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Sunday, February 10, 2019

#HIMSS19


The Big Show, the "Comdex of Health IT" (remember Comdex?) Not going this year. My last HIMSS Conference trip was HIMSS16 in Las Vegas. I appreciate them first comping me a press pass back in 2012. I've met a lot of cool people across my HIMSS Conference years.

I'm sure it'll be great. I'll just follow the tweets and news like lots of others. Expect the usual overload of grand, Gartner-hyperenthused rhetoric amid the keynotes and topical sessions. It's first and foremost a trade show. HIMSS is an $80+ million a year "non-profit" business. Look at their IRS 990s.
The average primary care doc makes about $200k a year. The CEO of HIMSS is paid about $1 million annually. Jus' sayin'.
Wonder if there will be any chatter about this (below) at HIMSS?


As Democrats mount 2020 Presidential campaigns, this is already a front-burner topic.
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UPDATE: HIMSS 2019 News, Trends, and Analysis from TechTarget. Succinct coverage.

Also, apropos of "health information,"


I'd notice this title before. It's not yet released (according to Amazon), but THCB has a good post reviewing it today, "Obsessive Measurement Disorder: Etiology of an Epidemic." Kip Sullivan rocks. I can't top that review.

Loved this:
It is impossible to identify a single Typhoid Mary responsible for the metrics-fixation epidemic, but it is fair to say a very important Typhoid Mary was Frederick Winslow Taylor. Muller identifies the rise of “Taylorism” in manufacturing in the early 1900s as a primary cause of the epidemic. Taylor, an American engineer, studied every action of workers in pig iron factories, estimated the average time of each action, then proposed to pay slower workers less and faster workers more. According to Taylor, determining who was slow and who was fast and paying accordingly required “an elaborate system for monitoring and controlling the workplace,” as Muller puts it. (p. 32) Taylor called his measurement-and-control system “scientific management.”
Yeah.
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More to come...

Wednesday, February 6, 2019

Data




Earth's long-term warming trend can be seen in this visualization of NASA's global temperature record, which shows how the planet's temperatures are changing over time, compared to a baseline average from 1951 to 1980.

UPDATES: "Can We All Agree the Earth Is Warming Yet?" and "Climate Change, or 'just the weather'?"

OK, THEN...


Let a million renderings of hip clip art ensue. I've not yet seen any details regarding what draft legislation has been offered up, but, suffice it to say, nothing will get through the still- GOP-controlled Senate (much less get Trump's signature). UPDATE. Legislative news from Naked Capitalism.


UPDATE: more Green New Deal news. All "sound and fury?" Or even more diabolical? Hmmm... Comrades?


LOL. SMH. Yeah, I know.
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More to come...

Saturday, February 2, 2019

Americans don't get enough fiber

Last mile optical fiber, in addition to diet.


Got onto this via a Science Magazine book review (may be firewalled).
In her latest book, Fiber, legal scholar Susan Crawford writes about the role of fiber optic cables as the enormously capable conduits of digital data flows. According to Crawford, fiber is the technological enabler that affords true high-speed internet connectivity. But even though the technology is well understood, incumbent telecommunications providers in the United States have so far failed to bring fiber to most homes.

This has locked the American people into slow and outdated internet connections that are grossly overpriced, especially outside major urban areas, stifling innovation and economic growth and perpetuating social, economic, and geographic inequalities. And whereas in other nations, from Singapore to Sweden, regulators have worked to make fiber available and affordable for many, in the United States, federal and state policies have acted as impediments to widespread fiber availability...
A very interesting read. We should be pushing massless pure energy photons around in lieu of electrons. The enormous differential bandwidth capacity implications are mind-boggling.

