Future of Health IT: Trends and Scenarios

Driven to Distraction - At 60 M.P.H., Office Work Is a High-Risk Job - Series - NYTimes.com

On Wednesday, the Transportation secretary, Ray LaHood, called the broader phenomenon of distracted driving a “deadly epidemic” at a meeting on the issue in Washington. Real estate brokers, pharmaceutical sales people, entrepreneurs, marketers and others say they have little choice but to transform their cars into cubicles. In this merciless economy, they say, they have to make every minute count, and respond instantly to opportunities and challenges.

And they argue that the convenience of constant contact — and the chance to tick off items from an endless to-do list while driving — far outweigh what they think are slim chances that it could lead to a wreck.

via www.nytimes.com

The NY Times has been running a series on the perils of multi-tasking while driving. Today's installment highlights how work pressures, often self-imposed in the case of knowledge workers, are causing people to kill themselves as well as innocent bystanders through stupid mistakes made while trying to be on the telephone, send email, and drive all at the same time (or similar combinations of ICT activities).

It may be that in our culture, this pattern of behavior is Darwinian natural selection at work, though the loss of innocent bystanders doesn't quite fit the pattern. It does represent a continuation of the obliviousness we feel with respect to the dangers of multitasking. In addition to this kind of life-threatening danger, there are less obvious but more pervasive effects. In a paper published earlier this year in PNAS Early Edition, "Cognitive control in media multitaskers", Ophir and colleagues described a controlled behavioral trial in which they showed that media multitasking degrades personal productivity and effectiveness:

A trait media multitasking index was developed to identify groups of heavy and light media multitaskers. These two groups were then compared along established cognitive control dimensions. Results showed that heavy media multitaskers are more susceptible to interference from irrelevant environmental stimuli and from irrelevant representations in memory. This led to the surprising result that heavy media multitaskers performed worse on a test of task-switching ability, likely due to reduced ability to filter out interference from the irrelevant task set.

In all likelihood, many of us in the knowledge business will be as oblivious to this evidence as we have been to the numerous past studies of the dangers of using cell phones while driving. Sad, but true, I fear.

Artificial Intelligence: Robots Rule When It Comes to Holiday Shopping: Scientific American

Scientific American recently published an article on the slow but steady evolution of intelligent robots. In spite of very non-humanoid appearances and behaviors, robots like the one they describe are becoming an integral part of our technological infrastructure. The article is entitled Robots Rule When It Comes to Holiday Shopping.

By most accounts, this holiday season has been a slow one for merchants due to the economic downturn (though you wouldn't know it by the lines at the stores where I did my last-minute shopping). Still, this is the time of year when inventory turns over rapidly.

For major retailers like Staples and Walgreens, efficiency is key to making sure the right products (read: those selling like hotcakes) get to stores as quickly as possible, while less popular items remain tucked in warehouses. Helping make sure that happens: artificially intelligent robots, who are part of companies' efforts to design their warehouses in a way that enables them to have big sellers at the ready, easy for workers to access.

Such bots are programmed with maps of the warehouse in which they operate, have software that instructs them to use logic to find the most direct paths from point A to point B and use optics to read specially placed markers on the floor to navigate, says Peter Wurman, chief scientist at Kiva Systems, Inc., a Woburn, Mass., maker of autonomous robots.

The manufacturer, Kiva Systems, has an excellent demo video that will give you a clearer understanding of what I mean when I say these robots are non-humanoid and behave in a very non-humanoid fashion. In spite of their non-intuitive nature, they get things done. Like the robots that have been ubiquitous in large-scale manufacturing (e.g., automotive) for two decades now, they are less like autonomous beings and more like cells in an intelligent organic environment.

Twenty-one years ago I heard Stanford's Ed Feigenbaum speak at AAAI 1988. In the context of a very optimistic panel about the first wave of business applications of expert systems technology, he talked about what was then the coming implosion of the artificial intelligence marketplace, and the eventual re-emergence of AI as something like "raisins in the bun". I don't recollect his exact words, but I do recall that he predicted AI's renaissance would be outside the bounds of common-sense human intuition.

Since then, AI has become manifest as an embedded component of a variety of devices, such as ECG monitors. Because AI was a buzzword with negative connotations for many during the 1990's and early "oughts", the term was not employed in marketing materials, but the various tools and techniques of AI were unmistakably present to any of us who had experimented with AI in the 1980's.

How will robots like these become manifest in the world of healthcare? That is not entirely clear to me yet, but I think we will find a place for them, if we can afford the cost of entry into this new level of automation.

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.

Using crowdsourced librarians to outsmart Google

Thanks to Ian Jones, I found a very interesting article on Ars Technica entitled Using crowdsourced librarians to outsmart Google. It's about a project that aims to "out-Google Google" using the collective brainpower of librarians in crowdsourcing mode. It's based on what the project leaders say is sound science. There is a growing body of research on the credibility of online material, so their claims may be valid, but I haven't had time to vet them yet, so I am making no claims of my own here.

Still, the idea is very interesting. I've been hyperfocused on the problematic findability of quality consumer health information via the commercial search engines. If there is a better way of building an online search engine in terms of returning credible results, I'm all for it, and who knows? This could be it.

