Future of Health IT: Trends and Scenarios

Personal Tech: Medical Apps for the iPhone

From NY Times Personal Tech: Medical Apps for the iPhone

After a lot of time reading "best medical apps" stories online, asking Twitter users for their suggestions and reading online reviews, I finally boiled the list down to about 50 promising apps. I tried them out and further winnowed the list to a bunch that I ultimately demo'ed in my talk. Eventually, the video of the talk will be posted at ted.com/talks, but in the meantime, here's what I covered.

(I haven't really given them full-blown testing, so read the online reviews before you spend good money on them. Except for the free ones--you've got nothing to lose!)
--Dave Pogue

I read David Pogue's personal tech blog at the NY Times to keep up on consumer IT trends, but this post from a couple weeks ago seemed really relevant to the readers of FutureHIT. I've been putting off posting because I wanted to say something eloquent, but work and home life have made that impossible. I'll settle for a few hints at what I believe are the most interesting among the items Pogue lists. I'm focused on the ones targeted at health professionals, but the consumer tools have a lot of potential as well.

• OsiriX. "An amazing viewer of medical images (X-rays, scans of all sort)".  I think this is probably just a DICOM viewer, but it requires special server software, so it may be adding some value. Regardless, it's very cool.
• AirStrip OB. "Lets an obstetrician monitor a patient’s status, right down to the baby’s heartbeat, from elsewhere in the hospital (or the town)."  As Pogue points out, this is a good pointer at the types of remote monitoring applications we can expect to see as ubiquitous/pervasive computing moves into the mainstream.

Actually I will mention a thought I've had about one of the consumer apps...

• Retina. "It’s for color-blind people like me. You hold it in front of something—clothes in your closet, for example—and it tells you by name what color you’re seeing."  This is an examplary augmented reality application, intriguing not so much for what it does -- which is of great value, I don't mean to denigrate it -- but for what it portends.  As image analysis becomes more sophisticated, it's easy to picture diagnostic tools that will look at the patient in visible light and infrared and point out diagnostic signs the clinician might overlook. A more prosaic application not yet built but within the reach of current technology would be a program that "looks" at the patient and points out relevant facts and decision guidelines based on the part of the patient's body on which the phone's camera is focused.

I think all this is intimately related to the technology I spotlighted in my recent post on the Open Data Kit, which is aimed at moving advanced tech for the clinician into community settings. As I said in that post, these types of tools will serve the developed world as well as the developing world, because even in the most advanced economies there are segments of the population that are underserved because they can't or won't go to a traditional healthcare provider setting.

There are challenges in all this that take some of the rosy glow out of the picture, notably patient privacy and truth maintenance, i.e. making sure the various information stores relied on by the remote devices have the most up to date information, and can update it as well. In addition there is the very real concern I feel as a patient that healthcare providers may become overly dependent on distributed computing and communications technologies, and be at a loss when connections break down (and they will, oh yes, they will).

Nonetheless, on balance the future for these technologies is bright and getting brighter, and the value they add is potentially enormous.

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?

Red herrings swimming around Google and Microsoft PHRs

I spent three days last week at the American Medical Informatics Association (AMIA) Spring Congress. I was there to present lessons learned from Michigan's $3.2M NIH Roadmap contract funded under the 2003 "Re-Engineering the Clinical Research Enterprise" Broad Agency Announcement (BAA) in the Clinical Research Informatics track, but I spent a few of the sessions in the Personal Health Records (PHR) track.

Unsurprisingly, there was a lot of buzz in the PHR track about Google Health, and to a lesser degree, Microsoft HealthVault. Google Health was more prominent for several reasons, not all of which are enduringly pertinent: its public debut happened more recently; Google does not suffer from the Borg-like "Evil Empire" image from which Microsoft suffers; and Dr. Roni Zeiger, MD, Google Health Product Manager, was an eloquent and well-received speaker at one of the sessions.

That was Thursday. My presentations were on Friday right after lunch, so I was a bit distracted that morning and missed a couple of breakout sessions. After my time in the limelight, I spent a very inspiring hour talking with Bob DiLaura of Cleveland Clinic, during which we speculated about the future of PHRs. One assertion with which I believe we both agree is that the entry of these two major players is going to revolutionize the healthcare records "marketplace".

I put "marketplace" in quotes because in the USA a market implies exchange of value that can be represented in monetary terms. HealthVault and Google Health are free, and as FasterCures CEO Greg Simon said in one of the keynotes, "Free is the new money". Google and Microsoft will aim for volume, and monetization will come later. It's not terribly difficult to imagine a variety of ways huge volumes of consumer health records could be monetized without violating patient privacy. But there are a lot of red herrings in these waters. Let's look through the glass window in the bottom of the boat here and see what these red herrings look like.

THIS JUST IN: Announcing the arrival of the $1,000 Genome

OK  I admit it's not quite what the NIH is referring to in their $1,000 genome RFAs (RFA-HG-06-020 (R01), RFA-HG-06-021 (R21) and RFA-HG-06-022 (R21/33)), but it's a nice start, and it's available now.

I just got hold of a press release from a startup called 23andMe. The title is  23andMe Launches Web-Based Service Empowering Individuals to Access and Understand Their Own Genetic Information.

MOUNTAIN VIEW, Calif. -- November 19, 2007 -- 23andMe, Inc., a privately-held personal genetics company, announced today that it has officially launched and has begun offering its services directly to consumers in the United States. 23andMe is helping individuals understand their own genetic information through the latest advances in DNA analysis and web-based interactive tools. The Company's service will enable customers to gain deeper insights into their ancestry and other inherited traits which are marked in an individual's genetic code.

