Future of Health IT: Trends and Scenarios

The emerging "Internet of Things" - a UW experiment in progress

There's an exciting project going to start next year at the University of Washington's Computer Science Building. You can read about it in a press release they put out recently. Here's a wee bit of it:

If you need information, the Internet offers a wealth of resources. But if you're hunting down a person or a thing, a computer's not much help. That may soon change. Electronic tags promise to create what some call the "Internet of things," in which objects and people are connected through a virtual network.

To see what this future world would be like, a pilot project involving dozens of volunteers in the University of Washington's computer science building provides the next step in social networking, wirelessly monitoring people and things in a closed environment.

Beginning in March, volunteer students, engineers and staff will wear electronic tags on their clothing and belongings to sense their location every five seconds throughout much of the six-story building. The information will be saved to a database, published to Web pages and used in various custom tools. The project is one of the largest experiments looking at wireless tags in a social setting.

I first heard about the "Internet of things" concept from folks at the MIT Media Lab, in particular Nicholas Negroponte, who was focused on this before he got obsessed with the One Laptop Per Child concept. A hands-on practitioner there was Neil Gershenfeld, who wrote about "Internet Zero" back in 2004.

The Internet is appearing everywhere. Phones speak it, appliances process it, coffee shops and even coffee pots serve it. But we'll be doomed if your coffee pot demands the services of an IT department.

As remarkable as its growth has been, Internet implementations that were appropriate for mainframes are not for connecting everything everywhere.  Yet there are compelling reasons for a light bulb to have Internet access, ranging from construction economics to energy efficiency to architectural expression.

Accomplishing this with the cost and complexity expected for installing and maintaining a light bulb rather than a mainframe raises surprisingly fundamental questions about the nature of scalable system design. The success of the Internet rests on the invention of "internetworking" across unlike networks; the Internet zero (I0) project is extending this insight to enable "interdevice internetworking" of unlike devices.

I really like the name "Internet Zero", whose origin is in an impromptu jest during a conversation between one of the I0 people and a baffled Internet2 engineer, who couldn't figure out how you could afford to network all these kinds of mundane objects:

At an opening event one of the architects of the high-speed Internet 2 project kept coming back to ask how fast data could be sent through the building infrastructure. After being reminded that light bulbs don't need to be able to watch broadband movies, he was jokingly told that the emerging network of everyday devices was part of an Internet zero, not Internet 2. The name stuck. I0 is not a replacement for the current Internet (call that Internet 1); it is a set of principles for extending the Internet down to individual devices.

If a networking researcher had trouble understanding the value of slow networks, the building construction industry did not. Ever faster computer networks have paradoxically become less and less relevant to their needs. Unlike plumbing or power, both the network infrastructure and the workers required to plan, install, and operate it have become increasingly specialized. Countless "smart home" projects have sought (with limited success) to find killer applications for bringing this kind of connectivity into homes, neglecting the biggest one of them all: building the buildings themselves.

In the 1997 US Economic Census, the annual revenue from making computer and electronic products was $438B, compared to $858B for construction. Even if the hardware was free, the cost of installing intelligent infrastructure in all those buildings could add up to the size of today's entire IT industry. This presents a technological challenge that demands neither gigabit speeds nor gigabyte storage, but rather simpler configurations.

To me this is a classic example of the "less is more" concept in action. I worked on a project in the late 1980's for Andover Controls Corporation, where we chose Arcnet rather than Ethernet as the link layer protocol: Arcnet was significantly slower, but also significantly less expensive, and more than fast enough for the HVAC control systems ACC produced. I make no claim to responsibility for that decision, by the way; it was then and is now outside my areas of expertise. HVAC engineers are an eminently practical bunch, and if I learned anything from them, it was a healthy skepticism for the latest and greatest technologies.

The dicey economic situation prevailing in the "Bush decade" has limited the growth of the market for the Internet of Things, but technologies grow in a steady evolutionary fashion in spite of economic conditions. I expect the next upward trend in the global economy will see the widespread emergence of the Internet of Things in the commercial marketplace.