The Reference Extract project hopes to turn all of this credibility research into something practical. The team consists of professors like Lankes and the OCLC, an academic technology organization that counts more than 60,000 (!) libraries among its members. The initial work is funded by the MacArthur Foundation. Their first goal is certainly ambitious: use the web sites that librarians suggest most often as the basis of a more credible search engine that can return reliable results.

Reference Extract already believes that it can best Google, even before work has begun in earnest. That's because it has already used librarian-recommended sites to populate a custom Google search engine. Simply doing this produced search results that testers ranked as "more credible" than searches run on the main Google index, even when the testers had no idea that one of the searches was based only on librarian-approved sites.

I don't have time to think about this much at the moment, much less write intelligently about it at any length, being in crunch mode on a couple of projects all at once. Still, I wanted to pass it along. Others with a similar passion out there may find this very useful.

IEEE Spectrum: New Brain-Machine Interface Reactivates Monkey's Paralyzed Muscles

I just noticed this in the October issue of the IEEE Spectrum: New Brain-Machine Interface Reactivates Monkey's Paralyzed Muscles.

Though it will be years before spinal bypass surgery reaches even the clinical-experiment stage, researchers at the University of Washington (UW) and the Washington National Primate Research Center, both in Seattle, have figured out a way to get macaque monkeys in their lab to manipulate temporarily paralyzed muscles in their arms using brain-controlled electrical stimulation. In research reported last week in Nature, they describe what happened when they attached electrodes to neurons in a monkey’s motor cortex—the part of the brain that controls voluntary movement—and used fairly simple algorithms to translate activity in these cortical cells into electrical signals that tell muscles when, how much, and how forcefully to contract.

This is very encouraging news on a number of fronts. Of course it is good news for spinal trauma patients and patients suffering from degenerative structural nervous system disorders. But it also potentially bodes well for some unusual types human-computer interfaces.

Picture the scenario described above, but with the downstream actuator side of the circuit embedded in the body of someone other than the person whose brain is generating the signal. Imagine a surgeon teaching a surgical resident a very tricky procedure, and able to guide the resident's hand just as she would her own. Although the stimuli are coming from the outside, I'd bet that the resident's nervous system would retain the "muscle memory" of the surgeon-guided actions, aiding the buildup of tacit knowledge that characterizes expertise.

That's the first outside-the-box use that's occurred to me in a few minutes of reading and thought, but this is outside my current scope of activity (darn it!). I'll bet many other and better ideas will arise in the fertile minds of the biomedical engineering community as this unfolds.

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.

BBC NEWS | Virtual health care gets UK trial

You can read about the Aberdeen Royal Infirmary's venture into the brave new world of virtual healthcare in the  BBC News article entitled Virtual health care gets UK trial.Here's a taste:

Cutting edge telemedicine technology, that will allow medical staff to offer "virtual" health care, is being trialled at Aberdeen Royal Infirmary.

HealthPresence, a system developed by Cisco, links up doctors with patients through a video conferencing booth.

Blood pressure, temperature, pulse rate, weight and lung function can be assessed at a distance in the booth if patients can not make appointments.

If the trial is successful, booths may be set up in locations across the UK.

Possible future locations for the mobile health suite could include schools, workplaces, shopping centres and even people's homes.

(picture from BBC news story)

This trial uses kiosks manned by a human attendant; the kiosk can administer simple diagnostic tests, in addition to providing audiovisual teleconferencing. The presence of the human attendant goes a long ways toward allaying my fears about patient data security.

While not exactly a groundbreaking innovative concept, the Aberdeen trial is one of the first uses of rich Internet-based telecommunications media in the mundane world of primary care. I'm excited to see it, especially on behalf of my less well-off rural relatives and friends who currently have limited access to high-quality healthcare.

Now, if we could only get them health insurance coverage... :-)

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. :-)

Microsoft Explains HealthVault Strategy

I didn't get around to writing about this at the time, but a couple weeks ago I read in eWeek about how Microsoft Explains [its] HealthVault Strategy. There are a couple of analogies I wouldn't have made myself: MS compares HealthVault to XBox and PayPal.

The goal was to provide ways for consumers to better understand their health and health information and manage that information for themselves.

Conn [Grad Conn, Healthcare and Life Sciences senior director for global consumer strategy] explained that with consumers as the aggregators and the controllers of to whom, how and when their information can be shared, the traditional health information model is turned on its head.

"Right now, the mechanism for this is through HIPAA, which dictates how to control patient privacy when patients don't control the records," Conn said. HIPAA, he said, has very clear rules that patients can request to see, copy, add to or delete any piece of health information in their record, and HealthVault uses those same procedures, but in a digital format.

So far so good. This (when properly implemented, whether by Microsoft, Google, or some other "fourth party") will accomplish in nimble form what is already one of the clumsiest and least effective of the HIPAA provisions, the portability requirements. Your health records are indeed available to you as a patient, but the care provider has the option of charging you for the cost of making a copy, and in virtually all cases will only supply the records in hard-copy format, even when an underlying EMR or EHR is in use.

Now, on to the first of the startling analogies: