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Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, and board service. I am fortunate to have quite a few affiliations and I get to work with Net Attitude people from whom I am constantly learning. Prior to “e-tirement”, I was vice president of Internet Technology at IBM Corporation. Nearly everything I have ever said or written is here at patrickWeb or in my book, Net Attitude. As of today, the patrickWeb blog contains 1,410 posts. I hope you enjoy reading some of them. Get the email version of patrickWeb if you prefer. Find me on Facebook, Google+, and LinkedIn. Follow me on twitter. You can also find me in Wikipedia.

Siddhartha Mukherjee and Apple

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Emperor of All Maladies

This post reflects on two amazing sets of accomplishments. First is about a Medscape One-on-One, in which Eric J. Topol, MD, author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care interviews Pulitzer Prize-winning author Siddhartha Mukherjee, MD, PhD. Dr. Mukherjee is the author of The Emperor of All Maladies: A Biography of Cancer. Topol’s book is great, and Mukherjee’s is another one of my favorites. The title sounds boring, but the book reads like a novel. It reveals the history of cancer going back 5,000 years all the way to the present. Mukherjee is not only a writer and cancer researcher, but also a practicing oncologist and assistant professor of Medicine in the Department of Pathology and Cell Biology at Columbia University in New York. His book has had a positive impact on the wider understanding of cancer for non-medical lay-people. Another book and a movie are expected from Dr. Mukherjee next year, and he will continue to have a significant positive impact on greater understanding of complex topics.

Another amazing set of accomplishments is reflected in Apple’s quarterly earnings report released yesterday. The financial performance was better than anyone had expected, and Apple’s cash on hand now exceeds $150 billion. That’s billion, not million. What I find even more amazing is the production of iPhones – sales for the quarter were 43.7 million. If you assume the beginning and ending inventory of iPhones on hand for the quarter were equal, that would mean that Apple produced 43.7 million iPhones in 90 days. Each day yielded 485,556. That translates to 20,231 each hour, 337 every minute, and 5.6 every second. I am not sure a popcorn maker can equal that level of output. Think about it. Every second of every day for 90 days, Apple produced 5.6 supercomputers loaded with a sophisticated operating system that can understand your voice and your fingerprints, connect to iCloud or iTunes, and replicate your songs, pictures, movies, settings, emails, contacts, calendar, reminders, and apps.

I remain in awe of Mukherjee and Apple. They both contribute to global communications and understanding. We are very fortunate to be living in these times.

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DACS 22

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DACS Meeting PosterOn May 6th, the Danbury Area Computer Society will hold it’s monthly meeting, and it will be my honor to give a talk there about The Future of  Healthcare and the Internet. This will be the twenty-second year in a row that I have shared my thoughts with this fine group. The meeting will be open to the public and will take place in the auditorium at Danbury Hospital at 8PM. Following are some examples of the things I will be talking about on May 6th.

Patient Awareness and Home Diagnoses:

The availability of information on the Internet has dramatically changed how involved patients are in their own care and diagnosis. There is always the concern that a patient may self-diagnose, self-medicate, and self-destruct, but the increased awareness of common conditions and preventative medicine can go a long way to improve everyone’s health. Smartphones have enormous potential to provide monitoring, testing and video consultations that previously required an office visit. Home healthcare telemonitoring may grow ten-fold over the next few years.

Process Improvements:

In the past, it took days for a lab to run tests, for a doctor to review the results and share information with the patient. With today’s technologies, laboratory, imaging and other tests can be recorded electronically and delivered immediately through a patient portal. In some cases, a doctor may want to deliver the results in person, but in many – if not most – cases the patient can interpret the results. After all, the data belongs to the patient, not to the doctor. Doctors and patients can get the information they need faster, and patient care plans can be developed and implemented sooner. For example, there have been great advances in e-prescribing. Not only is it more accurate than the traditional scribble on a piece of paper, but the script is compared against other medications and known allergies, thereby greatly reducing medication errors.

Mobile Devices:

The mobile device explosion has enabled health information to be at a patients’ fingertips, helping to extend preventive and diagnostic healthcare to the entire population in a more accessible way. At the same time, mobile technologies have made it easier for doctors and nurses to share and access information – improving their ability to see the latest industry news and advances, to share information with patients, and to provide top-notch care. Today’s smartphones are as powerful as early supercomputers and they will take on a larger role in all aspects of healthcare.