 From the Amazon blurb:
The world of fiber optic connections reaching neighborhoods, homes, and businesses will represent as great a change from what came before as the advent of electricity. The virtually unlimited amounts of data we’ll be able to send and receive through fiber optic connections will enable a degree of virtual presence that will radically transform health care, education, urban administration and services, agriculture, retail sales, and offices. Yet all of those transformations will pale compared with the innovations and new industries that we can’t even imagine today. In a fascinating account combining policy expertise and compelling on-the-ground reporting, Susan Crawford reveals how the giant corporations that control cable and internet access in the United States use their tremendous lobbying power to tilt the playing field against competition, holding back the infrastructure improvements necessary for the country to move forward. And she shows how a few cities and towns are fighting monopoly power to bring the next technological revolution to their communities.
The history of fiber optics goes back to the 1960s, with the invention of the laser. Lasers apply energy to billions of atoms, exciting their electrons and making them emit photons that then turn around and make already-excited atoms give off even more photons. When some of the photons are allowed to escape, the result is an amplified, concentrated beam of light—Light Amplification by Stimulated Emission of Radiation, or LASER. That light has a frequency; it is wobbling at a rate of millions of millions of times a second, and each of those wobbles can be modulated to carry data. That [sic] data then travels at the speed of light.

The trouble was how to transmit that focused data reliably from point A to point B. Light can be carried by water—just imagine a nighttime fountain lit by purple light from below—but light can’t carry information through water very far. You need the waves to maintain their strength and definition in order for the information they carry, encoded in the height or frequency of these waves, to be understood. Back in the late nineteenth century, a Viennese medical team identified only as “Dr. Roth and Prof. Reuss” experimented with guiding light through bent glass rods to illuminate body parts during surgery.4 With the arrival of the laser, scientists saw the possibility of guiding information across many miles with very little loss of accuracy.

Enter “optical fiber.”…
Crawford, Susan. Fiber. Yale University Press. Kindle Edition [Location 382]
CHAPTER 7, FIBER AND HEALTH

Very good, though mostly about "telemedicine" applications for optical fiber.
Most U.S. states already require private insurers and Medicaid to reimburse for a wide range of telemedicine-provided services without discrimination. But the field is still in its infancy: often, “telemedicine” means either very-low-bandwidth remote patient monitoring (of blood pressure, for example), or simply a phone call with a provider. It’s hard to imagine a doctor-patient relationship forming through just phone calls, emails, text messages, and online questionnaires. Several states have restricted or banned reimbursement for telemedicine services that fall short of full-bandwidth communications. That makes sense: the game-changing, cost-reducing developments will require the real-time, reliable, visible presence of health professionals in patients’ actual lives; a human, two-way connection that can convey empathy and compassion as well as two-figure data updates. Those are the connections that can vastly reduce the country’s spending on hospital and in-office care.

The problem is that the vast majority of Americans—upward of 84 percent of us—don’t live in a house that has a fiber connection to the outside world. And unless we upgrade to fiber as a country, we will never be the nation with the world’s most advanced health care system. Instead, we will make more people unsafe and sicker, keep people waiting unnecessarily at medical offices and hospitals all over the country, and spend untold billions on services that are inadequately tailored to people’s individual needs…
Fiber, location 2108
OK, that's all good, as far as it goes. Add to that perhaps some advances in portable dx technologies like, say, a football helmet size "brain MRI" unit delivered to your door. Strap it on, hook it up to your fiber optic internet interface, and let your clinicians get an MRI remotely in real time? More mundanely, I might get my next follow-up Cardiac Echo done here at the house. Labs, vitals, etc?

Lots of apps potential (beyond trendy wi-fi'd "wearables").
apropos of my prior post on updates regarding Jeff andApril's NeuroTrainer, perhaps they could develop a wrap-around VR "helmet" for real-time neurological monitoring while engaging with core the NeuroTrainer technology?
ONE CURIOUS OMISSION

Often, when I begin a new read, I first do some keyword/phrase searches, to cut to a chase of interest. In this case, "crypto," "blockchain," distributed ledger," "bitcoin," "datamining, "data mining..."
"0 matches found."
Need I elaborate? I usually reach for my Photoshop...


