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 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 1,339 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.
On May 7th, the Danbury Area Computer Society held it’s monthly meeting and it was an honor to give a talk there about The Future of Healthcare and the Internet. This was the twenty-first year that I had shared my thoughts with this fine group. The meeting was open to the public and took place in the auditorium at Danbury Hospital. Following is an excellent review of my talk written by David Mawdsley.
DACS General Meeting
May 2013 Meeting Review: John Patrick – The Future of Healthcare and the Internet
By Dave Mawdsley
John Patrick gave an enthusiastic talk on his 21st visit to DACS to update us on the many happenings related to Healthcare and the Internet. Ready or not, the electronic healthcare revolution is upon us.
John is the president of Attitude, LLC, the author of Net Attitude, and was Vice President of Marketing for Personal Systems and Vice President of Internet Technology for many of his 34 years while working for IBM. His long list of activities included computerizing libraries, advising the World Wide Web Consortium, and more recently, activities in multiple aspects of the healthcare industry, from the personal to the corporate level. He has worked with Danbury Hospital on its board for 10 years.
John emphasized in tonight’s talk that while the Internet is still like an adolescent, it is growing up fast. Healthcare is merging with the Internet big-time through “disintermediation.” The effect is that the usual middlemen in healthcare are gradually being cut from the action while patients and doctors are increasingly using the Internet to access and share health information and data. This allows for greater efficiencies and reduced cost. “There is a personal healthcare revolution ahead.” The Internet allows ways to empower people to improve their own healthcare.
However, still in its infancy is the “power of the click” in healthcare e-prescribing and other healthcare services. Healthcare on the Internet still has numerous problems to overcome including: privacy, security, massive amounts of data to analyze, compatibility of data across e-labs, e-dispensing, e-imaging and healthcare provider forms, to name just a few.
By contrast in retail, “Amazon gets clicks right,” with 10-15% of the $200 Billion of U.S. online retailing. (All retail sales in the U.S. are about $4 Trillion per year with about 5% of that number consisting of online retail sales.) In retail, however, the print media industries of books, magazines and newspapers are still struggling to stay profitable and to adapt to the Internet.
The good news for healthcare includes advances in personal health applications and devices which work with smart phones and tablets to instantly connect individuals with their doctors when a condition is detected needing intervention. iPads connected wirelessly to personal sensors on the skin or in the body are already reporting data to doctors and flagging important conditions. For example, a tiny chip in a pill can now transmit to a skin patch that can transmit to an iPhone–sending information to the doctor that the patient took the pill. A smart bathroom scale can transmit health data too.
Smart ambulances already can retrieve your personal data on their way to the hospital thus speeding up the required services. CardioNet can transmit your heart rhythm 250 times per second to a smart phone monitoring your condition. By doing this, hospitals can reduce hospital returns of discharged patients—a bad situation that drives up costs while upsetting patients and their families. AliveCor from the back of an iPhone can transmit vital statistics. Patients can even do their own cardiograms. Asthmapolis, a wireless unit that fits on an inhaler, uses GPS to report patient use, allowing quick intervention should a problem arise. LUMOback is a band aid-like device that can continuously monitor posture in real time–sensing and sending vibration reminders to the individual to stand or sit better to reduce back pain. LUMOback helps to keep people healthy thereby helping to reduce the huge Healthcare costs for back pain mitigation.
Using an e-bedside application, a surgeon can show images of muscle and bone to explain the procedure that will be used in surgery. By doing this, patients feel better knowing what’s going to happen to them, happy that the doctor has connected with them on a personal level, and receive more information about the rehabilitation needed later. To do things like this with personal virtual modeling and personal genomics for a patient requires that really big amounts of data must move around on Internet optical backbones. Smaller or sparsely spaced communities require thinking “out of the box” to allow for the new healthcare initiatives to reach them via dependable broadband optical fibers.
By 2020, John estimated that the power of IBM’s Watson (Watson of computer chess tournament fame) linked with healthcare information from research and patients will be available to doctors on their iPhones. The use of powerful analytics such as this will potentially greatly improve personal and community healthcare initiatives. Assessing the overall health of communities and regions will be possible and allow for interventions against epidemics or regional chronic conditions.