Analytics:

Business Intelligence and analytics are poised to enable new insight into the mounds of big data that are being accumulated in healthcare every day. This will lead to better, more accurate diagnoses and patient care. If Watson could defeat humans at Jeopardy, imagine what Watson will be doing to assist physicians. IBM is working closely with major healthcare providers to do just that.

Medical Records in the Cloud:

There is much to be optimistic about when it comes to electronic medical records. Currently, they’re not as easily interchangeable and accessible as they should be – but this will change over the next few years as the government adds dollar incentives to make it happen. The result will be better quality of care, better outcomes and fewer errors. Doctors will be able to quickly access the latest, most up-to-date information on any patient, from anywhere in the world. No longer is getting sick while out-of-town a threatening situation. Say goodbye to the clipboards! When you go to a specialist, he or she will actually know why you are there and everything about your recent care and diagnoses.

I’m looking forward to discussing these topics and more on May 6. As always, I will learn a lot from the Q&A session. The talk is at 8 PM. No RSVP is required. The DACS press release and a preview written by Andrew Woodruff are here.

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Net Attitude

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Net Attitude

When I wrote Net Attitude 12 years ago, I thought that by now, all organizations would be exploiting the Internet effectively. Sadly, this is not true. There are so many web sites that do not do what they are supposed to do. You enter a date or a phone number or a social security number, and the site says you left out the dashes, or you can’t have dashes. The incredible computing power available to virtually all users and the ability of javascript programming to be embedded directly in a web page makes it easy for the page to add or delete dashes and slashes and present the data to a database in the format that the database expects. Many websites such as AT&T are next to impossible to navigate. You are presented with att.com, att.net, consumer pages that are labeled as being for the enterprise, and on and on. Many sites ask you a set of questions before they let you find what you want to find. Others have an obvious priority that the site is for their benefit, not yours.

Many websites allow booking of flights, theater or dinner reservations, and other appointments. However, many of them still do not provide the basic and simple idea of adding the reservation to your calendar. Hundreds of millions of people have electronic calendars on their smartphones, yet many companies do not effectively enable them to be used. Others offer one choice — add to Outlook. Do such companies think that everyone in the world uses Outlook? Don’t they realize that millions of people use Apple, Google, or Yahoo calendars? Even more mindless and benighted is what Delta Airlines does. After making a reservation, they offer an option to add your flights to your calendar. Bravo! I booked a couple of flights the other day and added them to my calendar, but after looking at the calendar entry, I was greatly disappointed. The entry said, Your Itinerary: Laguardia — Jacksonville, GY3MQ. No where in the visible part of the calendar entry did it say Delta Airlines. No flight number appeared. What could they have been thinking? Perhaps that all flights that you book are with Delta? My conclusion is that they were not thinking at all. Websites have come a long way in the past 20 years, but many still don’t have Net Attitude! We are still in the early days of the Internet.

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Inside Bitcoins

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Bitcoin Jar

I first met Jeremy Allaire when he was chief technology officer at Macromedia back in 2001. Fast forward 13 years, and I saw him give the opening keynote speech for the Inside Bitcoins Conference and Expo at the Javits Conventions Center in New York. His opening remark was that Bitcoin is an historical innovation. As noted here before, Bitcoin has all the trappings of the web in 1994. Jeremy referred to Bitcoin as being in the pre-Netscape era of digital currency. While some say that BTC is a fad, Jeremy said it just needs time and a “build-out” just like the web did. He said it may take decades. As we all know, sometimes painfully, video is really taking hold on the web, but yet 90% of video is still conventional broadcast, and it has taken 20 years for the web to get where it is today.

Bitcoin at its infancy should not discourage us. There are more than 2,000 companies involved — building out the infrastructure and services that will be needed to make BTC mainstream. Jeremy estimated that BTC will reach that point in 10 years. Today, 90% of BTC activity consists of investing and trading. The evolution to a global payment and transactions platform will require an architecture that can handle a large number of transactions. There must be a link between those transactions and the identity of the participants in transactions, a capability  to handle refunds, derivatives, futures, options, integration with foreign exchange platforms, and electronic communications trading networks. 
 
