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Engaging Patients with “Gamified” Mobile Care

There’s a new buzzword floating about town.  That word is “gamification”.  So, what is it, and why do I think it has everything to do with the fastest moving trend in healthcare technology?

In their great piece on gamification, Mashable defines the term as “the use of gameplay mechanics for non-game applications. The term also suggests the process of using game thinking to solve problems and engage audiences.”

Gamification is seen as the next frontier in mobile, web, and social technology.  Industries far and wide are climbing on board with the trend in hopes of engaging consumers.  In this age where patient engagement is at the fore (read: I sunk a good half hour of my life playing with the symptom checker on the Texas Health homeage) healthcare organizations can certainly profit from this trend more now than ever before.

Using Gamification to Solve Health Problems

The best thing about gamification is that it can be used to solve real-world health problems like diet, fitness, adherence to medication, and managing care protocols.

In a recent article on MobiHealth News entitled, “Should health apps be as fun as Angry Birds?”  Dr. Jessie Gruman is profiled as asking developers to explore what their target audiences have to accomplish in their daily lives to manage their medical issues.  Devices and apps should simplify those tasks for patients.  Even more, Dr. Gruman feels it is important to not just get caught up in the fun and frivolity of gamification.  Rather, these health apps should make the lives of those managing chronic disease easier.

In the Mashable article, Gabe Zichermann, the author of Game-Based Marketing, speaks of balancing the fun and frivolity of gamification with the task of making life easier for cancer patients.  He says, “I don’t presume to think that we can make having cancer into a purely fun experience,” he says. “But, we have data to show that when we give cancer patients gamified experiences to help them manage their drug prescriptions and manage chemotherapy, they improve their emotional state and also their adherence to their protocol.”

The obstacle that gamified health apps enable clinicians to overcome is helping patients manage guilt over failure to comply.  This is the key obstacle patients face when attempting to follow a diet, fitness, or medication regimen.  Games help patients manage that guilt.  The game navigates patients through their story of successes and failures until they ultimately become victorious.

Docs Love Mobile Devices, But Need Smarter Features

Vendors need to provide native applications and more intelligence to get EHRs to “play nicely” with mobile devices.

“Whatever the objections to mobility have been in the past, they are falling away as everything wireless becomes more powerful, more affordable and more user-friendly.”

That’s the conclusion of a new white paper from research firm Frost & Sullivan that summarizes the burgeoning new uses for mobile devices in healthcare.

Kenneth Kleinberg, a consultant with the Advisory Board, agreed with this perspective. “There’s a huge flood of interest in using tablets and smartphones by physicians,” he said. “They’re going to use whatever works to make their jobs easier and faster. They love these devices. They want to use them in the hospital and the provider environment.”

Frost & Sullivan projects smartphone penetration in North America will jump from 24% to 67% by 2015. Physicians are far ahead of the general population in this respect. Sixty-four percent of doctors were using smartphones in March 2010, according to a Manhattan Research study.

Frost & Sullivan noted that smartphone applications for healthcare range from drug and clinical references to diagnostic tools to real-time patient recordkeeping. In addition, its report said, “Electronic health records (EHRs) can be accessed via smartphone, allowing caregivers to diagnose and communicate virtually anywhere, anytime, including at the point of care.” It noted, however, that smartphones have limited displays and processing power, so they may yield incomplete information and require time-consuming paging through multiple screens.

The white paper pointed out that tablet computers have been around since the 1980s–and, noted Kleinberg, have had some impact on healthcare for the past decade. “However,” Frost & Sullivan observed, “a slimmer, less expensive, more feature-packed version is now taking the mobile device industry by storm. These new iterations, launched by a growing list of top-tier vendors, have significant potential in the healthcare sector.”

Among the uses for these tablets–which include iPads and the like–are applications for “diagnostic imaging and video, quick access to educational and reference resources, and on-the-spot access to electronic patient records,” said the report. Native applications being developed for the tablet, it notes, include those for MRI viewers, mobile film readers, and mobile medical calculators.

Kleinberg pointed out that clinicians can’t make good use of EHRs on either tablets or smartphones unless the software vendors have written device-specific native versions of their EHRs. “Depending on how the screen was designed and what the resolution is, the application might not fit well,” he said, if it were accessed through a browser or Citrix. “Also, the handwriting recognition might not be effective.”