Obstacles to this Internet revolution in healthcare still remain and are serious. They include security in the cloud, personal privacy, trust between patients, doctors and health providers—all of which will require much more forward thinking. John said “Think big, act bold,” and “Start simple, iterate fast.” The creative thinking requires an out-of-the-box approach, given that entrenched behaviors are hard to change. The government could be more helpful in getting health standards set. (Danbury Hospital is a leader in ways to improve compatibility of the hundreds of medical records that don’t share well.) Many things in healthcare could be simpler. Pay-for-view medical articles are a bottle neck and they have to change. John is annoyed that data about your blood still doesn’t belong to you; the doctor “owns” it.
Factors that would help to overcome these obstacles include improving Internet speed and reach to all communities. Game-changing technologies include tablets with web apps and the use of the HTML5 protocol, which improves compatibility across operating systems, computers, tablets, and smart phones, transmitting data to and receiving it from medical devices. Digital modeling of a human being allows for simulations of new drugs and treatments without harming the patient, to make customized personal care. A microarray is a multiplex lab on a chip that can allow for the assay of personal DNA and other tissue material.
Things are improving. Healthcare is aligning more with patients and care is becoming more accountable. Electronic health records are better and are more widely available. Specialized social networking with sites such as “patients like me” already helps people to share with other patients facing similar conditions, thus taking better charge of their personal health. ZocDoc allows patients to find doctors if one is needed immediately. Movement towards payment for health wellness rather than payment for illness is also a hopeful trend.
Fees for the quality of care, not just for service, are starting. Hospitals and doctors will be paid based on scores that include patient satisfaction. Doctors and hospitals will reach out to do better.
Despite the growing pains as healthcare and patients connect via the Internet, John Patrick is optimistic and sees lots of creative energy already being spent trying to tackle the complex problems. For further study, visit the links in this review to become more informed about our changing world of healthcare.
Most pundits seem to be bullish about the American economy, but they also seem to agree that a point of weakness is a widening “skills gap” in science and math education. Some claim the gap is the equivalent of a long-term national recession. One person who takes this issue quite seriously is Gary Beach, publisher emeritus of CIO magazine. I have known Gary for 20 years. He is an advocate for technology and became convinced that the technology skills gap threatens America’s future economic foundation and even national security. Gary personally did quite a bit of research that resulted in his new book, The U.S. Technology Skills Gap: What Every Technology Executive Must Know to Save America’s Future. All of us probably find the math and science gap to be an issue of great concern and Gary’s book provides the roadmap to get involved and do something about it. Gary tells a compelling story about the history of science and math skills, why decades of warnings were ignored, examples of private company efforts to supplement public education, a pragmatic 10-step action plan, and an intriguing theory that suggests America’s days as the global scientific leader may be numbered.
The World Community Grid has brought hundreds of thousands of people and millions of computers together from across the globe to create the largest non-profit computing grid benefiting humanity. It does this by pooling surplus computer processing power from users’ PCs. Although the PC will be the minority participant in the networked world compared to tablets and smartphones, there are millions of PCs out there and most of them are utilized a very small percentage of the time. Don’t throw any PC’s away — connect them to the World Community Grid, and let your spare computational capacity be deployed toward finding a cure for cancer and other diseases.
Grid computing has been around longer than cloud computing. It joins together many individual computers using the Internet, creating a large system with massive computational power that far surpasses the power of a handful of supercomputers. Because the work is split into small pieces that can be processed simultaneously, research time is reduced from decades to months. It is very easy to get involved in this–its very similar to installing a screensaver. Just visit worldcommunitygrid.org and in a few minutes you will be helping the world. When your PC is idle, the unused computing capacity is used by the World Community Grid to work on difficult computational problems. At the end of this story is a list of the projects you can choose from when you donate the idle time of your PC.
Thanks to the large number of contributors, computations have recently been completed for several projects, with a couple more wrapping up within the next few weeks. In most cases, the research teams will now comb through the massive number of raw results and write up their analyses for publication. In the meantime, the World Community Grid folks have new projects in the pipeline, including one from the researchers at the Ontario Cancer Institute (the team responsible for Help Conquer Cancer).
It is gratifying to visit your My Projects page and select which of the available projects you’d like to support! If you have not done so, make a visit to the World Community Grid website.
Dr. Ramin Ahmadi, director of graduate medical education and research (and a member of my doctoral dissertation committee) kicked off the day, which was attended by hospital physicans, department heads, and resident medical students.