Jeremy had a quite bullish outlook for the evolution of BTC, with which I agree. Consumer services companies will emerge as muti-billion-dollar companies that focus on making transactions easier (Jeremy’s stealth company in Boston, Circle.com, may be one of them). Major payment processors will join BTC — PayPal , Stripe, Square, and others.  ATM networks will provide the vital bridge between paper currency and BTC. Jeremy said that 75% of transactions today are still paper based, so there must be a seamless bridge between BTC and existing ATMs. Banking interoperability and deep integration, which will be demanded by consumers, will be essential to BTC adoption.
 
There is a lot to do, just like there was in 1994. Identity and security present a huge opportunity, and there were a number of startups at the conference providing such services. However, for BTC to go mainstream, industry-led standards efforts will be required. A number of such efforts were essential to the adoption of the web, such as Apache, Linux, IETF, ISO, W3C, and others. Governments will need to establish and enforce BTC legality. (Some countries may initially ban BTC, just like China and some Middle Eastern countries did with the web in the early days. ) Governance rules and oversight will evolve to provide consumer protection, ways to address theft, verifiable identities, oversight of monetary policy, and the necessary legal framework — all country by country.
 
BTC gets put into circulation through the efforts of mining operations. Mining is the process of adding transaction records to the block chain (Bitcoin’s public ledger of all past transactions). Jeremy said that mining will evolve from hobby to institutionalization. Consumer hobbyists will continue to be able to participate. (I hope so, because I am a miner myself. Rather than buy the specialized hardware to perform mining operations, I am using cloudhashing.com, which I learned about at the conference. As BTC is mined, I reinvest the proceeds in more capacity. I started with 100 gigahash/second as part of a pool at cloudhashing.com.)
 
After Jeremy’s enlightening and visionary keynote, the conference continued with a panel of experts. There are a number of seasoned vets involved in BTC, but walking around the conference floor, talking with vendors, and listening to speeches, one can see bright, young, creative, incredibly technical skills working on the evolution of BTC. This will be exciting to watch. I was optimistic before the conference, but am now even more so.
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Regenerative Medicine

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Human Liver

On the morning after the Blueprint Health lunch, Demo Day, and dinner, I headed back to the Javits Convention Center for day two of the 3D Printing Conference. I was quite interested in the medical implications of 3D printing, and I was thrilled with what I learned. The opening keynote speaker was Dr. Anthony AtalaDirector of the Wake Forest Institute for Regenerative MedicineThe U.S. Department of Health and Human Services called regenerative medicine the “next evolution of medical treatments”. The Wake Forest laboratory has already created 22 different human tissues, including muscles that can expand and contract. Dr. Atala said that regenerative medicine can not only improve the quality of life for many people, but save lives. With the potential to heal, Dr. Atala believes regenerative medicine will revolutionize health care.

Patients with diseased or injured organs can be treated with transplanted organs. However, there is a severe shortage of donor organs —  more than 75,000 actively waiting for transplants – that is worsening yearly due to the aging population. Regenerative medicine and tissue engineering may solve the problem. By applying the principles of cell transplantation, material sciences, and bio-engineering, teams such as Dr. Atalas, are able to construct biological substitutes that may restore and maintain normal function in diseased and injured tissues. 3D printing is playing a role. Living tissue can be printed using cells (instead of ink) from the patient . Rather than replacing an entire organ, regenerative medicine uses a replacement technique that supplements a failing tissue or organ. Cells can be extracted from a functioning part of an organ, enhanced and grown outside of the body, and then be printed on a lattice structure. The result is then implanted in the patient. Since the cells came from the patients body, there is no rejection. We can expect to see major advances in the technology in the months and years ahead. Dr. Atala said that regenerative medicine “promises to be one of the most pervasive influences on public health in the modern era”.

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Blueprint Health

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Hospital Building

After an exciting morning at the 3D Printing Conference, I headed to SoHo in an UberX car for lunch at Blueprint Health‘s 5th  annual Demo Day. Blueprint Health leverages NYC’s thriving entrepreneurial ecosystem of entrepreneurs and mentors. After a networking lunch with more than 500, they introduced seven companies, who then each gave a 10-minute presentation about their strategy, financial model, and financing plans. See a highly-abbreviated summary below from Blueprint Health about the startup companies and what they had to say.

