Stackoverflow Overflow

Posted on November 19, 2009 by Bob

I really like SO. It's quickly become an invaluable resource for finding and getting programming answers.

I generally browse the new questions to see if there's anything I might be able to a answer.  Even when you find a question you already (think you) know the answer to, it still requires  some research.  Answering questions is a great exercise.

A couple of weeks ago I started to take notice of how fast the question count was increasing.  So I decided to track it and quantify the growth. Here's what I found:

SO-Count-L

So on average there are about 1472 new questions every day! That means when I browse through my 50 or so new questions, there are more than 1400 other ones that I'm not seeing. And that's if I visit every day.

Yeah, yeah -- I know about searching, using the tags, unanswered questions, etc.  What's remarkable to me is the shear volume of questions.  Two things strike me about this:

  1. There seems to be a lot of question duplication. You can see that when you go to a question and look at the related questions on the right hand column.
  2. My sense is that the number of views per question is also going down.  I don't know for this sure, but it would follow that there must also be fewer answers per question.

These are just anecdotal observations on my part.  I didn't mean this to be an exhaustive analysis of SO, and I'm not trying to be critical. It just seems to me that the "weight "of SO is bound to become an issue in the future.

SO is a great site and I'm sure Jeff and Joel are very aware of these patterns and are plotting solutions while the rest of us sleep.

So based on 14 days of data - 🙂 -  here's about when the number of questions will hit future milestones:

SO-Count-Future

We'll have to wait and see if these predictions become true.

Posted in Programming | Tagged | 2 Comments

A Medical Device Gateway Data Standard?

Posted on November 18, 2009 by Bob

The Wipro OEM medical device gateway press release makes it all seem so easy (my highlight):

The device, consisting of interfaces that can feed-in data such as blood pressure, pulse rate, ECG reading and weight from the respective devices, is connected to the gateway that would format it into standard patient information and transmit it to either public health data platform such as Google Health or to private platforms like Microsoft Health Vault.

What exactly is "standard patient information"?  Maybe they've finally developed the magic interoperability bullet.  Yeah, right!  I'm sure companies like Capsule see these kind of claims all the time.  Statements like these are unfortunate because they give the impression that health data interoperability is a given. Of course we know that is not the case.

Also, since when is Google Health a public health data platform?

Hat tip: Avantrasara

UPDATE (11/19/09):  Wipro ties up with Intel for rural medical solutions

Posted in Google, Interoperability, Medical Devices, Microsoft, PHR | Tagged | 1 Comment

iPhone Health Applications for Medical Professionals

Posted on November 1, 2009 by Bob

Epocrates-iphoneThere are a lot of iPhone health and fitness applications available. Many are for the general public. Here are some vetted lists that target medical professionals:

Update (11/3/09):

There's an entire Web Site devoted to this subject:

iPhone Medical & Health Apps: news, reviews, trends

Hat tip: John Zaleski

Posted in Health 2.0, PHR | Tagged | 6 Comments

Standards should be as Simple and Stupid as Possible

Posted on October 31, 2009 by Bob

Great post by Adam Bosworth:

Talking to DC

Hat Tip: Joel on Software

Also see Dreaming of Flexible, Simple, Sloppy, Tolerant in Healthcare IT and Liberate the Data!

Posted in Interoperability | Tagged | 1 Comment

Selling Anonymized Health Data

Posted on October 18, 2009 by Bob

anonymous350The New York Times article When 2+2 Equals a Privacy Question raises some serious medical data privacy concerns.

But by 2020, when a vast majority of American health providers are expected to have electronic health systems, the data mining component alone could generate sales of up to $5 billion...

The magnitude of data needed to generate that kind a revenue is significant.  The likelihood that "de-identification" of someone's health information will occur is very high.  "Anonymized" Data Really Isn't points out the same thing that the NYT article does:

Computer scientists over the past fifteen years show that it is quite straightforward to extract personal information by analyzing seemingly unrelated, “anonymized” data sets.

The demand for the secondary use of health data (and here) is high because it is believed it will

Significantly improve the quality of patient care and offers the promise of even greater benefits in the future.

Many feel that use of secondary health information should be regulated by the government.

Here's a good overview that covers many health data secondary use issues: Toward a National Framework for the Secondary Use of Health Data: An American Medical Informatics Association White Paper.

UPDATE (10/20/09): Also see the Wired article Medical Records: Stored in the Cloud, Sold on the Open Market.

Posted in EMR, PHR | Tagged , | Leave a comment

The Desperate Need for Simplicity

Posted on October 13, 2009 by Bob

Ted Neward's article "Agile is treating the symptoms, not the disease" touches on several important points about the software industry.

  • Modern software development tools and technologies require a significant learning curve.
  • Development methodologies (like Agile) exist for managing complexity, but do not reduce the load of these technologies.
  • In the last decade there has been no "Next Big Thing", like Access was in the 90s.

What's most interesting to me is:

We are in desperate need of simplicity in this industry. Whoever gets that, and gets it right, defines the "Next Big Thing".

What's true in the broader software world is also generally true in Healthcare IT.  In HIT there has never been an Access equivalent, just a lot of pieces and parts trying unsuccessfully to work together.

The need was touched on in Liberate the Data!.  Simplicity is desperately needed in order to create the "First Big Thing" for HIT interoperability.

UPDATE (10/14/09):  More commentary:

Posted in Agile, Interoperability, Programming | Tagged | Leave a comment

Canyon Fire: To Close for Comfort!

Posted on October 5, 2009 by Bob

It's that time of year again. In Oct. 2007 over 1500 homes went up in flames in San Diego. It wasn't close to us then, but now I understand the danger much better.

