Future of Health IT: Trends and Scenarios

Wiser OWL learns to unravel doctor talk (The University of Manchester)

I saw a really good news bit today, actually two days old but that's how far behind I am on non-critical email:

A good example of the scale of the problem facing medics and computer scientists is the NCI Cancer Thesaurus that has swollen from 20,000 medical terms in 2004 to over 50,000 terms today.

As new terms are being added all the time, ensuring that all these terms are described, updated and linked together correctly is a mammoth task for humans. However, by using OWL 2 definitions can be written in such a way that computer programs can tirelessly update these terms, enriching the structure of the Thesaurus and pointing out where there are errors.
 
"The first stage was writing the NCI Thesaurus in the original version of the language, OWL, but now OWL 2 enables computer programs to interpret these terms in a much more human-like way, for instance reasoning that if a fracture is located on a bone which is part of a leg then that fracture is a fracture of that leg," said Bijan Parsia of the University of Manchester’s School of Computer Science.

via www.manchester.ac.uk

I can't write more about it now, but it's a critical step in the right direction for the evolution of the Semantic Web. Some maintain it hasn't even been born yet, much less started to evolve. There's an element of truth in that, but it's a sign of the change in our sense of time that we would expect something as complex as the Semantic Web to  move along more quickly than it has so far. Kudos to the folks at Manchester and Oxford who made this manifest earlier this week.

The future of computing and communications: random thoughts, part 5

The New Scientist recently published an article entitled "Cell phones could be used to build 'audio Internet'". (I'm not sure if the article requires a subscription to obtain full access, and I apologize if it doesn't, but the link should at least lead to the abstract in that case.) This is one more indicator of the proliferation of modalities for human-computer interaction (HCI) that has been a major theme of my random thoughts in recent months.

The spoken web is an attempt to bring the power of the internet to rural India. Despite India's highly touted knowledge economy, around 70 per cent of its billion-strong population lives outside its cities, and most of them earn just $4 per day or less. And even for those who can afford computers, attempting to access the internet remains a futile exercise, either because they cannot read or write or the information on the web is simply not relevant to them.

The answer, says Tapan Parikh of the University of California, Berkeley, is speech. "An audio format would provide much more access and opportunity for local people to contribute," he says. "While a farmer may not be able to write a memo, or an email, or a summary of his work, he can easily talk about it."

Between a quarter and a third of India's one billion-plus population have access to a cell phone, with the number growing at 8 million per month. This is far greater penetration than the World Wide Web in India, especially in semi-rural and rural areas. Moreover, the content of the Web is not useful to India's poor, either (or both) because they cannot read or the content is irrelevant to their daily lives.

So how to leverage cell phone technology to bridge the Digital Divide? The answer posited by the New Scientist article is the spoken web.

...Conceptually, the spoken web is a network of VoiceSites, just as the internet is a network of websites. A VoiceSite can only be accessed by a phone, and only requires the user to be able to speak and listen. Callers can create their own VoiceSites or access those of others. They can also surf the spoken web, jumping from VoiceSite to VoiceSite using speech.

In developing the system, the team took their cues from the growth of the internet. "The thing that really fuelled the adoption of the World Wide Web is the ease with which you can create websites," says IBM IRL's Amit Nanavati. So they focused on developing a simple way to create VoiceSites.

Say a plumber wants new customers. First he calls a number and software called VoiGen then guides him, in his local language, through the process of setting up a VoiceSite. Relevant information, such as a welcome greeting and the plumber's contact details are recorded. Behind the scenes, the VoiGen system then creates a VoiceSite. A phone number, analogous to a URL, is then assigned to the plumber.

Anyone who calls the plumber's VoiceSite number is greeted with his welcome message, and then given help to navigate the information. For example, the caller can say "address" to hear the plumber's address, or "appointment" to request a call-out with him.

Conceptually, the spoken web is a network of VoiceSites, just as the internet is a network of websites. A VoiceSite can only be accessed by a phone, and only requires the user to be able to speak and listen. Callers can create their own VoiceSites or access those of others. They can also surf the spoken web, jumping from VoiceSite to VoiceSite using speech.

In developing the system, the team took their cues from the growth of the internet. "The thing that really fuelled the adoption of the World Wide Web is the ease with which you can create websites," says IBM IRL's Amit Nanavati. So they focused on developing a simple way to create VoiceSites.