The keynote speaker was Dr. Ramiro Garzon who talked about microRNA expression and function in normal hematopoeisis and leukemia. If that speech title sounds complex, I can assure you it is nothing compared to the brilliant presentation about how microRNA is changing the face of cancer. I had never heard of microRNA and immediately started Googling away on my iPad. After reading the FAQ at microrna.org, I realized how much I do not know. In fact, I have read some books about DNA and genomics, and the more I read, the more I find out that I do not know. Someday, I will find the right book and begin to understand this important topic.
I have not attended a Research Day before, and in looking at the list of Prior Research Day Keynote speakers, I see what I missed. Dr. Ahmadi and his outstanding staff, led by Dr. Joann Petrini, put together a great Research Day Program focused on research studies performed by Danbury Hospital medical researchers.The residents developed large posters that were hung around the learning center. See the topics and abstracts (view the first two pages here and the last page of abstracts here). You can see a complete summary of the day at the link below. It was a great day of learning for all.
It is a privilege to be able to participate and contribute to various boards. Board service is a way to learn new things, meet interesting people, and gain new perspectives. That has certainly been the case since I joined the board of OCLC in 2009. Fifteen years ago some pundits — myself not included — were saying that libraries were history — as in toast — they were not long for the emerging digital world. Been to a local or college library lately? They are full of people and many libraries are expanding their facilities. Library use has doubled over the past decade. What happened to the digital “vision”? It turns out that the digital and physical modes can get along together quite well.
The crown jewel of OCLC is WorldCat – the world’s most comprehensive database of resources held in libraries, connecting millions of users to library collections and services of thousands of libraries around the globe. WorldCat, the most comprehensive online database of resources available through libraries around the world, has reached a major milestone with the addition of its 2 billionth holding. On Saturday, May 4, at 2:58 a.m., the University of Alberta Libraries, in Edmonton, added an e-book to WorldCat — Evaluation of the City of Lakes Family Health Team Patient Portal Pilot Project: Final Report — the 2 billionth holding in WorldCat.
WorldCat was created in 1971 so that libraries could share cataloging information from a central database, increasing workflow efficiency and the ability to locate and loan materials. It took OCLC almost 34 years to add 1 billion holdings in WorldCat, but has taken just seven years and eight months to add the next billion holdings. The holdings in WorldCat span six millennia of recorded knowledge, from about 4800 B.C. to the present, and encompasses records for books, serials, sound recordings, musical scores, maps, visual materials, mixed materials and computer files.
Academic and cultural researchers value WorldCat as much for its depth and distinctiveness as its size. Libraries often hold unique and significant materials, including maps, music, artifacts, theses and other research materials that can be found nowhere else. In a world where general reference, entertainment and news content becomes widely available online, WorldCat helps libraries describe and promote local and specific knowledge far beyond the boundaries of any single institution. For example, many genealogists value WorldCat as a central source for unique family and local history records. Because WorldCat represents items from more than 170 countries and 470 languages, scholars use the database to locate and borrow items around the world. More than 40 national libraries contribute to WorldCat, including recent additions from Japan, Spain, Israel and China, and over 60 percent of the records in WorldCat are for materials in non-English languages.
WorldCat information is syndicated through relationships with partners such as Google, Goodreads and EasyBib. When searching these and other popular online services, information seekers can connect to local libraries through WorldCat links and data services. WorldCat grows steadily. Library members add seven records to the WorldCat database every seven seconds. Take a minute and visit worldcat.org and enter the title of your favoirte book to see the breadth and depth of this great resource. Or if you want to witness the next milestone, visit “Watch WorldCat Grow“. As I type this, WorldCat is at 2,001,695,395 holdings.”
On May 7th, 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 the Healthcare and the Internet. This will be the twenty-first 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 7th.
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 through a patient portal immediately. 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 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 7. As always, I will learn a lot from the Q&A session. The talk is at 8 PM. No RSVP is required.
It is hard to imagine that the World Wide Web has been there for us for twenty years as of this week. See the original text-only web page of The World Wide Web project. Tim Berners-Lee had great insight and we all owe him our gratitude for creating something that has changed the world for the better. There are bad things on the web, but the good things far surpass them. The web is all about grass roots initiatives and there continue to be new web startups every day. I am highly optimistic that the web will make a huge impact in healthcare over the months and years ahead. Combined with mobile, cloud computing, big data, and analytics, the web will enable patients to take much more responsibility for their health and enable healthcare providers to facilitate sharing of healthcare data on behalf of patients. I gave a speech in Boston in March about this (link to the video). I plan to write much more about healthcare and the Internet but, for now, I want to thank Tim and his colleagues for making the web available to all of us.
