Institute of Regulatory Institute of Regulatory ExcellenceExcellence

The Use of Technology in The Use of Technology in Regulatory Reform and Public Regulatory Reform and Public

Policy InitiativesPolicy Initiatives

Mark MajekMark Majek

Director, OperationsDirector, Operations

Texas Board of NursingTexas Board of Nursing

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

Ray KurzweilRay KurzweilFuturist – Inventor - AuthorFuturist – Inventor - Author

The Law of Accelerating Returns:The Law of Accelerating Returns:The impact on Healthcare and The impact on Healthcare and

MedicineMedicine

The Law of Accelerating ReturnsThe Law of Accelerating Returns

The price-performance, capacity The price-performance, capacity and bandwidth of information and bandwidth of information technologies progresses technologies progresses exponentially through multiple exponentially through multiple paradigm shiftsparadigm shifts

LinearLinear Projections are accurate for short term Projections are accurate for short term projections, i.e. state strategic plansprojections, i.e. state strategic plans

Technological change is Technological change is exponentialexponential due to due to the pace of changethe pace of change

Moore’s LawMoore’s Law describes a shrinking of the size describes a shrinking of the size of features on an integrated circuit and is of features on an integrated circuit and is associated with the exponential growth of associated with the exponential growth of computer technology.computer technology.

Paradigm ShiftParadigm Shift

Thomas Kuhn wrote Thomas Kuhn wrote The Structure of Scientific The Structure of Scientific RevolutionRevolution and defined and popularized the and defined and popularized the concept of “paradigm shift”.concept of “paradigm shift”.

Kuhn argues that scientific advancement is not Kuhn argues that scientific advancement is not evolutionary, but rather is a “series of peaceful evolutionary, but rather is a “series of peaceful interludes punctuated by intellectually violent interludes punctuated by intellectually violent revolutions”, and in those revolutions “one revolutions”, and in those revolutions “one conceptual world view is replaced by another”.conceptual world view is replaced by another”.

The Paradigm Shift Rate The Paradigm Shift Rate

is now doubling every decadeis now doubling every decade

Doubling (or Halving) timesDoubling (or Halving) times

Dynamic RAM Memory “Half Pitch” Feature SizeDynamic RAM Memory “Half Pitch” Feature Size 5.4 years 5.4 years Dynamic RAM Memory (bits per dollar)Dynamic RAM Memory (bits per dollar) 1.5 years1.5 years Average Transistor PriceAverage Transistor Price 1.6 years1.6 years Microprocessor Cost per Transistor CycleMicroprocessor Cost per Transistor Cycle 1.1 years1.1 years Total Bits ShippedTotal Bits Shipped 1.1 years1.1 years Processor Performance in MIPSProcessor Performance in MIPS 1.8 years1.8 years Transistors in Intel MicroprocessorsTransistors in Intel Microprocessors 2.0 years2.0 years Microprocessor Clock SpeedMicroprocessor Clock Speed 2.7 years2.7 years

Information Technologies Information Technologies (of all kinds)(of all kinds) double their power double their power (price performance,(price performance,

capacity, bandwidth)capacity, bandwidth) every year every year

Measure MIT’s 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

Article in the Austin American Article in the Austin American StatesmanStatesman

IBM aims to wire chips with light pulsesIBM aims to wire chips with light pulses Technology could mean bring Technology could mean bring

supercomputing power to business, supercomputing power to business, home, research applications.home, research applications.

By David HoBy David HoNEW YORK BUREAU NEW YORK BUREAU Friday, December 07, 2007Friday, December 07, 2007

The Biotechnology revolution:The Biotechnology revolution: the intersection of biology with the intersection of biology with

information technologyinformation technology

Every form of communicationsEvery form of communicationstechnology is doubling technology is doubling

price-performance, bandwidth,price-performance, bandwidth,capacity every 12 monthscapacity every 12 months

Miniaturization: Miniaturization: another exponential trendanother exponential trend

Respirocyte (an artificial red blood cell)

Copyright Vik Olliver, vik@asi.org.

Respirocytes with Red Cells

Copyright Vik Olliver, vik@asi.org.

The FutureThe Future

2010: Computers disappear2010: Computers disappear

Images written directly to our retinasImages written directly to our retinas Ubiquitous high bandwidth connection to the Ubiquitous high bandwidth connection to the

Internet at all timesInternet at all times Electronics so tiny it’s embedded in the Electronics so tiny it’s embedded in the

environment, our clothing, our eyeglassesenvironment, our clothing, our eyeglasses Full immersion visual-auditory virtual realityFull immersion visual-auditory virtual reality Augmented real realityAugmented real reality Interaction with virtual personalities as a Interaction with virtual personalities as a

primary interfaceprimary interface Effective language technologiesEffective language technologies

Other examplesOther examples

By 2015, you will witness three dimensional self By 2015, you will witness three dimensional self organizing molecular computing. This means, organizing molecular computing. This means, once the law of accelerating returns kicks in, once the law of accelerating returns kicks in, you will be able email a shirt or any three you will be able email a shirt or any three dimensional object.dimensional object.

By 2020, the key features on the integrated By 2020, the key features on the integrated circuit will be about four nanometers. They’re circuit will be about four nanometers. They’re now at 65 nanometers!now at 65 nanometers!

2029: An intimate merger2029: 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 completedReverse engineering of the human brain completed Computers pass the Turing testComputers pass the Turing test Nonbiological intelligence combines Nonbiological intelligence combines

the subtlety and pattern recognition strength of human the subtlety and pattern recognition strength of human intelligence, withintelligence, with

the speed, memory, and knowledge sharing of machine the speed, memory, and knowledge sharing of machine intelligenceintelligence

Nonbiological intelligence will continue to grow Nonbiological intelligence will continue to grow exponentially whereas biological intelligence is exponentially whereas biological intelligence is effectively fixedeffectively fixed

What does this have to do with What does this have to do with regulation?regulation?

Everything!Everything!

Guiding Principles of Nursing RegulationGuiding Principles of Nursing Regulation Adopted by 2007 NCSBN Delegate Adopted by 2007 NCSBN Delegate

AssemblyAssembly

Evidenced-Based RegulationEvidenced-Based RegulationNursing regulation uses evidenced-based standards Nursing regulation uses evidenced-based standards of practice, of practice, advances in technologyadvances in technology, and , and demographic and social research in its mission to demographic and social research in its mission to protect the public.protect the public.

Mark MajekMark MajekCirca 1987Circa 1987

Human evolution speeding up, study Human evolution speeding up, study sayssays

Anthropologists thought evolutionary Anthropologists thought evolutionary pressures on humans had eased but pressures on humans had eased but found the opposite to be true.found the opposite to be true.

By Karen KaplanBy Karen KaplanLOS ANGELES TIMESLOS ANGELES TIMESTuesday, December 11, 2007Tuesday, December 11, 2007

October 12, 2012October 12, 2012

Any significance to this Any significance to this date?date?

The Next GenerationThe Next Generation

Mature Mature 1925 to 19451925 to 1945 Baby BoomersBaby Boomers 1946 to 19641946 to 1964 Generation XGeneration X 1965 to 19831965 to 1983 Millenials (Y)Millenials (Y) 1984 to present1984 to present

Bill Felkey, MSBill Felkey, MSProfessor, Auburn UniversityProfessor, Auburn University

Enterprise wide connectivityEnterprise wide connectivity Single electronic medical recordSingle electronic medical record Replace repetitive and tedious jobsReplace repetitive and tedious jobs High quality evidence-based informationHigh quality evidence-based information TelepracticeTelepractice Existing technology exists but not used Existing technology exists but not used

The Use of TechnologyThe Use of Technology

Accept itAccept it Embrace itEmbrace it Understand itUnderstand it Use itUse it Test itTest it Validate itValidate it

Kurzweil says:Kurzweil says:

We don’t have a real balancing of risks in our We don’t have a real balancing of risks in our society when we talk about regulation.society when we talk about regulation.

Nothing is risk-free.Nothing is risk-free. If you are a regulator and you approve something If you are a regulator and you approve something

that goes wrong, there’s hell to pay.that goes wrong, there’s hell to pay. But, infrequently there is very little credit given But, infrequently there is very little credit given

when all is going right.when all is going right. With the generation of technologies getting With the generation of technologies getting

shorter and shorter, we must also accelerate our shorter and shorter, we must also accelerate our regulatory approval processes.regulatory approval processes.

Nursing Regulation Paradigm ShiftsNursing Regulation Paradigm Shifts

June, 1978 – Creation of the National Council of State June, 1978 – Creation of the National Council of State Boards of Nursing (NCSBN)Boards of Nursing (NCSBN)

1979 – Directed by the NCSBN Delegate Assembly 1979 – Directed by the NCSBN Delegate Assembly (DA) to develop a central data bank for the primary (DA) to develop a central data bank for the primary purpose of serving the Member Board’s needs for purpose of serving the Member Board’s needs for statistics and informationstatistics and information

1980 – Voluntary disciplinary data bank created1980 – Voluntary disciplinary data bank created 1982 – Directed to install the NCSBN’s first computer 1982 – Directed to install the NCSBN’s first computer

to serve as a resource for informationto serve as a resource for information 1984 – an electronic mail system, or e-mail was 1984 – an electronic mail system, or e-mail was

introduced to the Delegate Assemblyintroduced to the Delegate Assembly

Paradigm Shifts ContinuedParadigm Shifts Continued 1985 – NCSBN Board of Directors (BOD) participate 1985 – NCSBN Board of Directors (BOD) participate

in computerized clinical simulation testingin computerized clinical simulation testing 1986 – NCSBN Board of Directors direct staff to 1986 – NCSBN Board of Directors direct staff to

prepare a proposal for funding computerized adaptive prepare a proposal for funding computerized adaptive testing (CAT)testing (CAT)

