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Healthcare

Tuesday, April 29, 2008

Yottabytes

MRI A reader of the story about the hospital SmartCard project asked me if the card could store an MRI. The short answer is no, not today, but in the long term, yes for sure. The most important short-term role for the smartcard is authentication. The best example to explain that is Clear. The Clear smartcard contains a digital representation of each iris, all ten finger prints, and your photograph. When you present your Clear smartcard at the airport, there is no doubt that you are who you say you are. You then "fly through airport security" to your destination. Imagine the same at the hospital -- no more clipboards and filling out information they already have. It seems like a dream today but in the not too distant future we will be able to "fly" through the healthcare process, experience personalized medicine, and feel like the providers are giving us concierge treatment.

Back to the MRI question, where are the MRI's -- and CAT scans, X-Rays, and mammogram's -- stored? They used to be on film and the patient would carry them around from specialist to specialist and the hospital would keep football field size storage rooms loaded with them. Progressive hospitals today use a PACS (Picture Archiving and Communication System). The performance and reliability of PACS are critical to a hospital's ability to provide patient care. The PACSs have gotten better and better but physicians are continuously raising the bar. Understandably, CIO's and CFO's are concerned about the fast growth of storage needed as the imaging technology supports higher resolutions, more images per study, and escalating federal and state government storage requirements. Physicians want online access 24x7 from the office, hospital or their home to not only the MRI you had today but the one you had a year ago and maybe ten years ago. Hospitals have tried to cope with the increased demand by offering online storage for very current images and "nearline" storage for those that have been archived. Nearline often means that the image is stored on tape and can be brought online if a special request is made. Increasingly physicians and patients do not feel there is anything "special" about it -- they expect all data to be online all the time just like Amazon. The online retailer has every order they have ever received since the company started in 1995 online and available 24x7. Easy for them some might say. An order for a book is trivial compared to a digital MRI image.

How big is a digital MRI image? A recent cervical spine MRI contained 160 images and was approximately 60 megabytes in size. About the same as 200 iPhone pictures or 20 iTunes songs. Let's suppose a community hospital has 25,000 patient visits per year and that on average a patient has two image studies performed. That would be 50,000 times 60 megabytes which equals 3 terabytes. Now let's consider what size storage is available and how much it costs.

In the mid 1970's an IBM "disk pack" for a mainframe computer had a capacity of 200 megabytes -- about three MRI's. The entire storage system could contain eight "drives" for a total of 1.6 gigabytes. It seemed like a lot at the time. The cost of the disk drive that the disk pack fit on was nearly $200,000. During the last thirty years the cost has continuously plummeted while the capacity has skyrocketed. The Apple Time Capsule has a capacity of one terabyte and costs $499. IBM has a new storage system that offers up to 1,176 terabytes in a single system. Soon we will be talking about petabytes (1,000 terabytes) and then exabytes, zettabytes, and yottabytes. When I had written a story about yottabytes back in 2005 a reader said the term should be "alottabytes". A yottabyte is 1,000,000,000,000,000,000,000,000 bytes.

The bottom line is that there will be plenty of storage to put all our images online. The key challenge is the management of the data -- keeping it secure, backed up, resilient to disaster, and easy to access and manipulate. Many providers will decide to put all the data in the "cloud" and let someone else manage it. Amazon's Simple Storage Service (S3) is the tip of the iceberg. They charge $0.15 per gigabyte per month of storage used. IBM offers a wide range of storage services and also partners with many healthcare information technology companies.

The normal reaction would be that having all the images online is too expensive. I think many of us will instead think of it like electricity. Healthcare providers use a lot of electricity and some are beginning to cogenerate their own to save money. One thing they don't do however is consider having some of their electricity "offline" or "nearline". It is online 24x7. That is the way we will soon think of medical images.

Other patrickWeb stories about healthcare

Healthcare, Internet Technology, Personal Computing April 29, 2008 01:18 PM

Monday, April 28, 2008

Chocolate and Gum

Chocolate Chewing gum In the story about the hospital SmartCard project, I made a reference to both Wrigley's Gum and M&M Mars candy. Little did I know that a few days later would come an announcement that Mars Inc. -- with some financial backing from billionaire Warren Buffett -- is buying The Wrigley Company, the one-hundred year-old powerhouse of chewing gum. The price tag for the acquisition is $23 billion and the merged companies will be the world's largest confectionery company.

Healthcare, e-Business April 28, 2008 02:42 PM

Tuesday, April 22, 2008

Our Medical Records

Electronic Medical Records It is 11PM. Do you know where your medical records are? Most likely they are scattered across multiple doctors' offices in manila folders. The most information about our healthcare encounters is with "payers", the insurance companies which pay for care if we are lucky enough to have the coverage. Most of their information is about medical codes and money -- not much about the actual "healthcare" that we experience. Pharmacies have tons of information on what we were prescribed but not why it was prescribed. Specialists have notes about our visits that our primary care physicians often have not seen. Meanwhile, a very large number of people -- some studies put it at 100,000 per year -- die from medical errors.