Say a plumber wants new customers. First he calls a number and software called VoiGen then guides him, in his local language, through the process of setting up a VoiceSite. Relevant information, such as a welcome greeting and the plumber's contact details are recorded. Behind the scenes, the VoiGen system then creates a VoiceSite. A phone number, analogous to a URL, is then assigned to the plumber.

Anyone who calls the plumber's VoiceSite number is greeted with his welcome message, and then given help to navigate the information. For example, the caller can say "address" to hear the plumber's address, or "appointment" to request a call-out with him.

The vast majority of people on this planet are poor and illiterate, but more and more of these folks are acquiring access to cell phones, partly due to initiatives like GrameenPhone, but mostly due to the fact that cell phone infrastructure is profitable even in developing countries, in turn due in part to compelling economic reasons to want telephone access.

One example: I have read accounts of fishers in Kerala, one of India's poorest states, using cell phones to find out where to get the best price for their catch, eliminating their dependence on a single local bulk buyer. They can learn the price at various ports within sailing distance and mentally compute the tradeoff between the cost of traveling to a given port and the value of their catch at that port. A classic reduction of market friction.

Clay Shirky wrote an acerbic commentary 2002 on the tendency to sentimentalize the "digital divide". In Half The World, Shirky wrote:

Because wireless infrastructure does not require painstaking building-by-building connectivity, nor is it as hampered by state-owned monopolies, it offers a way for a country to increase its telephone penetration extremely quickly. By 2001, there were 25 countries where cell phone users made up between two-thirds and nine-tenths of the connected populace. In these countries, none of them wealthy, a new telecommunications infrastructure was deployed from scratch, during the same years that keynote speakers and commencement invitees were busily and erroneously informing their listeners that half the world had never made a phone call.

This shift suggests that characterizing the "digital divide" in terms of access to broad- and wideband connectivity is naive. The power a cell phone provides to a poor fisherman is impressive, as one can see from this quote from a 2006 Washington Post article:

Rajan said the dealers don't necessarily like the new balance of power, but they are paying better prices to him and thousands of other fishermen who work this lush stretch of coastline. "They are forced to give us more money because there is competition," said Rajan, who estimated that his income has at least tripled to an average of $150 a month since 2000, when cellphones began booming in India. He said he is providing for his family in ways that his fisherman father never could, including a house with electricity and a television.

The spoken web could extend the leverage described by this fisherman to myriad small businesses and to individuals in the general population of the developing world. As with the World Wide Web in its infancy in the early '90's, it is impossible at this point to imagine the potential of the spoken web.

Another question: when high-bandwidth connectivity does reach into regions where the population is largely illiterate, will we see the emergence of an audiovisual web, which could merge the spoken web with multiple visual and audio media? Only time will tell, but the possibilities are not remote: in India a little more than a decade ago there were no cell phones, and Web-enabled multimedia cell phones were a pipe dream. Wherever a cellular network exists now, the potential for a 3G/4G Web-enabled cellular network already exists. Unless a better technology emerges in the interim, an audiovisual web targeted at semi-literate and illiterate population segments seems to me to be inevitable.

The future of computing and communications: random thoughts, part 4

Here's another example of where HCI is headed: multi-touch sensing.

If you have seen an iPod touch or iPhone from Apple, or the Microsoft Surface coffee-table computer, you have seen early examples of what multi-touch computing is all about. Single-touch computing operates like a mouse: touching moves the mouse pointer, tapping is like clicking, tap-and-drag works like click-and-drag.

These early commercial products in the multi-touch realm add a second recognized touch point, allowing you to resize and rotate screen objects using two separate fingers. Multi-touch doesn't have to stop at two touch-points though, nor is it limited to the kinds of two-dimensional operations we associate with mouse-as-pointer interaction. Check out Jeff Han's (NYU) page regarding multi-touch interfaces:

While touch sensing is commonplace for single points of contact, multi-touch sensing enables a user to interact with a system with more than one finger at a time, as in chording and bi-manual operations. Such sensing devices are inherently also able to accommodate multiple users simultaneously, which is especially useful for larger interaction scenarios such as interactive walls and tabletops.

The Perceptive Pixel company is the vehicle NYU has spun off to commercialize Han's inventions. You can search YouTube to find more videos of Han showing off his inventions at various conference and media venues.

The future of computing and communications: random thoughts, part 3

To continue the thread I started in posts on 17 September and 20 September, here's another peek into the future of user interfaces.This is a short post but I guarantee you food for thought. I'm going to start trimming down my post size so I can increase the frequency, but I'll do my best to make sure they are still worth your while.