The entrepreneurs did an excellent job of explaining their business model and the benefits to healthcare providers from their solutions. Most of the financial flows they projected was from hospitals. The justification for the hospitals was for improved efficiency or more effective care delivery. Despite the justification, selling IT solutions to hospitals is not easy — it is a big, but tough market to crack. Hospital CIOs are conservative and rightly protective of security and privacy. Administrators are interested in savings, but under great financial pressure from reimbursement squeezes by public and private payers. The good news for the entrepreneurs is that they have excellent support from early adopters and the team of mentors organized by Blueprint Health

Following Demo Day was a small dinner with a few dozen healthcare investors and leaders. With healthcare representing nearly 20% of the U.S. economy, it is not surprising that there are many investment opportunities. I was more interested in policy-related and technology-related issues. The technology front is advancing very fast, but the policy front is mired in politics. I would like to be more optimistic on the policy front, but unfortunately, the population is divided, and the politicians are responding to what they believe to be the views of those that can re-elect them. The two political parties are equally guilty.

On the following morning, I headed back to the Javits Convention Center for day two of the 3D Printing Conference. I was quite interested in the medical implications of 3D printing, and I was thrilled with what I learned


bullet BoardRounds helps hospitals transition patients from the hospital to in-network physicians, improving patient care and generating additional revenue. BoardRounds schedules follow-up appointments for patients with providers to ensure that proper follow-up occurs. A typical hospital can generate over $1M in additional in-network services and also improve its quality scores. BoardRounds is in use at Mount Sinai Hospital and negotiating with 5 hospital systems.

bullet Decisive Health enables specialists to see more patients by improving the quality and efficiency of patient consultations. Decisive Health educates patients about recommended treatment options, predicts patient treatment preferences, and qualifies patients for procedures sooner. Clients include physicians at the Hospital for Special Surgery and Virginia Hospital Center.

bullet ProofPilot makes it easy to design, launch, and manage complex research studies and clinical trials. With the ProofPilot platform, researchers launch studies four times faster and cut over 50% of costs. Current clients include NYU Langone, Saatchi & Saatchi Wellness, and the Huffington Post. 

bullet MediQuire helps hospitals measure and improve clinician performance. Their platform takes EHR data and compares clinicians to peers based on the quality of care they deliver. MediQuire then reduces performance gaps by delivering personalized education in the areas where clinicians need to improve most. Their platform allows hospitals to efficiently manage hundreds of new performance requirements, thereby avoiding penalties and reducing waste. 

bullet PulseBeat is home healthcare for the 21st century. PulseBeat offers family members peace of mind by remotely monitoring and caring for their aging loved one. They provide caregivers with real-time notifications and daily health report cards that provide a holistic view of their loved one’s health. Through partnerships with home healthcare companies, PulseBeat offers 24/7 access to a home care nurse or aide. They are working with the Visiting Nurse Association of Orange County, opening the door to thousands of potential customers in southern California.

bullet RubiconMD helps primary care providers earn an additional $45k per year, by treating more specialty related cases. Over 40% of specialist referrals are unnecessary and could be treated by primary care providers. RubiconMD connects primary care providers with specialists for remote opinions. Provider networks see considerable cost savings. RubiconMD has 3 clients including Doctors Express Urgent Care Clinic, the largest urgent care network in the U.S.

bullet Twiage is a mobile and web-based platform that provides secure, real¬time transfer of information and rich media from the ambulance to the ER. They improve pre-hospital communication between the ambulance and the ER, saving the average ER over $350k annually in false service activations alone. Twiage is working with a regional Level 2 trauma center with 90k ER visits a year and is negotiating with 5 clients to launch inQ2’14.

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Inside 3D Printing

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3 D

I was one of the 4,000 people who attended the Inside 3D Printing Conference and Expo at the Javits Convention Center in New York on Thursday and Friday. Although 40% of the population sampled said they had never heard of 3D printing, it is clear from this conference that it is revolutionizing manufacturing, enabling new products, and impacting business processes. One speaker called it an industrial renaissance. Another said that the design-to-manufacturing value chain market opportunity is $35 billion.  I think of it as an industrial revolution that will be equal to the impact of the Internet.

The speakers and demonstrators at the conference made it clear that 3D printing is changing **everything**. In the early days, 3D printing  used bland-colored resin to print small objects one item at a time and one layer at a time. The printers cost many thousands of dollars and were not accessible to consumers. At the conference this week, a Chinese company, XYZprinting Inc., introduced a 3D printer for $499. It supports 12 different colors. What can you print? Just about anything. If you can imagine it, you can print it. Visit Shapeways to get an idea or buy 3D-printed objects.