Patient safety, ballooning costs, and government budget pressures are accelerating the move toward electronic medical records. There are many variations on the theme. EMR's in the hospital, Personal Health Records on a smartcard, and Personally Controllable Medical Records on the web. EMR's are emerging from insurance companies, pharmacies, community doctors, hospitals, regional health information organizations, employers and software companies. It is not yet clear which EMR or combination will prevail. Personally, I will be glad when all my medical information is encrypted and stored on the Internet where I will know that at last it will be safe and under my control.

One thing I know for sure is that it is time to make major strides. There will be many participants in making it happen. Government and non-profit organizations such as HL7 must play a key role in establishing standards so that the various kinds of EMR's can be compatible. Most experts agree that Personal Health Records sponsored by healthcare providers have the best chance of success in the short term. Longer term "cloud-based" PHR's such as proposed by Google, Microsoft, and others have great potential but need to overcome trust and privacy concerns of consumers.

One provider pilot program that I think has potential is the "SmartCard" at Danbury Hospital in Connecticut. Five-hundred patients in the trial program can insert their smartcard in a kiosk (very similar to an ATM), confirm the identity displayed, and then receive a "ticket" -- just like at the deli -- to await being called for their test or procedure. The patients like it because they don't have to use the "clipboard" and the staff like it because they don't have to ask patients to use the clipboard. The potential goes well beyond just automating the check-in process. The smartcard can be the "carrier" for our electronic personal health record. At some point our mobile phones may take over the task but in the short to medium term the smartcard may prove to be a very effective aid to empowering consumers to manage their own our healthcare.

The potential is huge. Upon entering the office of our primary care physician the office system could recognize our smartcard and an exchange could begin which updates the hospital with the latest information on the card, updates the card with any updated test results the hospital may have, and updates the primary care physician with the latest test results plus notes from any specialist consultations. If the primary care physician "writes" a script on his or her system it could be automatically transferred to the smartcard and to the pharmacy system and when the patient gets to the pharmacy the card could be recognized and the prescription would be filled. All the information on the smartcard would be encrypted and accessible only after authentication by the smartcard holder. This could be done using a password or a biometric such as an iris scan or fingerprints. This may sound futuristic to some but similar things are already being done. Denmark began a drive toward paperless hospitals more than a decade ago and is achieving much success. Verified Identity Pass, Inc. has a vision of using smartcards to enable us to breeze through airport security lines. The Fly Clear smartcard contains digitized versions of both your iris scans and fingerprints.

There are numerous technical and financial challenges inhibiting the rollout of a smartcard system in a pervasive way. The biggest challenge is that the benefits are "shared" -- neither patient, provider, or payer can justify the cost but collectively everyone wins. It reminds me of the UPC challenge of the 1970's. In spite of large benefits from knowing what got sold and when, the grocery stores were hesitant to invest in UPC scanners because there were no products that had UPC symbols on them (the first product to have a code was a packet of Wrigley's Gum in 1974). The stores found it difficult to justify the cost even though there would be labor savings from scanning versus "ringing up". The package goods manufacturers were also skeptical, despite the benefit of knowing exactly how their products were doing at retail on a timely basis. I remember visiting the M&M Mars candy factory in Hackettstown, NJ in the early 1970's and discussing UPC scanning with the director of product packaging. She said there were not enough benefits to offset giving up the "real estate" on the candy bag to place a symbol for which there were hardly any scanners to scan them. (The first UPC scanner was installed at a Marsh's supermarket in Troy, Ohio in June, 1974). It took strong leadership, competition among retailers, and perseverance to get us to the ubiquitous scanning which we enjoy today.

Likewise with personal healthcare records. The benefits are huge -- increased accuracy of information leading to better outcomes and reduction in duplicative procedures, and ultimately personalized healthcare. Physicians will spend less time ordering procedures and medications, liability costs should go down due to fewer errors, increased collaboration will improve caregiving, patients will be able to relocate and take their healthcare data with them, and patients will be able to take a more proactive role in their own health and selection of providers. All it takes is strong leadership, competition among healthcare providers, and perseverance. The glass is half-full, not half-empty. It is likely that in the next five years we will see more progress toward electronic medical records than we have seen in the last twenty.

Other patrickWeb stories about healthcare

Healthcare April 22, 2008 09:22 PM

Sunday, January 6, 2008

Innovations That Will Change Our Lives

The annual "IBM Next Five in Five" is a list of predicted innovations that have the potential to change the way people work, live and play over the next five years. The list is based on market and societal trends expected to transform our lives, as well as emerging technologies from IBM’s Labs around the world that could make these innovations possible. Following is a sampling of the five areas.

The press is covered with stories about all things "green". IBM believes the technology is actually going to make it easy to be green and save money in the process. A range of "smart energy" technologies will enable us to manage our personal "carbon footprint". As data begins to run through our home electrical system, appliances, air conditioners, lights, and computers, we will become connected to a "smart" electrical grid, making it possible to turn our appliances on and off using a web browser from a PC or cell phone. In addition to alerting you about leaving appliances on when they could be off, we will be able to establish rules to be followed to automatically conserve energy. Reports will show us electrical usage just like we track our cell phone minutes. Intelligent energy grids will also enable utilities to provide you with the option to use only green energy sources such as solar and wind.