Take a look at this page from Tokyo designer Mac Funamizu's petinvention blog (opens in a new window or tab, depending on your browser settings). Scroll down and you'll see some examples of his Futuristic Glass concept applied to Internet search, and further down links to several other blog posts giving other example applications of the concept. Here's a picture I stole from his blog to lure you into taking a look:

This illustrates another facet of the revolution in HCI devices I discussed earlier: in addition to rendering far more realistic simulations, they are becoming a lot more varied in form and function.  Prices of LCD screen components are becoming less expensive, as is touch-screen input overlay technology. The integration Mac describes is fanciful, but no more than five to seven years away from commercialization in all likelihood.

His glass looks like a portable windowpane, but glass is glass: this could as easily be a heads-up display on a vehicle windshield or a set of goggles worn by a surgeon to give a multidimensionally enhanced view of the patient under the scalpel.

The future of computing and communications: random thoughts, part 2

I am testing a new software package I just bought called Dragon NaturallySpeaking, which I was lured into buying due to a substantial discount offered by a spam e-mail that I accidentally looked at -- a real success for the spam industry. It's turning out to be very successful at translating my voice into text.

I tried out voice-to-text software in the late 1990s, and decided then that it was not ready for prime time. This is one example of the kinds of interfaces and affordances I wrote about in my last blog post. If voice-to-text software is working as well as this seems to, and thus far I have had to make only a couple of corrections in this post, I can envision situations in which a keyboard is not feasible as an input device today, but where voice-to-text would be a very acceptable substitute, for example as an aid to surgery where no one in the operating room can spare their hands for a keyboard, least of all the surgeon.

I am still a complete novice at using Dragon NaturallySpeaking, which means I am still spending a lot of time learning how to use my voice to do a number of things that come naturally when using a mouse -- or at least naturally to someone who has used a mouse for as many years as I have. The program actually seems to work quite well at navigating through and selecting text in word processing programs, including Microsoft Word and the Firefox page where I am creating this blog post.

What I have written so far has taken me most of an hour, mostly due to the learning curve that is a natural part of learning an entirely new way of using a very familiar technology. What it reminds me of most, though I haven't done it in many years, is training a dog. In training a dog, part of what happens is you training the dog, and the other part is the dog training you. With respect to Dragon NaturallySpeaking, the bulk of the time is spent on the second part; that is, the dog is training me most of the time.

The most encouraging thing about the experience of the past hour or so is that Dragon NaturallySpeaking has failed to recognize only two words out of what I have written. Most of what I am learning is how to revise text as I write, and the vast bulk of the revisions are due to me changing my mind about what to say rather than errors on the part of the voice-to-text program. [I did find 3 or 4 more misrecognitions on reviewing the text.] When I watch closely what I do with the mouse under similar circumstances, I expect I will find that the ratio holds there as well; at this point, after using a mouse for more than 25 years, using the mouse is second nature to me. If I keep using Dragon NaturallySpeaking on a regular basis, and especially if I use it exclusively for some period of time, I suspect that its way of doing things will become second nature to me as well.

I don't think I will be able to use Dragon NaturallySpeaking on his regular a basis as I would like, though. I do a lot of work in circumstances where I am surrounded by other people, and where speech is not encouraged -- our open plan office at the University, for example, or at the public library. I can imagine using it in a coffee shop, but I suspect it will look very strange to the others around me. Then again, they already think I'm pretty strange, so maybe it won't matter. :-)

The future of computing and communications: random thoughts, part 1

I've been giving a lot of thought over the past several months to the future of information technology and its implications for society and culture in the 21st Century. We face a future in which we will be - already are being - deluged with toys, but which will also have - already does have - many dark facets as well.

This summer, when I started working on this post, I had been looking at the whole spectrum of social and technological changes afoot in the world, and realizing the momentous changes I had predicted in my 2002 Rogue Wave white paper have finally begun to gain momentum. 

This post, or the series of posts I hope it is going to start, is the reason I have been so quiet, and I apologize to my regular readers for this decrease in productivity. The problem is that the signs of change are so diverse and multitudinous that it is difficult to categorize them, and once categorized, to prioritize them. I got stuck on trying to wrestle this into a rational framework. As University of Michigan bioinformatics guru Dr. Brian Athey often says, "The perfect is the enemy of the good," and my months of near-silence are definitely an example.