The range and variety of things on display was nothing short of amazing. A ring with rotating gears — printed as one item. Custom eyeglasses that were based on the width of your nose bridge and distance between your temples. Dental and hearing implants. Jet engine parts. A ChefJet prints chocolate candies and offers personalized nutrition — print your food. Games. Dollhouse furniture. Fashion items including accessories, shoes, jewelry, belts, and even garments. One presenter showed off his colorful 3D-printed shoes as he walked on stage. The conference had a Ford Torino with a multi-surfaced 3D-printed car body. See some of the pics I took at iCloud.

3D printing is an exponential technology that can change everything, and the low-cost technology has now enabled democratization — anybody can print things. If you don’t want to own a 3D printer, you can design something or select from hundreds of thousands of designs online and send your 3D file to a service to print it for you. No expertise is required and the software tools make shape complexity a non-issue. Material science may be the most important aspects of 3D printing. Printing with metal is now possible but continued development is needed to get the strength, cost, and speed where it needs to be. 

The big picture is that manufacturing is becoming digital. 3D printing is just one part of it.  One speaker described four major parts of  where manufacturing is headed. Additive, subtractive, robotic assembly, and nanoscale/bio. Additive manufacturing is accomplished with 3D printing. Subtractive manufacturing is when an object is milled to remove certain parts of the material. Integration will enable an end-to-end process from design to robotic assembly of 3D-printed parts. 

As I listened to speakers and walked the expo floor and talked to demonstrators, I got excited about the many possibilities. I thought of one of my motorcycles — a 1977 Honda Trail Bike — for which it is hard to get parts. I thought of various gadgets, knobs, brackets, and things around the house that are not available. They are now. If you can take a picture or draw it, you can print it. Before this conference, I thought of 3D printing as being limited to a prototyping tool. Now I can see fabrication-grade direct metal printing, where thousands of parts can be printed per printer per day. The printed parts will be lighter and more effective than parts of the past. 

The area I most excited about is in medicine and the potential for patient-specific surgeries. In the afternoon I went to a healthcare conference and then returned to the 3D printing conference the next day to hear some medical speakers. More about the medical area in the next post.

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3-D Printed Brainwave Headset

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EEG Headset

Monitoring of brainwaves is not a new idea, but the technology is now moving from a clinical and research environment to a consumer hobby.  Medicalautomation.org reported that OpenBCI has developed a low-cost, programmable, open-source EEG [electroencephalography] platform that can enable anyone with a computer to have access to their brainwaves (see 3-D Printed Device Allows Users Access to Brainwaves). The possibilities are endless, ranging from neural self-therapy to improve your productivity or attention, to interacting with video games using your motor cortex, to controlling the lights and music in your home based on your mood. To get access to your brainwaves, you need a headset with sensors to pick up the waves from various points around your head. Where do you get such a headset? No problem — just print one! 3D printing may be be retrospectively considered to be like the industrial revolution, which took place from the 18th to 19th centuries. It will change just about everything. If you can imagine an object and design it with 3D software, you can print it. Next week, I will be attending the  Inside 3D Printing Conference and Expo in New York. I expect to see many things that I had not previously imagined.

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My Doctoral Journey – Part 8

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Scholar
As of today, it has been 43 months since my August 2010 decision to begin a doctoral journey. At my last update, on December 21, I thought I was a few weeks away from completion. I was in for a surprise, as the process for completing a dissertation along with the necessary approvals turned out to be nothing like a business process. In a follow-on post next week, I will describe the “process” in more detail for those who may be interested. For now, I am very happy to report that the oral defense lasted 68 minutes and the committee approved my research and dissertation without changes. The 43-month journey has ended. Friday afternoon began with the following email, and the rest of the day was a happy one.  


John

> On March 28, 2014 at 1:14:21 PM, 

Damien Byas (dbyas@email.phoenix.edu) wrote:
> > Congratulations Dr. Patrick! Enjoy your weekend.
> > 
> > D. Byas
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Reflections on Bitcoin – 4

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Bitcoin Jar

I have known Kevin Maney for more than 15 years. He is a talented author and journalist. He also writes music and plays in bands. I first met Kevin when he was writing for USA Today. His columns always included a mix of deep thought, humor, and sometimes a bit of cynicism. The mix was reflected in his current story “The Other Side of the Bitcoin“, which was published in Newsweek. In just over 1,100 words, Kevin completely nailed it — a simplified and understandable insight to what Bitcoin is about and how it is evolving. See other patrickWeb posts about Bitcoin here.

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