By next summer, when 500 people with asthma in Louisville, Ky., decide to take a whiff from their inhaler, they won’t just be injecting much-needed medication into their lungs -- they’ll be participating in a cutting-edge experiment that's pushing the limits of health data.

Participants' inhalers will be implanted with GPS trackers that notify the product's manufacturer every time the user pulls the trigger for air. The manufacturer, Asthmapolis, will then depersonalize the data (removing a patient’s name and vital statistics, for example) and give it to a commission of city officials and health-care providers. The hope is that this data -- combined with other public information like air quality, pollutants, traffic patterns and school absences -- will eventually allow Louisville officials to make informed decisions about how to create a healthier living environment for their residents.

“It represents what I think government should do, thinking innovatively and for the good of the public,” says Louisville Mayor Greg Fischer. “I’m always scanning and looking for something different. Cities really are the incubators for getting things done.”

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The Louisville Asthma Data Innovation Project is a public-private partnership between the city, Asthmapolis and IBM, which is funding the initiative through its Smarter Cities Challenge. Collaboration is key to its success. Pharmacies and physicians are distributing the inhalers; doctors will guide care based on the data collected (if patients allow it); and health-care providers are sitting on the steering board overseeing the project and deciding what to do with all the information. Ted Smith, Fischer’s director of economic growth and innovation and a former senior innovation adviser for the U.S. Department of Health and Human Services (HHS), is the lead representative for the city.

After his time at HHS working with U.S. Chief Technology Officer Todd Park, a passionate advocate for health data, Smith says he sought to bring that mentality to Louisville -- and the asthma data project provided a perfect opportunity. Louisville is located in the Ohio River Valley, which amplifies the presence of allergens and small particulates and in turn exacerbates problems for people who suffer from asthma. Those issues can vary in intensity within different sections of the city, based on other factors, such as traffic pollution and air quality. The resulting public health concerns can deter businesses to locate in Louisville, Smith says, furthering the economic troubles of a city that's struggled to bounce back from the recession.

So the GPS inhalers present the possibility of diagnosing a public health and environmental problem using data rather than anecdotes and using that information to drive public policy decisions. The city hopes to pinpoint potential asthma “hotspots" and then respond accordingly. That could mean seasonal fuel blend requirements, targeted tree planting or targeted highway housing barriers, according to Smith.

"Sensor technologies like these can make direct connections between health and our environment -- all the trends suggest that sustainable green cities are also those that have a handle on measures that inform policy," says Smith.

But the bigger idea, say both Fischer and Smith (both of whom have a background in the private sector) goes beyond the specific public health and environmental policies that the asthma data project could influence. It’s about reimagining how government thinks about data and innovation.

"I foresee many, many more programs like this," Smith says. "There are hundreds of new things to do, but I think the big difference is the ground we are breaking in how government does this, how we go from talking the talk to walking the walk on open government and open innovation."

States Make Rapid Movement on Health Exchanges Post-Election

With President Barack Obama’s reelection, Affordable Care Act (ACA) opponents are confronting the fact that the law will be implemented in its entirety. For states, that's meant a scramble to figure out what they’re going to do about health insurance exchanges, the digital marketplaces (which will be similar to Expedia or Orbitz for air travel) that more than 20 million people are projected to use to buy health coverage.

States have three options: a state-run exchange, a state-federal partnership or a federal-run exchange. The White House wants as many states as possible to run their own exchanges -- both because a state-led effort is more likely to be accepted by the citizenry and fewer federal-run exchanges means less work for HHS -- but so far, only 18 states (and the District of Columbia) have committed to a state-based exchange. Five are planning for a partnership, 21 have deferred to a federal-run exchange and six remain undecided.

Since the election, there's been an intriguing game of cat-and-mouse between Republican governors who ideologically oppose the ACA and an administration interested in implementing its signature legislative achievement as effectively as possible. First, HHS gave states an extra month to submit their detailed health exchange plans but kept the deadline to decide which plan they will choose to Nov. 16. Then, a day before the deadline and after Republican governors sent a letter to HHS asking for more time to consider their decision, the Obama administration extended the decision deadline to Dec. 14. It seems the White House is interested in allowing as much flexibility as possible if it means getting more states onboard for a state exchange. Deadlines for partnership and federal-run exchange plans were pushed into early 2013.

Kaiser Health News and PBS Newshour have published a great map (which is current as of Nov. 16) outlining each state’s status -- with the caveat that these plans could change as HHS offers new incentives for states to build their own exchanges. Here are a few of the more notable developments since the election:

  • Florida Gov. Rick Scott, whose state led the effort to overturn the ACA in the U.S. Supreme Court, now says he is at least open to discussing state implementation of the law. At the moment, the state remains officially undecided.
  • Many analysts watched Wisconsin Gov. Scott Walker, thinking he might be a candidate for a GOP governor that would push forward with a state exchange, but he squashed such speculation when he announced last week that his state would opt for a federal exchange.
  • Missouri residents took to the ballot box on Election Day and said, by a 62-38 margin, that they did not want a state-based exchange. Democratic Gov. Jay Nixon had, at the ire of some state legislators, created an executive commission to explore the possibility. Many saw the ballot measure as a repudiation of that effort. With his hands tied by the vote, Nixon has since notified HHS that his state will have a federal exchange.

Must Reads in Health News

A new Government Accountability Office report found that it's still difficult for many Medicaid programs to find health-care providers that will accept their patients, Modern Healthcare reports.

U.S. Rep. Edward Markey of Massachusetts has introduced a bill that would put compounding pharmacies -- which have been blamed for the fungal meningitis outbreak that's killed more than 30 people -- under the authority of the Food and Drug Administration, according to Roll Call.

Meanwhile, the Baltimore Sun reports that states such as Maryland are continuing to examine their own policies after Massachusetts regulators came under scrutiny for failing to enforce their state laws.

Lastly, the diabetes epidemic continues to grow. New CDC estimates found that 18 states saw their diabetes rates double from 1995 to 2010, Reuters reports. The state with the biggest increase? Oklahoma, where the diabetes rate jumped by 226 percent over those 15 years.