The way we drive will be changing dramatically. In the next five years, IBM says our cars will connected to the roads we drive on and thereby we will be safer and remain out of traffic jams. The technology will keep traffic flowing smoothly, cut pollution, curb accidents, and make it easier and less stressful for us to get where we are going. Intelligent traffic systems will make real-time adjustments to traffic lights and divert traffic to alternate routes while our cars will communicate with each other and with sensors along the road -- allowing them to behave as if they have 'reflexes' so they can take preventive actions under dangerous conditions. When traffic is jammed up alternative routes will be activated.

Since we are what we eat, we should know what we eat. With foods being sourced across international borders, the need to know exactly what we eat has never been more important. According to IBM, in the next five years, new advancements in software and wireless radio sensor technologies will enable us to know the exact source and make-up of the food we buy -- the climate and soil the food was grown in, the pesticides and pollution it was exposed to, the energy consumed to create the product, and the temperature and air quality of the shipping containers it traveled in on the way to our dinner table.

In the next five years, IBM says our cell phones will become our wallets, ticket brokers, concierge, bank, shopping buddy, and tour guide. New technology will allow us to snap a picture of someone wearing an outfit we want and will automatically search the web to find the designer and the nearest shop that has the outfit in stock. We will then see what that outfit would look like on our personal avatar – a 3-D representation of our self on our phone, and ask our friends to check it out online and give their opinion. When we turn on our phone in a city we are visiting, it will automatically provide us with local entertainment options, activities, and dining options that match our preferences -- and then make reservations and purchase tickets for us.

Perhaps the most important area where IBM sees major advances is healthcare. Doctors will get enhanced “super-senses” to better diagnose and treat us. In the next five years, our doctor will be able to see, hear and understand our medical records in entirely new ways. In effect, doctor’s will gain superpowers – technologies will allow them to gain x-ray like vision to view medical images and super sensitive hearing to find the tiniest audio clue in our heart beat. Our avatar will allow doctors to click on a part of our body and then visualize the relevant information for that part of us. The hospital system will then be able to compare those visual and audio clues to thousands of other anonymous patient records and be able to be much more precise in diagnosing us and providing us with a personalized treatment plan.

Some of the innovations IBM is predicting may seem like a stretch but the basics of all of them are already in place. If we were to step back five years it is likely most of us would not have foreseen how we would be doing on the Internet today.

Other IBM annoncements made in December

Gadgets, Healthcare, Home Automation, IBM, Internet Technology, Mobile January 6, 2008 12:04 PM

Sunday, November 11, 2007

BioEverything

Biology In 1963 there were two tracks that an electrical engineering student at Lehigh University could choose from -- electronics or power. Electronics was about solid state devices such as transistors. (The Intel 4-bit 4004, was not to come until 1971). The "power" track was mostly about electric motors and power generation. There was no computer science program, but the university had recently acquired a GE 225 which occupied a good part of the basement floor of Packard Laboratory. Nearly every department at Lehigh began to include computer programming as part of their curricula. Some departments evolved toward strong computer orientation more rapidly than others but eventually computer science and computer engineering became formal programs of their own.

Fast forward forty years and you can see a very similar evolution occurring with regard to bioengineering. Initially "bio" was a special interest area that spread roots from the biology department into various engineering disciplines. Bioengineering has already become a structured curriculum for students interested in the intersection between engineering and biological sciences. The bioengineering faculty is drawn from several departments in the college of engineering and applied science and the college of arts and sciences. Bioengineering combines engineering principles with the life sciences. There are three tracks available to students. Biopharmaceutical engineering encompasses biochemistry and chemical engineering. Bioelectronics/biophotonics focuses on applications of electrical engineering and physics in bioengineering such as signal processing, biosensors, and biochips. Cell and tissue engineering straddles the fields of molecular and cell biology, materials science, mechanical and electrical engineering and encompasses biomaterials and biomechanics. Studies range from cells and tissue to organs and systems. Sound a bit different than transistors and electric motors?

The exciting part of all this is that engineering students with "bio" in their pedigree have much broader career potential including healthcare, biomedical, pharmaceutical, biomaterials, and medicine. Even more exciting is the possibility for those of us who started out back in the days of the transistors and motors and have aging bodies that some day will benefit from bioengineered "components". The implantable pacemaker was just the beginning. Bioengineering graduates will be developing pacemakers for the brain, cochlear implants for hearing deficiencies, artificial cartilage for our knees, devices to enable the blind to see, and cures for today's incurable diseases. At some point a nanotechnology "cocktail" will bring nanobots to our internal systems to replace faulty cells with newly engineered ones. Just like computers have become ubiquitous, it is clear that bioeverything is on the horizon. Bioethics will become a larger concern but it is clear that the trend toward The Singularity is underway.

Healthcare November 11, 2007 05:09 PM

Friday, November 2, 2007

IBM Happenings: October 2007

The month of October set a face pace for the last third of the year. The month was filled with a slew of announcements in hardware, software, services, acquisitions, and strategic alliances. One of the most interesting announcements to me was that IBM announced new software and services to help ensure clients' success in creating a healthy IT environment based on a service oriented architecture. This comes on the heels of an announcement last month where the company unveiled innovations for healthcare that will have a dramatic impact on patients, hospitals and the general public. The key trends IBM pointed out were in secure sharing of patient data, fully-informed diagnosis from doctors, healthcare providers and hospitals, speeding drugs to market, and stemming the spread of pandemics.

Here are all the other announcements made by IBM during the month. The complete index of prior IBM Happenings is here.

Healthcare, IBM November 2, 2007 05:11 PM

Friday, October 26, 2007

Governance

Doctor and Patient It was an educational week at the Leadership Conference for Trustees, Physicians, Executives, & Nurse Executives at The Greenbrier in White Sulphur Springs, West Virginia. The conference, which focused on the subject of governance, was organized by The Governance Institute. Although not a new term, governance has taken a much higher profile in both for profit and not for profit organizations. At a very high level governance aims to assure that an organization produces a pattern of good results while avoiding an undesirable pattern of bad circumstances. The Governance Institute focuses on helping hospitals achieve best practices among the leading healthcare boards across the country.

The conference included three days of speeches, Q&A, and breakout sessions that covered many topics including clarification of a hospital board's basic fiduciary duties and core responsibilities, exploration of "best practices" of high-performing boards, understanding of various hospital-physican relationships and complexities of physician credentialing and privileging, approaches to hospital financial planning and capital allocation, and an analysis of the healthcare reform (and cost) being advocated by the various political candidates.

Governance can be a complex topic but at a high level it is mostly common sense. The way I think about it, good governance means being financially efficient but not pushing so hard on the numbers as to cause people to do unnatural things in order to "make" the numbers, focusing on how the leadership of the organization is selected and how they are paid, being transparent with the various stakeholders so they understand the decisions that are made and the rationale behind them, and insuring personal accountability is in place at all levels.

Although governance was the main focus of the conference, all of the speakers had some predictions about where things are headed with American healthcare. It was not a pretty picture. Costs are going to cointinue to escalate to the point where they are a huge part of the economy and exceed the cost of primary and secondary education at the state level. As costs rise they will be pushed toward hospitals and pressures will continue between payers (insurers) and providers. Primary care physicians, already in short supply in many areas, will be in even shorter supply as new graduates seek out speciality areas with more economic potential. As the cost of running a medical practice continues to increase many doctors will choose to become employees of hospitals. Hospitals will consolidate and as they gain economy of scale they will implement electronic medical records and become highly efficient providers of high quality care. Although America does not today offer the highest quality health care in the world, there is significant progress being made toward curing cancer and heart disease. The glass is half full, not half empty.

There was not a lot of spare time but enough to get in a look around the Greenbrier's spectacular 3,500+ acres, have a good hike up Kates Mountain Road, and also locate a benchmark near the old White Sulphur Springs train station (a few pictures in the photo gallery). That brings cumulative benchmarks found to eighty-eight. Some of my colleagues took a tour of the Bunker but we had been there before.

Other patrickWeb stories about healthcare
Pictures from 2002 trip to the Bunker

Conferences, Healthcare, Hiking, Travels October 26, 2007 04:19 PM

Monday, July 30, 2007

Authentication Redux

Vascular map of hand The trip to New York for a board meeting last week went smoothly. Traffic was light -- even within the city -- and I got to the hotel lobby in much better than normal time. The one thing that went less well than it could have the check in process at the Radisson Martinique on Broadway. After a long wait line I was greeted by a person at the desk. Hoteliers actually think that guests want to be greeted by an employee and have them ask how you are today. One would think that they would realize is that the most important thing a guest wants to get to their room. I had a reservation. All the information about me is already in the reservation record and the frequent stayer record. In spite of this the hotel agent had to enter a lot of keystrokes for some reason. The only thing they did not have was authentication. They wanted to make sure I was the person I said I was. I showed them my driver's license in the flip-up plastic window of my wallet but that was not good enough. The agent had to go to the back office and make a photocopy. No wonder the waiting line is so long.

The solution to speeding up and improving the accuracy of the authentication process is the use of biometrics. The technology has been around for decades. Pick your favorite -- hand geometry, fingerprint, iris scan, face scan, or voice print. There are many working solutions available today from many vendors. None are perfect and that is why we don't see more implementations. Rather than take a leadership approach, many institutions in effect say, "we can't do *anything* until it is perfect. Some lawyers say that if it hasn't been to the Supreme Court then don't use it. The result is that we stand in line waiting for someone to photocopy what might be a stolen driver's license.

My favorite approach is hand vascular pattern biometric a technology that originated from a conventional vein pattern recognition system. Studies show that 99.98% of the world's adult population can use it. It is highly secure because there is no back door, such as a key or numeric password. Fingerprint devices suffer from usability because some users have faint fingerprints while iris and retina scan devices may not be appropriate for people with eye diseases. On the other hand, no pun intended, hand vascular patterns are unique to each of us and to each hand. The chance of someone being incorrectly recognized is 0.0001%. Not perfect but that is good enough for me. The best part is that hand vascular scanning does not require physical contact, compared to fingerprint scanners which require users to press a finger onto the scanner in order to capture the print. The idea of wiping your finger over something that millions of other people have wiped their fingers seems inconsistent with what people on cruise ships are told. One other subtly for increased security with hand scanning is that because of the sensor's capability to sense the user's temperature, there assurance that the hand is alive. Being able to establish that we are who we say we are could speed the lines at airports, hotels, sporting events, and hospitals.

Other patrickWeb stories related to authentication

Healthcare, Internet Technology, PKI, Travels July 30, 2007 09:41 AM

Wednesday, June 13, 2007

Stem Viruses

Virus One of the scary things out there is the potential spread of infectious diseases such as avian influenza (bird flu), dengue fever, and other dangerous viruses. The challenge has always been to try to gain an understanding of how they spread -- what they will do next. Will the virus mutate? Will it jump across continents? Where are the greatest vulnerabilities? Can the path be predicted in time to get vaccine to the next area? There is now new hope to get our arms around these questions and more. IBM is donating some very sophisticated software to help scientists and public health officials build digital models of infectious diseases to help understand and plan more efficient responses to potential health crises. The software is known as Spatiotemporal Epidemiological Modeler (STEM for short) and is one of the key technologies being used in the Global Pandemic Initiative, a collaborative effort of IBM and over twenty major worldwide public health institutions, including the Center for Disease Control and the World Health Organization to help prevent the spread of infectious diseases.

The Spatiotemporal Epidemiological Modeler (STEM) tool is designed to help scientists and public health officials create and use spatial and temporal models of emerging infectious diseases. The models can not only aid in understanding diseases, but potentially even prevent them. The software, which was designed so that it will work on any type of computer, creates a graphical representation of the spread of a disease based on a variety of parameters such as population, geographic and macro-economic data, roadmaps, airport locations, travel patterns and bird migratory routes around the world. STEM also facilitates collaboration between governments, scientific researchers and other players in the public health community who can share the customized epidemiological models that STEM creates.

Policymakers responsible for creating strategies to contain diseases and prevent epidemics need an accurate understanding of disease dynamics and the likely outcomes of preventive actions. In an increasingly connected world with extremely efficient global transportation links, the patterns of infection can be quite complex. STEM allows the building of models involving multiple populations (species) and interactions between diseases. It would be speculative to say for sure but STEM is potentially a breakthrough that will large numbers of lives in the years ahead.

For any techies out there that want to download STEM, you can find it here. If you would rather just see a CNBC movie clip about it, take a look here.

Other patrickWeb stories about healthcare

Healthcare, IBM June 13, 2007 03:00 PM

Sunday, May 20, 2007

IBM Happenings: April 2007

The month of April at IBM was filled with a slew of announcements in hardware, software, services, acquisitions, and strategic alliances. Many of the announcements are occurring in the healthcare area. I was particularly impressed hearing that the Mayo Clinic and IBM are advancing real-time medical imaging. Collaborators from Mayo Clinic and IBM have exploited parallel computer architecture and memory bandwidth to dramatically speed up the processing of 3-D medical images. Here are all the announcements made by the company during the month. The complete index of prior IBM Happenings is here.

Healthcare, IBM May 20, 2007 09:56 AM

Thursday, November 16, 2006

The EMR

Doctors Last week's story about healthcare got some reactions. At a high level there is both concern for privacy and on the other hand hope that paperwork, healthcare costs, and medical errors can be reduced. It is no slam-dunk for sure, especially in the short run. Most people agree that electronic medical records are a key element in the overall solution. There are many potential benefits including not having to fill out a clipboard of paperwork every time you go to a healthcare provider and not having to get repeat blood work or imaging because the doctor can't get access to the data from tests you recently had. EMR's also have the potential to increase collaboration among doctors and other providers resulting in better outcomes. Longer term, the electronic medical records can lead to "information based medicine" which has the potential to base prescriptive care on the specifics of each patient combined with a large database of what worked and did not work for people who have the same condition. Ultimately we will have medications based on a DNA analysis of the an individual patient. There is much to hope for in an electronic world.

Larry Medina in Danville, California is more than skeptical. Medina, who has spent decades working with information related technologies, is concerned about EMR implementations -- especially if managed by a large tops down government program. (See his story called Are you ready to risk YOUR LIFE on "Electronic Medical Records"?). I agree with many if not most of Larry's points. Big projects are always risk prone. Larry points out a good example of this at Kaiser Permanente (See Problems abound for Kaiser e-health records management system where an internal report details hundreds of technical issues and outages). If there is one thing I have learned over past forty years it is that the best projects are the small ones. My motto is "think big, act bold, start simple, iterate fast".

The role of government in healthcare is important -- not to implement big ideas but rather to foster the creation of standards among IT companies, healthcare providers, and the payers (insurance companies). It is really critical to our health that all the "players" can interchange data. Larry has expressed valid concerns about security, privacy, systems reliability, and project management. The question becomes what to do. Some would say don't do anything until you can be sure you can do everything and do it right. To me that means we never get to the starting line let along the goal line. A better approach is to start simple, build pilots, try something with a small number of patients in one department, extend it to a second department, connect with the payers, add some more patients, and another clinical area, etc.

The best proof point of start simple, iterate fast is the Internet itself. The Net is a global network operating in nearly every country on Earth and connecting millions of computers and a billion people. It did not start that way. I can remember when email was about all you could do and only between a handful of universities and government labs. The Net did not get to what it is in big steps. It was continuous evolution through a huge number of baby steps. In my opinion, the same approach needs to be taken in healthcare. I agree with Larry. We don't need big steps. We need a lot of little steps and we need them urgently.

Healthcare November 16, 2006 04:32 PM

Monday, October 30, 2006

Personal Healthcare Data

Hospital Emergency Room Seems like healthcare issues are being discussed in the media everyday. The bad news is that there are medical errors and runaway costs that are becoming painfully more obvious. The good news is that hospital management is working very hard to improve their systems, community doctors are beginning to invest in more automated systems, and the governments of the world are very focused on standards for healthcare information. It is a long process but it is happening. IT vendors are very focused also. In the U.S., healthcare expenditures are nearly $2 trillion. It is estimated that 20% of that is for duplicate procedures. A good chunk of the $400B in duplication can be saved through improved IT systems.

IBM has been making a large investment in healthcare solutions that use it's software, systems, and technology. More importantly the company acquired Healthlink, along with 600 of the top healthcare thought leaders in America. IBM has just released a new seventy-two page report called Healthcare 2015: Win-win or lose-lose? (Please note that the pdf file is 3 megabytes in size). The report describes a "portrait and a path to successful transformation" that will become a "how to" book for many healthcare leaders around the world. Some of the background and statistics cited will really get your attention -- like the World Health Organization rating the United States #37 in the world on overall health system performance.

Most of us have experienced the duplicate data problem. A doctor finds it easier to order a new blood test than to get the data from a blood test you had a few days before. As consumers we are finding the data to be out of our reach. Blood tests start with blood which then goes into analytical equipment which creates digital information about the blood. The best "data" you can hope for is to get a faxed copy of the results. Contrast this with the financial part of our lives where millions of people use various software to download, record, store, analyze, and review every detail of their financial life. When it comes to data about our health we are mostly isolated -- even though it is our data. This is going to change dramatically as standards and online systems emerge for EMR's (electronic medical records). EMR's will enable us to get control over our health data and also allow healthcare providers to have access to it -- authorized by us as we see fit. There are many resources available about EMR's if you want to learn more. In fact, you can securely store and manage your personal health records for free at myNDMA. The site allows you to access your medical images -- for example, mammograms and other x-rays -- and electronic health records whenever you need them. You can also document your personal and family medical history and have your records available to you on-demand to give to a new doctor or to get a second opinion. One step closer to getting control of our health data.

Other patrickWeb stories about healthcare
IBM Healthcare and Life Sciences solutions

Healthcare, IBM October 30, 2006 11:22 AM

Tuesday, October 24, 2006

Blue Brain

Brain The human brain is one of the many marvelous parts of humans. It has been quite interesting over the last few years to read books and hear lectures on the subject. (See references in patrickWeb). The complexity of the brain can appear overwhelming but Big Blue is trying to make it understandable by working with a team of computational neuroscientists in Switzerland on a project called The Blue Brain. The goal of the project -- being developed at the Brain Mind Institute at the Ecole Polytechnique Federale de Lausanne-- is to create a digital 3D model of the brain.

IBM’s Blue Gene supercomputer is helping to advance our understanding of important biological processes such as protein folding and a growing list of applications including hydrodynamics, quantum chemistry, molecular dynamics, climate modeling and financial modeling. The topics have vocabularies of many-syllable words but they are changing the world for the better. The Blue Gene supercomputer has a peak speed of 360 Teraflops. In layman terms that means that the machine can perform 360,000,000,000,000 (trillion) calculations every second. That kind of horsepower doesn't match the human brain but it is getting closer. I have seen a Blue Gene in operation at IBM's Thomas J. Watson Research Center in Yorktown Heights, New York. It is a sight to behold.

Back to brains. The idea is to create a detailed model of the circuitry in the neocortex – the largest and most complex part of the human brain. Over time, the project hopes to model other areas of the brain and eventually build an accurate, computer-based model of the entire brain. The process starts with "wet" chemistry. A dye is injected into each neuron of the brain to reveal a kind of map called a morphology. After gaining a view of the neurons, it sets the groundwork to build a digital model in the Blue Gene that emulates the real thing. The neocortex is organized into thousands of columns of neurons. Each column has a diameter of less than two one-hundredths of an inch and contains 10,000 neurons. Each neuron stands a little more than 1/16 inches high and receives over 10,000 inputs from other neurons. Suffice it to say that the brain is a very complex thing. In the case of Blue Brain, the end result will be a greatly enhanced understanding of how the human brain works which will lead to curing the things that can go wrong with it. A better understanding of the brain -- the supercomputer of all supercomputers -- will also help develop even better supercomputers.

Healthcare, IBM October 24, 2006 10:17 AM

Sunday, September 24, 2006

Conference Time

Cactus Thursday was Venture Capital day at IBM's T. J. Watson Research Center in Yorktown Heights, New York. Monday will be the tenth anniversary celebration of IBM's alphaWorks program in San Francisco, and Tuesday will be the DEMO Conference in San Diego.

The IBM Venture Capital Group facilitates relationships between the company's vast research and development, product, and marketing resources venture capital firms and their portfolio companies. Many are recent start-up companies that build their business and technology solutions on IBM's industry solutions platform and then use the IBM marketing resources to get the word out and to act as a distribution channel. It is a symbiotic relationship that works well for all parties. Yesterday's conference was attended by dozens of "VC" firms, more than fifty of their portfolio companies, and a dozen or so industry thought leaders. It was a very positive day of interaction with numerous IBM executives focused on vertical industry segments including banking, retail, media & entertainment, telecommunications, government, and healthcare. I attended three of the sessions but the most interesting was healthcare.

The biggest trend that the IBM healthcare experts talked about is an understanding of disease at the molecular level and development of targeted drugs based on genomic insight. This will lead to individual diagnosis and treatment based upon medical history and genetic predispositions, as opposed the anecdotal approach used today. This new level of understanding will also enable "pre-emptive medicine" -- don't wait until you get sick to seek treatment. Genetically we are all 99% the same but the small differences are what cause health problems. The innovation in patient-centric healthcare is going to happen much more quickly than people think. Why?

There is a convergence of four disruptive changes underway...

1. Rapid evolution in technology. Computers keep getting smaller and faster. Nanotechnology is emerging rapidly.

2. Pressure on existing business models. Many hospitals are losing money, insurers are trying to put on the brakes, consumers are not happy with the services they get, waste and duplication are rampant, and medical errors are causing deaths.

3. Social pressures. People are beginning to realize that medical data about them is their data, not the doctor's or hospital's. Hundreds of millions of people more than sixty years old have high expectations for their health and are demanding treatment for things that once would be considered incurable.

4. Political pressures. Politicians are feeling the heat and want to see progress. They want more people to get affordable or subsidized care and they want to protect privacy.

Any one of these four factors would be interesting and create pressure for change. The convergence of all four are creating a firestorm of activity. Stay tuned. (See other patrickWeb healthcare stories).

Conferences, Healthcare September 24, 2006 03:03 PM

Friday, September 15, 2006

Paper Paper Everywhere

Microscope Somehow I managed to pull a muscle in my leg. Most likely it was launching back into an aggressive set of exercises after having been away on a trip in Eastern Europe. The doctor thought it would be prudent to get an x-ray of my hip and so there I stood at the window at the radiology lab being asked to fill out a form with a lot of information they already had. I knew better but could not resist asking why it was necessary. "We need the information". I said they already had it. The receptionist said they could look it up but only if I had been there in the last thirty days. I resisted the temptation to explain that the cost of storage had plummeted in the last decade and was close to zero for the data I would be putting on paper for the hundredth time. It certainly isn't the fault of the receptionist or the x-ray technician or even the radiologist who later read the results. The problem is the "system" and the system is owned by the management of the healthcare providers and the insurers. The hundreds of billions of dollars being spent could be reduced substantially if the management could move faster to implement basic information technology such as is used in retail, manufacturing, and by various arms of government (like e-file at the IRS). All of us should be pushing for this. The result will be lower costs, higher quality of care, and fewer medical errors.

On a more positive note, great progress is being made in the use of information technology in the clinical area. One of the important approaches to understand the underlying mechanisms of cancer has been to analyze cancer tissue microarrays (TMAs). The analysis can result in improved treatment and therapy planning for cancer patients. The problem is that it takes a lot of computer power to do the analysis. The World Community Grid is now changing the amount of computing power available.

Our laptops and desktops are idle most of the time. Even when we are "using" them, the percentage of their horsepower actually being used is small. That is the simple concept behind the World Community Grid. More than 200,000 people have "donated" 400,000 PC's to the grid. When any of the PC's are not busy, a software "agent" kicks in and delivers the unused capacity to the grid. The combined computing power of the PC's in the grid can do as much TMA analysis as a traditional computer would do in 130 years!

"Help Defeat Cancer" is one of three projects using the World Community Grid. The Human Proteome Folding project is analyzing the structures of human proteins and pathogen proteins. FightAIDS@Home is a project focused on using computation methods to identify candidate drugs that have the right shape and chemical characteristics to block HIV protease.

Anyone can donate idle and unused time from their personal computers by downloading World Community Grid’s free software and registering at the WCG website. No forms required. I have been participating in the grid since November 2004 with several of my PC's and have found it to be easy, safe and secure. It is also a good feeling to know that your spare cycles are going toward something that can improve humankind.

