all used HPCC.
Figure 2. – Reports on high-performance computers and communications. Supplement to the President’s FY 1997, FY 1998, and FY 1999. Produced by the White House’s National Science and Technology Council, Committee on Computing, Information and Communications (CCIC).
Policymakers and the Role of Technology Policy
During an interview with Esquire [1] in 2008, Vint Cerf described how “Al Gore had seen what happened with the National Interstate and Defense Highways Act of 1956, which his father introduced as a military bill. It was very powerful. Housing went up, the suburban boom happened, and everybody became mobile. Al was attuned to the power of networking much more than any of his elective colleagues. His initiatives led directly to the commercialization of the Internet.” Gore became the HPCC force in the U.S. Congress. In 1976, Rep. Gore initiated legislation for the construction of a “data highway.” In 1986, Sen. Gore’s Supercomputer Network Study Act called for mapping public information needs onto university and government networks, laying the foundation for the public Internet. It was said that a key reason Don Lindberg was asked to chair the HPCC and Information Technology (HPCCIT) Subcommittee and be NCO Director was that he represented an applications agency and not just a “technology agency.” Ackerman et al. [2] note that “Promoting grand challenge applications [like Health] that could benefit from HPCC technologies, and not just the technologies themselves, was, in fact, the key to passing the high performance computers (HPCs) Act of 1991” [2], [3].
Most Congressional leaders are lawyers who lack a science and technology (S&T) background, yet we expect them to make decisions in regard to S&T legislation. (In my personal experience, most of their staffers have degrees in English and history, so they write very well without understanding most of the social implications of technology or how S&T may solve some of society’s “grand challenges.”)
Most Congressional leaders are lawyers who lack a science and technology (S&T) background, yet we expect them to make decisions in regard to S&T legislation.
IEEE Societies and Councils publications are written and read mostly by engineers and computer scientists whose similar backgrounds, languages, and concepts are easy to understand and accept. Yet, these same articles are very difficult for policymakers to follow and understand given the language and or nomenclature used. (For example, the use of mathematical formulas may add a level of complexity that discourages the reading of an article.)
Bridging Technology with Policymakers, a Different Approach
Before 9–11, and in addition to the MTPC’s HPCC/EHR working group, several other WGs were created to help support better policies. One was on bioterrorism, another on genetics/informatics (i.e., an IEEE Position Statement was generated in terms of nondiscrimination, based on “personal genetics”). (Later, on 1/1/2007, the IEEE BOG approved the creation of the Critical Infrastructure Protection Committee and I was asked by the IEEE-USA leadership to be the founding chair.)
Figure 3. – Special issues of the IEEE-EMBS magazine dedicated to bioterrorism, homeland security, and the protection of the healthcare and public health critical infrastructure with input from congressional and executive leaders were written and distributed to members of the U.S. Congress [4], [5], [6].
Three special issues of the (then) IEEE-EMBS Magazine (Figure 3) were dedicated to “Combating Bioterrorism with Biomedical Engineering” [4], “The Many Facets of Homeland Security” [5], and “Protecting the Health Care and Public Health Critical Infrastructure and Key Assets” [6]. The first issue had as our “distinguished guests of honor” the then Secretary of Health and Human Services, Tommy Thompson, Senator Bill Frist MD (R, TN), and Senator John Rockefeller IV (D, WV). The second issue had as our invited distinguished guests: then-Senator Joseph Lieberman (who had just helped create the Department of Homeland Security, DHS) and Senator John Rockefeller IV from the Democratic side. Senate Majority Leader Bill Frist MD and Past Speaker of the House Newt Gingrich represented the Republican side. The final issue had as distinguished guests Senator Sheldon Whitehouse (D, Rhode Island), Senator Susan Collins (R, Maine), and Dr. Robert Kolodner (National Coordinator for Health IT) and his Deputy Dr. Charles Freedman, Deputy National Coordinator for Health IT, both representing the U.S. Department of Health and Human Services. The IEEE-USA staff distributed these magazines to members of the U.S. Congress. The inclusion of comments from members of both parties was an encouragement for other members to take an interest in these science and technology issues and challenges.
A Great Opportunity exists today for SSIT to become the de-facto link to policymakers globally on the social implications of technology and how Society’s grand challenges can be met through their use.
Author Information
Luis Kun is the 2023–2024 President of the IEEE Society on Social Implications of Technology. He is a distinguished professor emeritus at the William J. Perry Center for Hemispheric Defense Studies, National Defense University, Washington, DC 20319 USA. Email: l.kun@ieee.org.
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