So where do the vendors stand on mobile devices? “Almost every major vendor has a ‘skunkworks‘ that is working toward native support of at least a couple of these devices, like an iPad or an Android smartphone,” Kleinberg responded. “Some of them can demonstrate this now; some of them have even released it. But it’s a difficult, time-intensive venture to design these versions.”

The mobile health explosion is coming at a time when other issues–including Meaningful Use and ICD-10–are placing big demands on their resources, Kleinberg noted. The bigger companies are capable of forging ahead on all fronts, but the smaller firms may have to put off designing native mobile applications.

The new generation of devices “is almost there,” he said, for effective use of EHRs. A physician can document a visit on an iPad, for example, by using the touchscreen, typing, digital handwriting, and voice recognition. But the workflow factor has not been sufficiently addressed. To reduce the number of screens a physician has to go through and the amount of data he has to enter, he said, applications must be designed with more intelligent features.

“EHR vendors have not done a very good job of designing knowledge-based algorithms that take the information you’ve provided and attempt to reduce the number of questions you have to answer to get to the solution,” said Kleinberg.

iPads are perfectly capable of handling other tasks, such as viewing digital images or taking photos of a patient to show his condition, Kleinberg said. And doctors can use various mobile devices to place orders in computerized physician order entry systems, as long as they don’t expect much in the way of decision support, he added.

The main advantage of mobile devices, he said, is that they have the potential to increase physician adoption of health IT, because doctors love their smartphones and iPads. “If these mobile devices get physicians to use these systems, the adoption issue–which is crucial for Meaningful Use—will be alleviated.”

Personal Cloud Computing

The cloud is a deceptively simple concept for the modern consumer. Most of us use the cloud every day and probably never think about it. Popular online services and destinations like Gmail, Netflix, MobileMe, and Twitter are all operating in the cloud and the information and media we send to, or receive from, these sources is all passed through the cloud.

When people talk about the cloud, they’re using the concept of a cloud as a metaphor for the internet. Services like Gmail, which save you from having to own and operate your own email hosting server and software, are actually hosting your emails and information in many remote data centers via the internet or cloud. These redundant data centers, where your information is housed, are important because they’re the reason using the cloud is so powerful, cheap, and easy for all of us.

For example, when you send a new tweet on Twitter, your new tweet is instantly housed in and across a wide expanse of data centers- large groups of powerful computers you never see. These data centers store your tweet securely and make it possible for you and your friends to see your tweet from multiple devices (smart phones, laptops, desktops) and from anywhere in the world (your house, your office, on the train) instantly. Your new tweet is in the ‘cloud’ and the benefits that come with using the cloud don’t end there.

In addition to allowing device and location independence, the cloud provides security for your data. Data, once in the cloud, is essentially backed-up and lives in the cloud even if you lose the original copy on your PC. Decentralizing your data means you’re covered should something go wrong. Services and applications that use the cloud make it easy to instantly upload, backup, share, and access information to and from anywhere in the world. Because the cloud has so many applications, it’s already become a big part of many users’ daily online activity.

California is home to many of the leading services using the cloud like Google, Flickr, Twitter, Netflix, and Apple. The cloud is the online space in which the future of exchange between users and services will be made possible and Californian innovators are leading the way. Whether or not users are aware that they’re utilizing the cloud when they log-in to read their mail or upload some photos, the cloud is becoming an integral part of how we all use and share information more freely and effectively.

Towards Universal Broadband: Flexible Broadband Pricing and the Digital Divide

Reaching Universal Access through Affordability at All Income Levels1

Driven by the conviction that the widespread use of broadband can support economic recovery and help the United States achieve other important national goals, President Obama has proposed that every American should have the opportunity to connect to broadband service. On his campaign web site, the President declared: “America should lead the world in broadband penetration and Internet access” and he promised to bring “true broadband to every community in America.”2 In enacting the American Recovery and Reinvestment Act of 2009, the Congress signaled its agreement by providing $7.2 billion in dedicated funding to advance broadband’s spread and by directing the Federal Communications Commission to develop a national strategy to achieve universal broadband.

