Future of Health IT: Trends and Scenarios

The Internet of Things and its implications for health IT

The Internet of Things (IoT) refers to the enormous wave of sensor and actuator devices becoming manifest on the Internet, each with its own address that allows its sensor(s) to be read and/or its actuator(s) controlled via other devices, including but not limited to those providing human-computer interfaces.

IBM is working with OASIS to promulgate a standard for communications with and between IoT devices. The connection to health IT may not be intuitively obvious, but this trend is important. Standards-based technologies are what drive the Internet and the World Wide Web, not to mention just about all information and telecommunications technologies.

Some pundits disagree with the need for standards, for example Kishore Swaminathan of Accenture, mostly based on the premise that device inter-communications will be highly specialized and conducted over proprietary networks. I can only say that I heard such arguments in the 1980's with respect to electronic mail and social online environments like Compuserve and America Online.

Network effects put paid to proprietary email and online service protocols. Critical mass is immensely powerful as a driver of societal and technological evolution. 

What will the IoT mean for the world of healthcare? Ubiquitous monitoring of vital signs is just one example of how the IoT will be of benefit to healthcare providers and patients.

For decades, computing devices have been the machine equivalent of Helen Keller, with an extremely limited amount of sensory input from the real world. That is changing rapidly. Individually and in distributed configurations with a facade of individuation, computers are beginning to access the same sources of real-world experience that are available to us real human beings.

I have long been skeptical of the concept of the Technological Singularity promoted by Vernor Vinge and Ray Kurzweil, in which machine intelligence surpasses human intelligence, but thinking back to Helen Keller's sudden transformative leap in comprehension gives me pause. It is no longer unthinkable that at some point, our thus-far-unintelligent machines will be capable of independent learning. Given their tirelessness and access to vast quantities of data, a singularity event no longer seems out of the question.

Does that mean I believe that machines could render their human progenitors irrelevant? No. Is my mind open to the possibility? Reluctantly but definitely. Were it to come to pass, would I want to live to see the day? Likely not.

Ubiquitous computing aficionados, take heart: cardiac monitoring via your Android phone - Imec news

This isn't "new news", dated May 2010, but I just stumbled across it, so I thought I'd pass it along. Body Area Networks (BANs) are the newer, more intimate successor to the Personal Area Networks (PANs) that Bluetooth was going to engender. As a person approaching the age where cardiac care becomes a hot topic, I'm hoping that BANs achieve and exceed the success of the PAN concept.

Imec and Holst Centre, together with TASS software professionals have developed a mobile heart monitoring system that allows to view your electrocardiogram on an Android mobile phone. The innovation is a low-power interface that transmits signals from a wireless ECG (electrocardiogram or heart monitoring)-sensor system to an android mobile phone. With this interface, imec, Holst Centre and TASS are the first to demonstrate a complete Body Area Network (BAN) connected to a mobile phone enabling reliable long-term ambulatory monitoring of various health parameters such as cardiac performance (ECG), brain activity (EEG), muscle activity (EMG), etc.

via www2.imec.be

 

Coming soon via Harvard/MIT Health Sciences and Technology: Your vital signs, on camera

You can check a person’s vital signs — pulse, respiration and blood pressure — manually or by attaching sensors to the body. But a student in the Harvard-MIT Health Sciences and Technology program is working on a system that could measure these health indicators just by putting a person in front of a low-cost camera such as a laptop computer’s built-in webcam.

via web.mit.edu

I found this through ACM TechNews. The technology's in a pretty raw state at this point, but it points to one facet of where we're likely to be 3-5 years down the road. Here's a YouTube video in which the inventor describes it in a nutshell. There's a link in the lower right, only barely visible, which will open the video in YouTube itself. If you slide your mouse cursor down there, you'll get hover text ("Watch on YouTube") when you're over the link.

 

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.

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.

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 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.

BBC NEWS | Technology | Microsoft unveils its web vision

Some context on my last post, which concerned Microsoft's Live Mesh and developers' reactions to it. Here's more detail on what they were reacting to: Microsoft unveils its web vision.

Microsoft has lifted the lid on a new web service called Live Mesh, designed to connect a multiplicity of devices and applications online.

The service is seen by many as a key plank in the company's vision for the future of the web.

Live Mesh is designed to blur the lines between running software and storing data on a desktop and "in the cloud".

Microsoft's Amit Mital said Live Mesh would "connect and bring devices together... to work in concert".

Second Life and the Amish

My misgivings about Second Life expressed in the post Real Is Beautiful brought an email response from Paul Hartzog, a fellow grad student at Michigan and the a leading proponent of Panarchy, the most obviously sane, rational, and just form of government - therefore perhaps the one we are least likely to experience in our lifetimes. :-) Our brief exchange is reproduced here with permission. We ended up with him pointing me to a Wired article about technology and the Amish, which led me to look more deeply into the concerns I have.