BOD appoints committee to explore the BOD appoints committee to explore the implementation of a national license database systemimplementation of a national license database system

1991 – Delegate Assembly voted to implement CAT 1991 – Delegate Assembly voted to implement CAT for NCLEXfor NCLEX

1995 – DA directed a committee to be appointed to 1995 – DA directed a committee to be appointed to study telecommunication practices across study telecommunication practices across jurisdictional linesjurisdictional lines

Paradigm Shifts ContinuedParadigm Shifts Continued

1996 – DA directed to continue full development 1996 – DA directed to continue full development of an electronic licensure verification systemof an electronic licensure verification system

1997 – DA adopted mutual recognition model of 1997 – DA adopted mutual recognition model of nursing (Nurse Licensure Compact)nursing (Nurse Licensure Compact)

1998 and 1999 – Nursys adopted as the NCSBN 1998 and 1999 – Nursys adopted as the NCSBN license verification systemlicense verification system

Next shift ?????????????Next shift ?????????????

Next Paradigm ShiftNext Paradigm Shift

Kurzweil – specific paradigms do not run Kurzweil – specific paradigms do not run out of steam. out of steam.

The fading of one paradigm creates The fading of one paradigm creates research pressure to create the next.research pressure to create the next.

We find that another paradigm kicks in We find that another paradigm kicks in around the time that another runs out of around the time that another runs out of steam.steam.

Regulatory ReformRegulatory Reform

Regulation directly affects the innovative Regulation directly affects the innovative processprocess

Technical changes has significant impact on Technical changes has significant impact on regulationregulation

Regulatory reform is directed to making sure that Regulatory reform is directed to making sure that regulations are fully responsive to changes in regulations are fully responsive to changes in the economic, social and technical conditions the economic, social and technical conditions around themaround them

Regulatory Reforms include de-regulation, re-Regulatory Reforms include de-regulation, re-regulation, simplification and institution buildingregulation, simplification and institution building

What is Regulatory Reform?What is Regulatory Reform?

Security – Legal Security and predictable enforcementSecurity – Legal Security and predictable enforcement Transparency – clear and simple rules, openness Transparency – clear and simple rules, openness

through policy process, less discretion and less through policy process, less discretion and less corruptioncorruption

Legitimacy – protecting safety, health and consumer Legitimacy – protecting safety, health and consumer and public interestsand public interests

Efficiency – low-cost rules, orderly and timely Efficiency – low-cost rules, orderly and timely decisions, responsiveness to market needsdecisions, responsiveness to market needs

Expertise – good regulatory skills and understanding Expertise – good regulatory skills and understanding of complex practice and technologiesof complex practice and technologies

World Bank InstituteWorld Bank Institute

Regulatory Reform/Innovation InterfaceRegulatory 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.

Use of TechnologyUse of TechnologyInternal UseInternal Use

EnforcementEnforcement Case ReviewsCase Reviews Fact findingFact finding

Nursing School Approval ProcessNursing School Approval Process Educational StandardsEducational Standards Technology adaptationTechnology adaptation

LicensingLicensing Paperless ApplicationsPaperless Applications Paperless ReviewsPaperless Reviews No more paper anything!No more paper anything! Smart Card Smart Card

OperationsOperations Financial TransactionsFinancial Transactions Customer ServiceCustomer Service

Board MeetingsBoard Meetings

Use of TechnologyUse of TechnologyExternal UseExternal Use

NursesNurses Scope of PracticeScope of Practice Ongoing EducationOngoing Education

Nursing SchoolsNursing Schools Test AdaptationTest Adaptation Student RequirementsStudent Requirements

Nursing EmployersNursing Employers Legislatures Legislatures

Strategic PlanStrategic Plan LegislationLegislation Public PolicyPublic Policy

Other Boards of NursingOther Boards of Nursing National Council of State Boards of NursingNational Council of State Boards of Nursing International CustomersInternational Customers

NursesNurses PatientsPatients

In Between Paradigm ShiftsIn Between Paradigm Shifts

Information overloadInformation overload Saturation of technologySaturation of technology Allows for long-term strategic planningAllows for long-term strategic planning Assess areas of technological weaknessesAssess areas of technological weaknesses Allows for collaboration on a national basisAllows for collaboration on a national basis allows us to train staff in our areas of technological allows us to train staff in our areas of technological

knowledge deficitsknowledge deficits

Possible SolutionsPossible Solutions

Continued collaboration with the NCSBN Continued collaboration with the NCSBN and other state boards of nursingand other state boards of nursing

Resolution for Uniform Regulation Resolution for Uniform Regulation Through TechnologyThrough Technology

Regulatory E-Regulation ConferenceRegulatory E-Regulation Conference NCSBN Technology CommitteeNCSBN Technology Committee