Continue reading “Towards Universal Broadband: Flexible Broadband Pricing and the Digital Divide”

Confronting Bullies On The Digital Schoolyard

Policymakers and law enforcement officials at the state and federal levels have taken steps in recent years to address the safety of young people on the Internet. But one area of online safety in which there is a need for greater leadership is cyberbullying. There has been growing public awareness of the dangers of cyberbullying—the use of digital media by young people to harass, bully, or humiliate their peers—but there is no uniformity in how state or federal laws address the problem. Codifying a clear definition of cyberbullying in statute and distinguishing it from other forms of online harassment would go a long way toward helping legislators, law enforcement, schools, parents, and other community members create strategies for responding to such incidents. The response to cyberbullying in Texas illustrates the difficulty of mobilizing state officials to take action. At the federal level, most efforts to promote youth safety online have focused on stopping sexual predators, not bullies.

Introduction

In 2001, Lauren Newby, a sophomore at Lake Highlands High School in Dallas, Texas, was the victim of malicious taunting by current and former classmates. The students ridiculed the young woman about her weight, her disability, and her boyfriend. The incident began with disparaging remarks on a message board, but soon escalated into physical attacks on her home and vehicle. What distinguishes these attacks from traditional bullying incidents is their origin on the Internet instead of school grounds.Like many other young people across the United States, Ms. Newby was the victim of a pervasive and dangerous Internet practice known as cyberbullying.

This article examines efforts to address cyberbullying both in Texas and at the federal level, where officials are struggling with how to define the problem. Ultimately, cyberbullying merits a collaborative strategy among parents, educators, policy makers, and the private sector. Yet, this article explores some of the structural obstacles that have prevented such a strategy from coming to fruition. The example of Texas illustrates that even in a state where law enforcement officials recognize threats to youth safety posed by the Internet, there is a disproportionate focus on adult sexual predators and too little attention paid to youth-on-youth bullying. At the federal level, efforts to address cyberbullying and other forms of cyberharassment have been hampered by concerns about legislation that would curtail civil liberties.

Understanding Cyberbullying

Many scholars and child safety advocates have attempted to provide a useful conceptualization of the term cyberbullying; however, no single definition exists to guide parents, educators, and law enforcement officials. For example, John Palfrey and Urs Gasser define cyberbullying as “the intentional use of any digital medium, including text-messaging, pagers, and phone calls, to harm others.”2 They note that the only difference between bullying on or off the Internet is that cyberbullying is “put on the record in a more permanent way.”3 In this regard, cyberbullying, like traditional forms of verbal bullying, has the potential to precipitate actual physical vio- lence. What distinguishes cyberbullying from other forms of bullying is the likelihood of  emotional damage caused by the public and lasting nature of the communication by a potentially anonymous attacker.4

Although there have been some reports of cyberbullying perpetrated by adults, most definitions of cyberbullying frame the problem as one in which both the victims and the perpetrators are young people.5 The National Crime Prevention Council (NCPC) applies the term cyberbullying to harmful interactions  between  young  people,  with  an  emphasis  on teenagers. NCPC includes in its definition: posting abusive text or images, sending threatening messages, or the use of identity fraud to convince an individual to give up personal information.6

As one would expect, lack of a standard definition of cyberbullying has contributed to a failure to create a consistent statutory definition, but the lack of consistent definitions and legal practices does not mean cyberbullying is not a serious problem. In 2006, the Crimes Against Children Research Center (CCRC) estimated the risks for children and teens for certain behavior online. Specifically, CCRC found that one out of eleven young people was in danger of “harassment [through] threatening or other offensive behavior.”7 Between 2001 and

2006, harassment increased from six to nine percent of all “youth Internet users.”8 Revisiting this study in 2008, the di- rector of the CCRC noted that a significant amount of the harassment studied likely came from other young people, not “hardened Internet predators.”9

Action In The State of Texas

Current law and policy priorities in Texas reflect national trends of the response to cyberbullying; as in other states, officials in Texas publicly recognize the problem of cyberbullying, but they have focused law enforcement activities in the digital sphere specifically on the investigation and prosecution of online sexual preda- tors, not on efforts to curb youth-on-youth online bullying.