Will variants on the word "photon" become the "cool" new shiny thing to add to your start-up's name to bump up your VC market cap? One dude in Pennsylvania has already been squatting "cryptophotonics.com" for some time. No website, no business activity, just a domain name registration going back a number of years, LOL.

Seriously, read up on the breathtaking, unsustainable energy consumption of crypto data mining (all of which results in heat). Now, I couldn't give a flip about "Bitcoin" et al. I call that stuff "digital tulips." But "blockchain" is a current (Gartner Hype Cycle?) darling in the health care space (along with other commerce domains).

Transmit and compute with photons.
Of course, that assumes not only practically infinite fiber optic data transmission, but also optical-based integrated circuit boards in the computers doing the end-point processing. There's a reason why your laptop heats up in your -- well -- lap while you use it. There's a reason why Microsoft recently moved a huge server farm under the ocean.
See, e.g., "Photonic Integrated Circuit." See also stuff like
Fiber optic biosensor-integrated microfluidic chip to detect glucose levels
By integrating microfluidic chips with fiber optic biosensors, researchers are creating ultrasensitive lab-on-a-chip devices to detect glucose levels
'eh?

Taking it back to the top. In sum, Susan Crawford's Fiber is a great read. Notwithstanding that her policy recommendations -- with which I agree -- are swimming against a serious anti-regulatory Trumpian mega-corporate Rentier tide.
We’re missing a leader who has had the experience of connectivity over fiber—or at least understands that it is possible and necessary—and, like Lincoln, understands the connection between this upgrade and economic growth and social justice. That person needs to be a first-rate communicator, able to convey with color and verve why Americans should not have to settle for expensive, second-class data services, and why we cannot remain the world’s leading economy without first-class connectivity.

The second key step, one only a leader backed by federal agencies and Congress can take, is to declare (enforceably) that the standard connection for a thriving life in America requires a reasonably priced, open fiber network running to homes and businesses. Such a declaration could itself drive the upgrade: ancient last-mile copper networks could be forced into retirement through tax policy and other incentives; poles and conduit could be subjected to basic openness requirements as a matter of regulation and local ordinance; new housing could be approved for habitability and federal support only with fiber-readiness or actual fiber attached. By saying that anything that wasn’t fiber-ready, or actually connected to open fiber, wouldn’t be supported by federal funding, the federal government could push the entire process forward. There are limits to this power: state tax rules and state constraints on local authority can get in the way, and the details are difficult. But the federal government can do a great deal in the vast portion of the marketplace that is touched, directly or indirectly, by federal funding…
[Fiber, location 3596]
Lordy. "...convey with color and verve..." Is it too early to start drinking yet?

ON-TOPIC RANDOM NOTE

I cited this excellent Michael Lewis book last year.


FinTech applications of optical fiber, where milli- to microseconds of time burden ("latency") equate to big money.

UPDATE

To the broader point of this post (as pertining to the medical space), from the always excellent Neurologica Blog:

Powering Implantable Devices

...[O]nce we have the ability to self-power implantable devices, with small enough electronics that they can fit in tight biological spaces, and produce enough energy to work with, people will find many applications. Researchers are also working on developing more “squishy” electronics, that are flexible and will move with the body and are biologically compatible. More efficient electronics (for example, using carbon nanotubes) allow for using less energy and producing less waste heat.

Multiple features are progressing steadily and moving in the direction of better powered biological devices. We are probably rapidly moving in the direction of the human cyborg, developing technology that we can comfortably merge with. And as I often speculate – at first such technology will be used to mitigate and treat medical problems, but eventually may be used for routine monitoring and disease prevention, and then for augmentation.
Indeed. The Neurologica Blog should be on your daily surfing list.

CODA

Yet another one on deck:


Book reviews at Science Magazine and Science Based Medicine plus the Amazon "Buy now with 1-click" are gonna put me in Chapter 11, lol. "Communicating your ideas to decision makers?" Say, well, like patients? Hmmm... that whole messy "Art of Medicine" thingy?
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More to come...