Private Certifiers and Deputies in American Health Care

So-called “public programs” in U.S. health care pervasively contract with private entities. The contracting does not merely involve the purchase of drugs, devices, information technology, insurance, and medical care. Rather, government agencies are increasingly outsourcing decisions about the nature and standards for such goods and services to private entities. This Article will examine two models of outsourcing such decisions. In private licensure, firms offer a stamp of approval to certify that a given technology or service is up to statutory or regulatory standards. Via deputization, firms can pursue a regulatory or law enforcement role to correct (and even punish) providers who have failed to meet standards or acted fraudulently. Both private licensure and deputization provide new models for administrative governance in rapidly changing, technically complex fields. But they can also be abused if private licensors or deputies are not adequately supervised, or if they are faced with too crude an incentive framework. This Article suggests some best practices for the outsourcing of responsibility to these health care decision makers

To be or to become? An enquiry into the changing nature of requirements in open source health IT

This thesis develops a contemporary problematisation of software requirements. It departs from traditional conceptions of requirements as simple, tamed objects with deterministic force over socio-technical actors and based on assumptions of stability. Such views can lead to a narrow, ultimately unfruitful understanding of the significance of requirements and denied wider consequences of their modes of articulation. Instead, the thesis builds on perspectives where requirements are complex and interactive actors. The thesis uses openEHR—an open source health IT project aiming to build interoperable Electronic Health Records (EHRs)—as a case study. Studying open source practice offers a good opportunity to consider the nature of requirements because there is an ongoing debate about requirements’ role and influence on development activities and project organisation. The analysis uses Deleuzian concepts of assemblage, multiplicity and becoming. These themes align with a larger body of work influenced by STS and process oriented theorisations, which see the world as dynamic and performative. The philosophy of Deleuze and Guattari in particular provides a counter-balance to any assumed stability in the world. The thesis presents a new account of the nature of requirements, one that reflects their complex entanglement within software development and open source in particular. Requirements are not insipid descriptive statements that abstract and simplify the world deterministically. They have an intricate existence which serves to hold the potential in the assemblage to become many things. In particular, requirements insinuate themselves into a project’s identity, guide a project through territories—some to be explored, some to be disregarded—and demand specific ways to be recognised, engaged, and cared for. The thesis argues that requirements are more virtual than originally thought, having a subtle, not necessarily visible influence on their assemblages and the way socio-technical actors can potentially relate to the project itself