“Federal and state laws need to address physical and electronic bullying and harassment together, with the understanding that the real campus is now integrated with the online world.”

Under  existing  law  in Texas, a person may be found guilty of harassment (a misthat the real camp with the online wordemeanor offense) if he or she uses e-mail, instant messaging, network calls, or other electronic communications to initiate communication with the intent to “harass, annoy, alarm, abuse, torment, or embarrass another” person or household.10 In this respect, the Texas Penal Code is progressive in its integration of electronic and non-electronic forms of harassment into a single statute with common penalties; there is no dis- crimination between the physical world and the virtual world. However, the Penal Code statute on harassment is separate from the state’s treatment of bullying, which falls under the state Education Code and deals specifically with victimization on public school property.11

During the regular session of  the 81st Legislature in Texas, Representative Mark Strama (D-50th District) introduced legislation designed to address the divide between the current reality of  online bullying and the legal tools that schools have at their disposal to respond to bullying incidents. As amended and reported out of the Texas House Committee on Public Education, House Bill (H.B.) 1323 would have added “verbal expression through electronic means” to the statutory definition of bullying under the Texas Education Code and would have clarified that bullying may include behavior on or off of school grounds.12 This legislation would have inextricably linked physical schoolyard behavior with malicious on- line conduct, and allowed school district boards the authority to pursue transfers of the bully or the victim, depending on verification of the behavior and the request of the victim’s par- ent or guardian.13 However, H.B. 1323 was not considered by the full Texas House of Representatives before the conclusion of the regular legislative session.

Legislative progress has been made in Texas. On June 19, 2009, Governor Rick Perry signed H.B. 2003, which amended the Texas Penal Code to create felony and misdemeanor offenses for certain types of online harassment. Under the re- vised laws, a person may be found guilty of a third-degree felony for using another person’s name or likeness on a social networking site for the purpose of harassing someone else.14 Also, a person may be punished with a Class A misdemeanor offense (the most serious class of misdemeanor offenses in Texas) if he or she sends electronic communication, including texts, emails, and instant messages, that make reference to a person’s name, Internet domain, or other identifying contact information, provided that the information was referenced without permission and the communication was made with the intention of harming or defrauding another person.15 The new law became effective on September 1, 2009, and its impact on Internet safety will be determined in the months ahead.

According to the Office of  the Attorney General in Texas  (OAG),  cyberbullying prevention is currently  most effectively treated not as a legal matter, but as a matter of community outreach.16 The OAG deploys personnel to school districts throughout the state on a weekly basis to discuss Internet safety with parents, students, and educators, focusing especially on the vulnerable online population of 12- to 15- year-olds.17 While Attorney General Greg Abbott has been aggressive in his efforts to protect children online, the majority of his efforts have focused on the protection of children from sexual predators.18

Federal Legislation

While some states like Texas now have laws with respect to various forms of cyberharassment, no federal statute or common legal standard has appeared. Federal law does con- sider threats communicated by the Internet to be criminal actions, punishable by up to five years in prison.19 However, this law requires the delineation between a threat, meaning “one that a reasonable person would take as a serious expres- sion of an intention to inflict bodily harm and … communicated to effect some change or achieve some goal through intimidation,”20 and the sort of harassment or annoyance that might occur through electronic communications. Federal law (under the Federal Telephone Harassment Statute, 47 U.S.C. 223) also permits the prosecution of cyberharassment through telephones, telecommunications devices, and email

Table 1: Selected State Laws Relevant to the Prevention of Cyberbullying of Minors

 State  State Law  Brief Summary
 California  CA Penal Code § 422  Establishes that threats made toward an individual or his or her familythrough the use of an electronic communication are to be considered aslegitimate threats, regardless of whether the threat will be carried out. Setsforth misdemeanor penalties for carrying out specific cyberharassment

actions.