As an example of my various dilemmas and conundra, I have an iPod Touch that came free with a MacBook I purchased over the summer. I am puzzled by it to no end. It's clearly innovative and has some downright revolutionary aspects, but it's hard to point out which feature or combination of features make it a harbinger of a technological sea change. I don't mean the iTouch in particular; it's really an iPhone without the phone, but with wi-fi instead of 2.5/3G connectivity. The iPhone OS is what they have in common, and that's got some revolutionary HCI (human-computer interaction) features, among them the first broad commercial implementation of a multi-touch gestural interface (the mouse and similar devices being the single-touch ancestor). But is the iTouch really just a dumber iPhone, or is it revolutionary in some way of its own?

The only way to sort through these ideas is to try to put them in writing, and that is the task I am setting for myself in this series of posts.  Let's start with a look at the future of HCI, the realm of user interfaces and affordances.

First let's consider this YouTube video of a new technology from Image Metrics, the tech wizards behind the latest and most controversial Grand Theft Auto game. It's less than two minutes long, and yes, you do want the sound on when you watch it, and yes, it's safe for work.

Do you begin to see some potential here?

Edge: GIN, TELEVISION, AND COGNITIVE SURPLUS A Talk By Clay Shirky

Edge has a talk by Clay Shirky about the cognitive surplus masked by our global culture's television viewing, entitled GIN, TELEVISION, AND COGNITIVE SURPLUS.The thesis in a nutshell is this: at the start of the Industrial Revolution in England, the population was so overwhelmed by the changes coming about that they went on a collective bender, with gin as the beverage of choice. It was only when this collective unconsciousness ended that the true social benefits of the Industrial Revolution - public education, publicly accessible museums, public libraries, and so on.

Our culture has undergone a similar phenomenon, only our revolution is the Information Revolution and drug of choice since the 1950's has been television. Information technologies began generating surplus wealth (and free time) beginning in the mid 20th Century. The changes taking place were radical, as visionaries like Marshall McLuhan recognized, and rather than succumb to the confusion and anxiety that radical change induces, we immersed ourselves in the emerging world of mass multimedia entertainment. In other words, we watched a lot of I Love Lucy, Gilligan's Island, Hill Street Blues, afternoon soap operas, and MTV.

We have begun waking up from our TV oblivion, freeing up a fraction of what Shirky calls the "cognitive surplus" that was soaked up by TV. One of the key signs of this wakeup is the emergence of projects like Wikipedia. Shirky (with help from an IBM scientist) estimates that Wikipedia in its entirety represents roughly 100 million hours of human effort. Where do we find the time for such altruistic cognitive endeavors? We find it through a trivial reduction in the number of hours of television watched.

...the cognitive surplus ... [is] so large that even a small change could have huge ramifications. Let's say that everything stays 99 percent the same, that people watch 99 percent as much television as they used to, but 1 percent of that is carved out for producing and for sharing. The Internet-connected population watches roughly a trillion hours of TV a year. That's about five times the size of the annual U.S. consumption. One per cent of that  is 98 Wikipedia projects per year worth of participation. [italics added]

This page has an introductory piece by Tim O'Reilly which would be worth the read all by itself. In the food for thought category, Shirky and O'Reilly together set out a virtual banquet in this fairly lengthy op ed page.

The IT community's greatest challenge

This is another one of those posts that has taken me a while to write - a little over a month, in fact. Today I added a few final sentences and feel it is finally good to go. Whew! I feel the subject was important enough to be worth the effort. I hope you feel that way too.

Back at the end of March, I read an online article by Bill Snyder at the Infoworld site called Multi-core to leave developers in dust?. It concerned the looming challenge of leveraging the parallel processing resources being made possible by the emergence of inexpensive, soon-to-be-utterly-ubiquitous multiple-core CPUs.  Snyder feels the IT industry is not ready for the challenge. I agree. I first wrote about the problem last December in a post entitled The Landscape of Parallel Computing Research: the NY Times and Berkeley EECS. In many ways this post is a continuation of that thread.

Here's a bit of what Snyder has to say:

That's not to say that the IT industry is scoffing at the potential benefits of multi-core processing. But the mountain between IT and some future multi-core promise land -- namely, the task of developing parallelized apps that keep pace with continual core advances -- is huge, says David Patterson, the Pardee Professor of Computing Science at UC Berkeley and director of the parallel computing lab. "It's the biggest challenge in 50 years of computing. If we do this, it's a chance to reset the foundation of computing."