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... :-)

QUICKIE: BPL piece at the Technology Intelligence Group blog

Here's a pointer to a post on the blog of the Technology Intelligence Group regarding BPL (Broadband over Power Lines), and how it presents an alternative to the phone and cable companies' stranglehold on the Last Mile:

"Just because you can't insert at the point of generation of electricity and have it propagate through to the end consumer doesn't mean that Broadband over Power Lines (BPL) isn't viable as another tool in the overall toolbox.   You can insert at the point of transmission (where the Generating Company (GenCo) meets the Distribution company (DisCo), to over-simplify again) and then go wireless from the local step-down transformer in your neighborhood, ending up with a similar topology to DSL with the last mile being WiFi or WiMax instead of copper wires.  You could alternately feed fiber to substations (in the US, there are substations as aggregation points for electricity similar to the Central Offices used by telephone companies with DSLAMs), and try to sneak signals in the spectrum unfiltered by the step-down transformers direct to a piece of consumer premises equipment that would receive those signals and distribute them around your home."

This is a blog with a lot of potential; I'm going to subscribe and see what comes of it in the next few months. We'll see if the bloggers can sustain their energy.

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.

Remote Medical Monitoring

The IEEE Computer Magazine has an article this month on the topic of Remote Medical Monitoring. It starts with a compelling prediction:

The commoditization of computer hardware and software has enabled a new computing paradigm whereby computers will sense, calculate, and act on our behalf, either with or without human interaction as best fits the circumstances. Further, this will occur in an everyday environment, not just when a person is working at a desk.

They go on to discuss proactive computing, where computers anticipates the needs of people around them, and the implications its emergence will have for the public health. Their focus, as the article implies, is on networks of sensors that infuse the patient's milieu, including home and work and anywhere they go. They predict that telemedicine (the delivery of primary care in situ, wherever the patient may be, via information and communications technologies, or ICT) will be revolutionized by the decreasing cost and increasing power of the ICT that are becoming ubiquitous in our lives.

While it is difficult to speak of telemedicine in historical terms in light of its current implication of computing technology, it really began with the telephone, back in the day when it was possible to get your family doc on the phone when something went awry. The cliched "take two aspirin and call me in the morning" comes from that era. I actually shouldn't speak of those times as if they were ancient history, because my family doc's clinic has 24/7 telemedicine even today via telephone; I suspect many primary care providers (PCPs) are doing the same. In our case we are pretty much bound to get a resident on the phone rather than an attending physician, given that our network is part of the University of Michigan Health System and therefore an institution focused on medical education (along with its other two missions, providing care and conducting research).  But the care we have gotten over the years by telephone has been pretty good on the whole.

A Milestone in the evolution of intermittent connectivity: Google Docs made available for online/offline use

I just saw a pointer on eNews 2.0 to a Google Docs press release that confirms a prediction I made back in 2002. It's not the first confirmation - the competition between Microsoft Office Live and Google Docs has been analyzed in detail elsewhere, for example by Sarah Perez on the ReadWriteWeb site. Still, I consider this announcement very significant.

The enews20 article is called Google Docs Pack Made Available for Offline Use.  One aspect of a scenario planning project I did several years ago is coming to fruition as predicted.

”Cloud computing is great, but you need the cloud to make it work,” Philip Tucker, software engineer for Google Docs, recently wrote in a Google blog. ”On an airplane, on the shuttle commuting to work, or at home when my cable modem goes down, I want to work on my documents. And, until now, that usually meant saving a copy and editing on the desktop. "Now there's a better solution. With Google Docs offline, I can take my little piece of the cloud with me wherever I go. Once enabled, I have a local version of my document list and editors, along with my documents,” Tucker added.

I wrote a lengthy scenario planning document in 2002 entitled The Future of Application Architectures. In it, one of the driving forces of future application architectures was intermittent connectivity. I wrote about it as follows:

[HEALTH IT] Motion Computing, Intel Push Tablet for Doctors

I promised to clear out some of the backlog of draft posts that built up during the home stretch of my Master's thesis, and this is as far back as it goes. Here's a quote from an article in eWeek back in mid-February entitled Motion Computing, Intel Push Tablet for Doctors.

In addition to its Intel-based architecture and tablet design, the C5 will include a number of features specifically geared toward the health care market. These include a magnesium-alloy internal frame, a faceplate and backplate composed of disinfectant-resistant material, RFID (radio-frequency identification) technology to keep track of patients, a digital camera and Bluetooth wireless technology.

This time, it may really work.