 Florida  FL Stat. § 784.048 Defines cyberstalking to include a pattern of behavior targeting a specificperson through electronic mail or communication. Additional penaltiesexist for cyberstalking of a person under the age of 16.
 Illinois  IL Comp. Stat. 720 § 135 1-2 Specifically defines actions constituting harassment through electronicmeans of communications, including the harassment of victims under theage of 13 by defendants who are at least 16 years of age.
 Michigan  MI Comp. Laws § 750.411s Prohibits the posting of threatening or harassing messages through theInternet and computer systems, programs, and networks or by otherelectronic means.
 Oklahoma  OK Stat. 21 § 1172  Includes conspiracy or concerted action with others among prohibitedmethods of perpetrating cyberharassment.
Texas  TX Penal Code § 33.07  Creates felony and misdemeanor penalties for certain actions defined asonline harassment, including the use of social networking websites on theInternet.

Source: Alison M. Smith, Protection of Children Online: Federal and State Laws Addressing Cyberstalking, Cyberharassment, and Cyberbullying (Washington, D.C.: Congressional Research Service, September 5, 2008): 29-37.

communications, provided that the perpetrator remains anonymous.21  Federal courts have yet to rule specifically on whether Internet chat rooms or bulletin boards are included under this statute.

Similar to state legislation, federal legislation related to protecting children online has typically focused on the prohi- bition of “child pornography, child luring, and child sexual exploitation” because of the nature of physical harm associated with these three criminal activities.22 Congress has attempted to “maintain a balance between enacting statutes broad enough to cover undesirable behavior, while simultaneously narrow enough to prevent infringement upon an individual’s right to express oneself under the First Amendment.”23

Over the last twelve years, while three enacted federal laws have attempted to prevent young people from accessing sexual materials on the Internet, none have addressed concerns of cyberbullying. The Children’s Internet Protection Act of 2000 (CIPA), the only one of these three laws affirmed as constitutional by the Supreme Court, requires that “a school or library may not use funds it receives under [federal] statutes to purchase computers used to access the Internet, or to pay the direct costs of accessing the Internet” unless the institutions use Internet filters to prevent access to child pornography or other materials that are obscene or (in the case of young users) harmful to minors.[24] The Supreme Court held that users may turn off the filters for research or other legal Internet usage and that the ease of using such a switch guarded against constitutional concerns that users might be blocked from accidentally filtered material.25

For advocates of cyberbullying protections, the judicial interpretation of CIPA could mean that filtering or blocking software could be implemented to interpret online conversa- tion and block inappropriate contacts. While parents have the right to use filters at home, the CIPA ruling might allow the ex- tension of filtering technology to protect against cyberbullies during the use of school or library computers.

On April 9, 2009, Representative Linda Sanchez (D-CA) introduced H.R. 1966 that would amend federal law to make cyberbullying a crime, punishable by two years of imprisonment and/or a fine.26 The bill would make criminal anyone who “transmits in interstate or foreign commerce any communication, with the intent to coerce, intimidate, harass, or cause substantial emotional distress to a person, using electronic means to support severe, repeated, and hostile behavior.”27 H. R. 1966 would include as “electronic means” all email, instant messages, Web sites (including blogs), tele- phones, and text messages.28 Similar forms of this legislation were introduced during the 110th Congress; none were passed before the Congress adjourned in December 2008.29

Court Action

The American judicial system has established some precedents in the event that parents or students contest disciplinary action on the grounds of cyberbullying or cyberharassment. First, the United States Supreme Court has affirmed that the First Amendment does not provide safe harbor for so-called “offensive speech” that occurs on school campuses.30 Second, state courts have upheld the right of school districts to punish students for Web-based harassment, particularly in cases in which students create potentially threatening materials, access them at school, and share the content with other students.31 Courts at the state level have placed the language of cyberbullying outside of First Amendment protections on free speech. Third, however, while the state courts have generally determined that cyberbullying or cyberharassment must constitute legitimate disruption to school operations to justify school disciplinary actions, the courts have not made a clear determination on what materials cross the delicate boundary between harassment and a genuine threat.32

Recommendations

Clear evidence exists to demonstrate that cyberbullying exists and is a growing threat to young people. Understandably, both states and the federal government have focused on pursuing legal solutions to the problem of cyberbullying, and many lessons can be learned from the experiences of Texas and the federal government. The solution to this problem requires a multi-faceted collaboration between parents, educators, law enforcement officials, policy makers, and online social networking and communication companies. Recommendations for future action include:

1.    Legislators at the state and federal levelsshould develop clear-cut definitions o cyberbullying and cyberharassment and determine what rules govern the interaction between minors versus the interactions between minors and adults. Consistent statutory definitions of cyberbullying are imperative for the measurement of policy outcomes and the development of prevention strategies for law enforcement officials, educators, and parents. Jurisdictions could benefit from distinguishing between cyberbullying in which both the victims and the perpetrators are typically minors and cyberharassment, perpetrated by adults against other adults or children. Such a distinction would frame the response to cyberbullying within the traditional educational understanding of “bullying” as a schoolyard activity, which is a necessary step in developing strategies for combating the phenomenon.