I left work a little early because of the Packer-Viking game (MNF starts at 5:15 on the West Coast).  As I approached our Condo complex I saw smoke bellowing over the roofs. My wife had also just gotten home and we watched with amazement the canyon below going up in flames no more than 25 yards from our patio.

canyon-fire

A neighbor had called 911 a few minutes before, but the 15 or so minutes prior to the SDFD arrival was tense. The fire spread amazingly fast. Large shrubs literally exploded into flames. The wind was blowing pretty hard in our direction, but seemed to wane and shift a little, which slowed its progress some.

We collected photos and valuables and got them in the car, ready to escape.

Fortunately, the SDFD came to the rescue in time. A fire helicopter did a couple of water drops, but it was the firefighters that saved the day.

canyon-fire-out
Wow, close call!

I better get back to the second half. Go Pack!

UPDATE: Oh well. Brett and the Vikings will be at Lambeau on Nov. 1. It's a long season...

Posted in General | Tagged | Leave a comment

Medical Data in the Cloud

Posted on September 26, 2009 by Bob

secure_documentI just ran across a three-part series of articles by Practice Fusion:

Medical Data in the Internet “cloud”:

Being an EMR in the cloud requires Practice Fusion to address these issues in depth. If you're thinking about putting health information in the cloud like I've previously discussed, these articles are worth a careful read.

Hat Tip:  Healthcare IT News

UPDATE (10/1/2009):

Some commentary on the Practice Fusion EHR:  Cloud based EHRs – a response to PracticeFusion.

UPDATE (10/5/2009): EMR Vendor Practice Fusion’s CEO Interview

Posted in Cloud Computing, EMR | Tagged | 1 Comment

Access to Medical Data: Are PC Standards and PHRs (You) the Answer?

Posted on September 22, 2009 by Bob

Dana Blankenhorn's article Give medicine access to PC standards makes some good points about the medical device industry but (IMHO) misses the mark when trying to use PC standards and PHRs as models for working towards a solution.

I'll get back to his central points in a minute. One thing I find fascinating is the knee-jerk reaction in the comments to even a hint of government control.  How on earth can someone jump from "industry standard" to a "march towards socialism"? We saw the same thing at this summer's town hall meetings and in Washington a couple of weeks ago.  The whole health care debate is just mind boggling!

Anyway, let's focus on the major points of the article. First:

Every industry, as its use of computing matures, eventually moves toward industry standards. It happened in law, it happened in manufacturing, it happened in publishing.

It has not happened, yet, in medicine.

Very true.  In the medical device world, connectivity and interoperability are hot topics. A couple of recent posts -- Plug-and-Play Medicine and Medical Device Software on Shared Computers -- point out the significant challenges in this area.  In particular, the development and adoption of standards is a very intensive and political process. But where's the incentive for the industry to go through this? Dana's comment addresses this (my emphasis):

The role I like best for government is in directing market incentives toward solutions, and not just to monopolies or bigger problems.

The reason health care costs jump every year is because market incentives cause them to. Those incentives must be changed, but the market won't by itself because the market profits from them.

Only government can transform incentives. ...

Like it or not, this may to the only way to push the medical industry to do the right thing.  But those other industries didn't need government intervention in order to create their standards.  Using PC (or other industry) standards as a model for facilitating medical data access just doesn't work.  The health industry will have to dragged to the table kicking and screaming, and the carrot (or stick) will have to be large in order for them to come to a consensus.

Second, I don't see the relationship between the use of PHRs and the promotion of standards.

By supporting PHRs, you support your right to your own data. You support liberating data from proprietary systems and placing it under industry standards.  You support integrating your health with the world of the Web, and the benefits such industry standards can deliver to you.

Taking responsibility for your own health data is great, but both Microsoft HealthVault and Google Health are proprietary systems.  Just because your data is on the Web doesn't make it any more accessible.  And even if one of these PHRs did became an industry standard, it would have very little impact on how EMRs communicate with each other or medical devices in general.

There are no easy answers.

Posted in EMR, Google, Interoperability, Medical Devices, Microsoft | Tagged , , | 1 Comment

Plug-and-Play Medicine

Posted on September 20, 2009 by Bob

The MIT Technology Review article Plug-and-Play Medicine claims that:

... a Boston research group has come up with a software platform for sharing information among gadgets ...

Uh, what software platform? I discussed the MD PnP program a couple of years ago. Other than the Integrated Clinical Environment (ICE, ASTM F2761:2009) standards work I don't see a lot of progress, let alone software to look at.  The draft ASTM standard (Dec-2008) is still just a shell. The overall model structure makes sense, but the models themselves are not described in any detail (that I could find anyway).

I have a lot of respect for academic endeavors, but creating a comprehensive standard for something as multidisciplinary and complicated as medical device connectivity will not be an easy task.   I once participated in an ASTM standard that was limited to a single communications protocol, and it took years to finalize.  Developing models for how systems behave and interact is at a level of complexity that I'm not sure can ever really be standardized (how do you nail down a moving target?).

A good example is HL7 V3 RIM (Reference Information Model).  RIM has been under development for more than 10 years and as HL7 RIM: An Incoherent Standard (warning: PDF) points out, many mistakes have been made.  These issues may partially explain the woeful rate of HL7 V3 adoption.

The other thing HL7 V3 shows is the magnitude of work required in these standards efforts. The MD PnP group understands this and that standards are just part of the solution. The slide from here (warning: PDF) summarizes this well:

PnP

Unfortunately, the devil is in all these messy details and is the reason why plug-and-play medicine is still a long way off.

Hat tip: Mike Attili

Posted in HL7, Interoperability, Medical Devices | Tagged , , , | 1 Comment