On April 25, I will be speaking at the Constantine S. Macricostas Lecture Series at Western Connecticut State University. The event will be in the state-of-the-art, 122,000-square-foot science building on the Danbury campus at 181 West Street (see directions to the campus). My topic will be about healthcare in the Internet age. The dawn of the Internet age has changed healthcare forever – diagnoses can happen faster, quality and patient safety can be improved, information is more readily searchable, our healthcare providers can more effectively collaborate on our behalf, and our health records are available with the click of a mouse or a tap on our personal digital device. Despite the progress, we haven’t seen anything yet! Internet technology will be having a much larger role in healthcare. Following are some examples of the things I will be talking about on April 25 (see invitation below) at WesConn and at the Danbury Area Computer Society (DACS) on May 7. The DACS event will be at the Danbury Hospital auditorium. Both events are open to the public and no rsvp is required. If you are interested in the topic but cannot attend either event, you will find a video of a similar lecture in March here.
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 through a patient portal immediately. 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 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 April 25. As always, I will learn a lot from the Q&A session. The event will start with a reception at 6 p.m. in the Science Building atrium and then continue at 7 p.m. in Room 125. No RSVP is required.
A fellow student in the healthcare doctoral class I am currently taking — Community Health and Epidemiology — posted some thoughts and research about flu vaccinations. His post reminded me of my 2 years, six months, and 22 days in the U.S. Army from 1969 to 1971 during which time I received many vaccinations. (I keep a record of all immunizations in my HealthVault database.) There are many studies on the effectiveness of influenza vaccine, whether various categories of people should have the vaccination, and issues about whether healthcare providers should be required to be vaccinated. The purpose of this post is not about those issues but rather about the development and production of the vaccine. Flu vaccine is a wonderful thing that has saved many lives, but the process of making it using billions of chicken eggs is quite slow and archaic. In a video interview with Dr. Eric Topol, Dr. Craig Venter talks about an innovative new approach to the development of vaccines (E. Topol & Venter, 2013). Venter said that the current process for developing the H1N1 vaccine took many months and the supply was barely adequate to cover healthcare workers. He said that if the H1N1 virus had been as deadly and widespread as some had forecasted that we would have had a very bad situation. Venter describes in the video how vaccines can be developed using synthetic DNA. An email containing data about the DNA of the virus to be protected against can be analyzed and a vaccine recipe for production can be available within 12 hours. Venter says the FDA approval is imminent. As new viruses such as H7N9 and H3N2 emerge, with others predicted to arise, the new approach could become extremely important (E. J. Topol, 2012).
The Hammock Dunes Bicycle Club members call themselves “Folks on Spokes”. The Sunday morning weather in Palm Coast, Florida was perfect and eight of us enjoyed a 30-mile ride. We always stop for breakfast–75% or so of the way through the ride–and have a good time socializing. We talk about technology, healthcare, politics, bicycling, and other topics. This time breakfast was at the Oceanside Beach Bar & Grill. They have nice outdoor seating and the service and food are excellent. Shortly after sitting down, a young man stopped by the table to say that he had been trying to talk his father into taking up riding and he asked if he could take our picture to provide some marketing material for his mission. He probably described us as “Old folks on spokes”.
One of our spokespersons said that we were all 80 years old and that we normally ride 35 miles per day. Slight exaggeration on both counts! As we got talking about age, everybody volunteered their number and I was pleased to learn that I will no longer be chided for being the youngest of the group. It turns out that one member will turn 68 in November, three months after me. The more relevant part about ages is that the leader of the group is 75, the oldest, and I find it hard to keep up with him.
A friend and I took a follow-up 20-mile ride the next morning. I felt wiped out from the Sunday ride, but somehow found the energy to endure the ride, although completely expended. While riding on a boardwalk on the Lehigh trail in Palm Coast, we saw a large alligator who must have been expended also. Another rider said she had been watching for an hour and the alligator had not moved a muscle. See alligator picture.
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 1,339 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.
Help Fight Childhood Cancer
It is a privilege to be able to participate and contribute to 