2. Federal and state laws should address physical and electronic bullying and harassment together, with the understanding that the real campus is now integrated with the online world. Crucial  to  this  proposal,  cases  of  cyberbullying should be handled first through the educational sys- tem instead of  solely through the courts. Certain tragedies may merit criminal investigation and prosecution when serious physical harm occurs with—or is caused by—emotional damage.33

Many schools do have safety officers to patrol their campuses for the purpose of observing and preventing criminal behavior; however, a strong law- enforcement-only approach is inappropriate for stop- ping cyberbullying. While legal measures themselves may be inadequate for protecting children from cy- berbullying or inappropriate information online at all times, government entities have an important role to play in producing educational resources on the In- ternet and working with the private sector to develop protection mechanisms.34

3. Th educatio an polic communities should play active, collaborative roles in teach- ing students about the dangers of cyberbullying. In the digital age, countering bullying must involve understanding and acknowledgement of the fusion of real and online life. Because the anonymity of the Internet presents an extra danger of acting without full appreciation of consequences, educators must be capable of teaching students how to recognize, avoid, and report bullies both at school and on the Internet.35 As in Texas, it is important for policy makers  and  law-enforcement  officials  to  be  visible classroom participants as young people are educated on the means and consequences of cyberbullying.

4. Parent shoul activel discus Internet safety with their children and, to every extent possible, engage them about their own online habits. With effective home monitoring of minors’ computer usage, an effective program of  school- based education on cyberbullying, and a program of laws that adequately define and punish cyberbullying and cyberharassment, it may be possible to reduce the emotional harm that continues to spread among current and future generations of Internet users.

Conclusion and Next Steps

Before the public sector considers any change in the legal structure regarding online communication, the private sector of  online service providers has a crucial opportunity to demonstrate that they have concerns about protecting young subscribers from potentially harmful situations. MySpace, for example, has reached an agreement with 49 state attorneys general to develop a task force to study the online safety of minors who use its site.36 Notably, the only office to abstain from this agreement is the Texas OAG. Attorney General Abbott has stated that he believes MySpace provides inadequate protections for minors and that signing the joint statement to establish  the  task  force  “would  be  misperceived  as  an endorsement of  the inadequate safety measures contained therein.”37Attorney General Abbott also added: “[The OAG] cannot endorse any initiative that fails to implement a reliable age verification system. Doing so would give Texas parents and their children a false sense of security.”[38]

Mr. Abbott may be commended for standing on principle for age-verification protection, but the sort of  public-private partnership created by the MySpace task force remains a potentially valuable tool for understanding and combating cyberbullying through social networking Web sites.

A former United States Senate legislative  staffer and high school teacher, Jonathan Rogers is a graduate student at the Lyndon B. Johnson School of  Public Affairs and McCombs  School  of  Business  at the  University  of Texas, Austin.

 


 

1 Amy Benfer, “Cyber slammed,” Salon.com, http://dir.salon.com/mwt/feature/2001/07/03/c yber_bullies/index.html (accessed: October 21, 2009).

2 John  Palfrey and  Urs Gasser, Born  Digital: Understanding the First  Generation of   Digital Natives (New York: Basic Books, 2008): 90.

3 Ibid., 93.

4 Ibid., 93-94.

5 Ibid., 94. NOTE: The authors specifically cite the suicide of Megan Meier in Dardenne Prairie, Missouri. Meier was deceived by the false online persona of  a romantically interested boy created by a pair of girls and their parents.  Meier discovered the hoax before taking her own life.

6 National Crime Prevention Council. “What is Cyberbullying?”  National Crime Prevention Council http://www.ncpc.org/topics/cyberbullying/what-is-cyberbullying is-cyberbullying (accessed: July 7, 2009); National Crime Prevention Council. “Cyberbullying FAQ For Teens.” National  Crime  Prevention  Council. http://www.ncpc.org/topics/cyberbullying/cyberbullying-faq-for-teens (accessed: July 7, 2009).

7 Janis Wolak, Kimberly Mitchell, and David Finkelhor, Online Victimization of   Youth: Five Years Later (Alexandria, Virginia:  National Center for Missing & Exploited Children, 2006): vii, 1.

8 Ibid., 1.

9 Public Broadcasting Service. “Frontline: Growing Up Online (The Predator Fear).”  Public Broadcasting Service http://www.pbs.org/wgbh/pages/frontline/kidsonline/safe/predator.html (accessed: July 6, 2009).

10 Texas Penal Code Annotated, Title 9, Chapter 42, Sections 42.07a-42.07c.

11 Bully Police USA. “Texas: C-.”  Bully Police USA,http://bullypolice.org/tx_law.html (accessed: July 4, 2009).

12  Texas  House of Representatives, House Committee on Public Education, Committee Report on H. B. 1323 (Substituted), Texas House Bill 1323, 81st Legislature, regular session (2009): 1601. [13] Ibid.

14 Office of  the Attorney General of  Texas. “Cyber Safety.” Office of the Attorney General of Texas https://texasattorneygeneral.gov/cj/cyber-safety tml (accessed: July 6, 2009).

15 Ibid.

16   David   Boatright,   Chief    of    Criminal Investigations Division, Office of  the Attorney General of Texas, telephone interview with author, July 7, 2009.

17 Ibid.

18 Howard Witt. “To Texas AG, Net predators are fine prey.” Chicago Tribune, http://www.chicagotribune.com/chi-abbott_wittnov05-story.html (accessed: July 6, 2009).

19 Alison M. Smith, Protection of   Children Online: Federal  and  State  Laws  Addressing  Cyberstalking , Cyberharassment, and Cyberbullying (Washington, D.C.: Congressional Research Service, April 15, 2009): 5-6.

20 Ibid.

21 Ibid., 7.

Hospitals, doctors jumping into the digital age

By Andrea Suozzo  | Addison County Independent

While iPad-carrying doctors might seem futuristic, that image is not too far off for Porter Medical Center’s staff.

On Aug. 1, Porter flipped the switch on the first part of an information system that will digitize most functions at the hospital and its 11 satellite practices.

To read the rest of this article, click here

Wireless Overview

More than 95 percent of the U.S. population – those living in urban, suburban and rural America – are served by at least three competing carriers, and more than half live in areas served by at least five.  Eight years ago there were 100 million U.S. wireless customers. Today, there are more than 270 million, and in 2008 they used more than 2.2 trillion minutes – a tenfold increase since 2000.  At the same time, prices have declined precipitously.  Revenue per minute has fallen 89 percent since 1994, and U.S. wireless prices are much lower than in any other industrialized county.  And, while at&t and Verizon are currently the two largest wireless providers, the next two largest, Sprint and T-Mobile, have a combined 82 million customers, and the carriers that round out the top 10 have another nearly 20 million customers among them.

As wireless technology and services have grown exponentially in the last 25 years, California has been one of the prime engines of that growth.  Strategic partnerships between carriers and handset manufacturers, application developers and content providers, the private and public sector give consumers access to unparalleled innovation in the wireless space.

Today, more than 160 wireless service providers in the U.S. directly employ more than 257,000 workers who earn salaries totaling more than $12 billion each year.  This is in addition to the numerous early-stage companies, high-tech start-ups and small businesses in the wireless space that are also key contributors to the U.S. economy. California is home to one of the few areas where wireless start-ups cluster, Silicon Valley, where competition thrives, partnerships form and innovation flourishes.

According to the Federal Communications Commission, California serves the largest number of wireless users, 32,247,015, at the end of 2007.

The number of wireless users has more than doubled in California over the past 7 years.