The 23andMe service allows individuals to:

* Search and explore their genomes;

* Learn how the latest research studies relate directly to traits identified in their genome;

* Compare their genomes to family and friends who are also 23andMe participants;

* Discover their genetic roots and find where they sit on the tree of human genetic history; and

* Give individuals the option to actively participate in a new research approach.

Linda Avey, co-founder of 23andMe, said, "Over the past several years, significant advances have been made in the field of genetics. The mission of 23andMe is to take the genetic revolution to a new level by offering a secure, web-based service where individuals can explore, share and better understand their own genetic information."

Anne Wojcicki, co-founder of 23andMe, said, "23andMe is designed to provide our customers with scientifically accurate, high-quality information about their own genetic code in a format that is easy to understand and use. We believe this information provides intriguing insights into an individual's genetics, with the goal of expanding the collective knowledge base by enabling active participation in research."

But wait. It gets better.

First Annual Chinese New Year Predictions

Making my technology predictions during the Chinese New Year celebration seems like it will be a lot easier than joining the crowd at the Western calendar's equivalent.  Not only is there less competition, but I have the benefit of reading everybody else's before I do mine.

I find, though, that I have a distinctly different point of view (POV) than most prognosticators.  There are two varieties that seem to predominate.

Best Summary of Everybody Else's Predictions of Technology Trends for 2007

The best summary I've found of technology predictions for the coming year is in the post entitled Jaywalk - Technology Trends for 2007. Here's the summation:

As a distillation of these predictions, I would project the following top 5 trends for 2007 and beyond:

1. Outside-in-driven customer-focused process-oriented strategic management.
2. Governed enterprise architecture embracing BPM and SOA.
3. Virtualization of IT infrastructure.
4. Complete, unified security, common to applications and data, protecting business processes and Web services.
5. Use of social software – blogs, wikis, virtual communities – becoming more common in a corporate setting.

All of these apply to health information technology for academic health centers (AHCs) as well as to IT more generally. Numbers 1 through 4 are mostly enterprise-level trends that will affect mostly the IT infrastructure of the clinical care mission of an AHC. I'd say #5 is a slam-dunk; it's a rare project kickoff I've attended or heard of lately that doesn't involve setting up a community site using our local implementation of Sakai, which includes among other features archived group email, centralized resources, and a wiki.

From EDS: Ms. Dewey changes the uh, nature of Web search

I just read EDS' Next Big Thing Blog : Future of the search interface???.

I spend a lot of time studying search engine interfaces and results. There are some clever and useful interfaces, like Clusty and Healia, but search is not generally thought of as a form of entertainment (at least by the interface designers). Clusty analyzes knowledge structures in the results and produces a taxonomy on the fly; Healia is search tailored to health information, with a lot of useful filtering capabilities. But entertaining they are not. And then there is  Ms. Dewey, the first search interface that is both intelligent and nicely accessorized.

CAVEAT: Turn your sound down before you go there, if you are at work.

Tiny New Cable May Spur Big Technological Advances

An announcement published on Monday in the journal Applied Physics Letters described a breakthrough in the size of cable through which visible light can be conducted, as described in a recent eWeek article entitled Tiny New Cable May Spur Big Technological Advances and in the Medgadget post entitled Miniature Coaxial Cable Offers New Medical Opportunities. From the eWeek article:

Scientists have created a tiny cable—much thinner than a human hair—through which they can transmit visible light, potentially paving the way for improvements in solar energy, computing and medicine.

The achievement... involves a re-imagining of the coaxial cable—that commonplace conduit of cable television, telephone and Internet service—on a minuscule scale.

It is difficult to imagine overestimating the importance of this discovery.

Open Source Science: A New Model for Innovation?

Harvard B-School's Working Knowledge newsletter has a great article this week called Open Source Science: A New Model for Innovation.

In a perfect world, scientists share problems and work together on solutions for the good of society. In the real world, however, that's usually not the case. The main obstacles: competition for publication and intellectual property protection.

Is there a model for encouraging large-scale scientific problem solving? Yes, and it comes from an unexpected and unrelated corner of the universe: open source software development.

Karim Lakhani, an Assistant Professor at the B-school with lots of research experience in the Open Source software community, looked at ways the concept could be applied to research. In particular, he focused on the question of whether scientific advances spring naturally from the privileged core of a discipline, those immersed in it 150% of the time, or whether outsiders with a fresh perspective had an edge. His findings:

...it was outsiders—those with expertise at the periphery of a problem's field—who were most likely to find answers and do so quickly.

...The problem may reside in one domain of expertise and the solution may reside in another. I've done interviews with scientists who participated by posting problems for broadcast, and most of these scientists were highly skeptical about this method because they considered themselves to be at the top of their discipline. However, they had never thought about the possibility of scientists in other disciplines looking at their problem, reconceptualizing it, and coming up with a solution that could be off-the-shelf. So when they actually see solutions from this type of method, they're blown away.

This is the Web 2.0 mindset reaching the hallowed halls of science. It's a great interview piece, with more objectivity than I'm presenting here. He and the interviewer discuss the risks as well as the benefits of this approach. To me, though, this is all good news. No paradigm shift is all upside, but we are a world in desperate need of innovative, out-of-the-box solutions. Now let's see if the silos of the world can tolerate such openness.