In the short run, Patterson says, we can parallelize legacy software and gamble on getting value out of eight cores. But that would be only an interim solution, as such apps would not scale to 32 or 64 cores, he adds.

What is frustrating is that this problem didn't exactly sneak up on the industry. Chip development cycles are very long, and key software developers are well aware of what's moving through the pipeline. Sure, software always lags hardware. Many of us complained that we didn't have software that would take advantage of 500MHz back in the '90s. But what Patterson and others call the multi-core revolution poses problems for developers that are qualitatively different than the problems of the past. Why wait so long to get serious about solving them?

The answer to the last question is, in my opinion, a personality characteristic common among IT personnel, which is the always-incorrect belief that my current technology - architectural model, operating system, hardware platform, programming language, integrated development environment, application framework, or what-have-you - is the be-all and end-all of IT evolution.

Case in point: Not long ago I was indirectly involved in the port of an application from Ingres on a Vax to a Java/J2EE platform on Windows 2003 Server (web container) and JBoss/Oracle on Linux (EJB container and DBMS).  A single programmer had worked on the system for almost 20 years, was not far from retirement, and had much fear of and no interest in learning the new technologies. What was sad about the situation is not the programmer's mindset, but the fact that her managers had allowed the situation to devolve into the state it was in at the time of the need for conversion. If the leaders don't lead, the followers oftentimes don't follow.  This was by no means the only time I have encountered this mindset malaise.

This Is Not A Game: Alternate Reality Gaming and its potential for learning

Long-time readers will recall my interest in storytelling as a medium for therapy and clinical research, beginning in early 2006 with a post on Carolyn Watters' work with child cancer patients, and continuing with others, including one on Atari pioneer game designer Chris Crawford's StoryTron platform.  (You can find the whole collection of FutureHIT posts tagged 'storytelling' here.)

Last week I wrote about a CACM article on the emerging discipline of alternate reality gaming. following up on that, I found an article in the FutureLab site by Tash Lee entitled This Is Not A Game: Alternate Reality Gaming and This Is Not A Game: Alternate Reality Gaming and its potential for learning. It's not part of the latest ARG buzz: it was published in July 2006. 

Here's a taste:

It is the job of the game designers, or 'Puppet Masters', to weave the narrative through the different media to create a cohesive story for players. However, it is the players that drive the game forward, through the solving of puzzles closely connected to the plot. Generally puzzles are too complex to be solved alone, and so games are played with the support of an online community that works collaboratively to speculate, share expertise and overcome hurdles.

Storytelling is human nature, so the genre naturally has a number of antecedents; however, the birth of ARG as we know it is widely considered to have been in 2001, with the launch of an online 'wild goose chase' to promote Spielburg's film AI. It started with a credit in its marketing material for 'Sentient Machine Therapist' Jeanine Salla, alongside the actor's names. This anomaly tapped into people's natural curiosity and when they Googled 'Salla' they found her profile at 'Bangalore World University' where she worked - in the year 2142. From here there were countless links to other websites all set in 2142 - all convincing and seemingly 'real'. Those who had fallen down the proverbial 'rabbit hole' were rewarded with the discovery of an elaborate real-time story about a murdered man in which they were now active participants.

Tash is interested in the potential of ARG as a learning medium:

"Better Than Free": Lessons for Open Source healthcare software systems

In The Technium, Kevin Kelly's "Better Than Free" post should be a wake-up call for Open Source project leaders, in particular those in the healthcare arena. I first got wind of his post via The Edge, and when it popped up again in Seth Godin's blog, I had to stop and take a look.

This super-distribution system [the Internet] has become the foundation of our economy and wealth. The instant reduplication of data, ideas, and media underpins all the major economic sectors in our economy, particularly those involved with exports -- that is, those industries where the US has a competitive advantage. Our wealth sits upon a very large device that copies promiscuously and constantly.

Yet the previous round of wealth in this economy was built on selling precious copies, so the free flow of free copies tends to undermine the established order. If reproductions of our best efforts are free, how can we keep going? To put it simply, how does one make money selling free copies?

I have an answer. The simplest way I can put it is thus:

When copies are super abundant, they become worthless.
When copies are super abundant, stuff which can't be copied becomes scarce and valuable.

When copies are free, you need to sell things which can not be copied.

Well, what can't be copied?

A great question. Fortunately, Kelly has an answer ready, though I think he left out one important point.