Technology Taxes

California has been ground zero for technology development. For California to remain a global technology leader, the state will need to ensure a favorable business environment for innovation. Yet, recent studies indicate that increasing numbers of Silicon Valley businesses are looking outside of California to start new operations. Other states and countries, such as China, where the government has tripled R&D spending since 1998, are becoming more attractive to many companies. As California continues to suffer from record budget deficits and the search for new revenue becomes more urgent, the state must be careful not to hinder an industry that will be essential to a recovery and long-term prosperity.

The success of the technology industry in the state has brought huge sums of venture capital and wealth to the state that has benefited all Californians, and it is important to continue fostering the entrepreneurship and innovation that improves everyone’s quality of life. Maintaining a tax structure that does not place an undue burden on the technology industry is essential to California’s economic health and to keeping the state at the forefront of cutting-edge technology.

This industry is highly mobile and competitive, and tax policies play a critical role in determining competitive advantages. Taxing digital products (for example music, ring tones, e-books) could give out-of-state sellers a significant advantage since they can still easily reach customers online. In addition, R&D tax credit policies can influence where technology companies decide to locate. A great deal of R&D has found its way to California historically, but in this increasingly global economy revising this incentive could be necessary to keep the state competitive.  For instance, right now California’s R&D credit only applies to labor costs and not machinery. So there is double taxation on R&D – taxation of the equipment used in R&D and of the product when sold. The credit could also be more valuable if it was tradable so start-up companies that are not yet turning a profit can benefit as well.

Cyber bullying

The number of children and young people accessing the internet has increased dramatically in recent years. They have been key drivers of the social media movement, as services like Facebook and Twitter provide them with new spaces to engage their peers. However, the growth of online use among younger populations has made online safety a concern as the internet provides new opportunities for activities such as cyber bullying, where harassment occurs through technologies like text or instant messaging and email. Several studies have found that cyber bullying is not a small, isolated problem.  The National Crime Prevention Council has reported that cyber-bullying affects over 40% of all American teens. It is more common among females than males, and is most prevalent among 15- and 16-year-olds.

Everyone can agree that the internet must be a safe and secure environment for children so they can fully enjoy the educational and entertainment benefits that being connected to the wider world provides..  Cyber bullying can be psychologically harmful, and has led to suicide in extreme cases. CALinnovates strongly supports expanding educational efforts for online safety. Children must understand what personal information should not be given out online, what actions qualify as cyber bullying, and how to report it if they see it happening. This type of education should happen early, before children become active online users. All should feel welcome in the online community and not be deprived of its benefits by those who misuse technology.

Personal Cloud Computing

The cloud is a deceptively simple concept for the modern consumer. Most of us use the cloud every day and probably never think about it. Popular online services and destinations like Gmail, Netflix, MobileMe, and Twitter are all operating in the cloud and the information and media we send to, or receive from, these sources is all passed through the cloud.

When people talk about the cloud, they’re using the concept of a cloud as a metaphor for the internet. Services like Gmail, which save you from having to own and operate your own email hosting server and software, are actually hosting your emails and information in many remote data centers via the internet or cloud. These redundant data centers, where your information is housed, are important because they’re the reason using the cloud is so powerful, cheap, and easy for all of us.

For example, when you send a new tweet on Twitter, your new tweet is instantly housed in and across a wide expanse of data centers- large groups of powerful computers you never see. These data centers store your tweet securely and make it possible for you and your friends to see your tweet from multiple devices (smart phones, laptops, desktops) and from anywhere in the world (your house, your office, on the train) instantly. Your new tweet is in the ‘cloud’ and the benefits that come with using the cloud don’t end there.

In addition to allowing device and location independence, the cloud provides security for your data. Data, once in the cloud, is essentially backed-up and lives in the cloud even if you lose the original copy on your PC. Decentralizing your data means you’re covered should something go wrong. Services and applications that use the cloud make it easy to instantly upload, backup, share, and access information to and from anywhere in the world. Because the cloud has so many applications, it’s already become a big part of many users’ daily online activity.

California is home to many of the leading services using the cloud like Google, Flickr, Twitter, Netflix, and Apple. The cloud is the online space in which the future of exchange between users and services will be made possible and Californian innovators are leading the way. Whether or not users are aware that they’re utilizing the cloud when they log-in to read their mail or upload some photos, the cloud is becoming an integral part of how we all use and share information more freely and effectively.