Healthcare September 15, 2006 02:26 PM

Thursday, August 3, 2006

doctors@email.not

Doctor office Today I received two letters in the mail from medical practices in Connecticut. They were both routine, practice announcements about physician changes. What jumped out at me from both letters was that neither had an email address or a web site url. Here we are in the second half of the first decade of the twenty-first century and nobody at these multi-physician healthcare practices thought that it was important to offer the communications channel that a billion people around the world have adopted.

It is understandable that physicians do not want to spend their time slogging their way through an email inbox, sorting out spam, reading life histories of patients, requests for second opinions of " medical" opinions of friends and family, etc. Then there is the legal side. Attorneys advise against giving online advice, warn about authentication of emails, express caution about liability when giving advice without actually seeing the doctor, etc. Just to round out the downside, I have no doubt that most doctors believe it is a choice -- spend time with patients or spend time with email.

On the other hand, the glass could be half full instead of half empty. There are numerous software packages and Internet services which offer encrypted, authenticated, secure, tamper-proof email capabilities. There are various challenge/response systems, such as spamarrest (which I use), that can ensure zero spam in the doctor's inbox. The issue is not technical -- the technology is available to be as safe and secure as wanted or needed.

The issue is attitudinal and cultural in nature. Someone has probably done the study, but I believe that looking at the entire time spent and the entire experience for both physician and patient, that healthcare would be better with greater use of email. Physicians do not have time to shoot the breeze on the phone with patients for sure, but they do get phone calls and make phone calls, they do get interrupted by their assistants, patients do call back, and some get dissatisfied with a curt call-back at an inopportune time. Email is certainly not a substitute for "hands on" medicine but there are many cases when the hands are not needed. Doctors have incredible memories and know a lot about their many patients. Simple questions could be answered with simple answers. How many calls does the doctor get like "Is it ok to take two Tylenols for....". If you get through the switchboard and call center menus, good chance the receptionist may ask a nurse who may then ask the doctor and then tell the receptionist "Ok to take an extra Tylenol. If you don't feel better in the morning call for an appointment to come see me".

More sophisticated approaches will evolve as docs get into the swing of things with email and the web. Artificial intelligence will enable a patient to send an email and have it be automatically analyzed for keywords and then be presented to the doctor along with a set of possible responses which he or she can then customize easily and quickly. Appropriate reference material could be automatically appended. The web has empowered all of us to gain information and somewhat take control of our health, but an electronic connection -- in addition to, not instead of -- the hands on approach of seeing our doctors would be a big plus for healthcare.

The other big change is the personal electronic health record. We can download our financial transactions every day into Quicken and be on top of our financial health. Get a blood test, however, and the data goes from our arm to a computer to a digital analysis and back to a faxed piece of paper. When we have that information in our PC, and this is happening for millions of people, we will know more about our chemistry than doctors do today. It may make some of our emails harder to respond to but ultimately will make us healthier. The patient centric world is coming, and quickly.

Beyond that is the world of genomics. The breakthroughs in the next ten years will exceed the progress of the last one hundred years. There are other stories about healthcare here on patrickWeb in the healthcare section.

Healthcare August 3, 2006 09:54 PM

Wednesday, May 17, 2006

Healthcare and IBM

The Intellectual Property briefing by IBM on May 2 in Greenwich was extremely interesting and I hated to leave a bit early but there was an overlap with another briefing down the road in Stamford, Connecticut -- this one about healthcare. IBM's healthcare and life sciences business is huge with 4,000 employees and revenues in the U.S. alone that would put it well into the Fortune 500. The company counts as customers 8 of the top 12 hospitals and all of the top 30 pharmaceutical companies. What has really put IBM on the healthcare map is last year's acquisition of Healthlink, which brought with it 400 top healthcare consultants. The insight of the consultants plus the smorgasbord of IBM technology has put the company on a mission -- to be a major factor in creating "Transformed Healthcare".

IBM's vision is significant -- to build patient-centric information systems, shared health and wellness management systems, and integrated networks to pull it all together among the payers, the providers, and the patients. Many of the benefits are obvious but some are more subtle. Payer insurance companies may be transformed from claims processors to wellness concierges. Smoother workflow and process optimization due to better integration and access to information can lead to improved quality, fewer errors and lower healthcare costs.

IBM has a vested interest in becoming the leader at these things because it has a half-million employees and retirees. Their Global Health and Wellness program is a partner in developing solutions for clients and may itself become a model. The company not only has a wealth of information at the intranet web portal but also enables an electronic health record into which employees enter their personal information which is then supplemented by automatic updating from claim and pharmacy data. The company also provides incentives to exercise and stay healthy. As a result, IBM's labor cost is significantly lower than industry averages.

The conference was attended by several dozen healthcare software vendors and various industry experts, including more than a half-dozen physicians. Most of the discussions revolved around the notion of "Patient centric" -- connecting healthcare information about patients with insurers and healthcare providers for the benefit of the patient. The key to make all this work is standards and they will evolve through Regional Health Information Organizations (RHIO) and a National Health Information Network (NHIN). The RHIO includes consumers, hospitals, labs, pharmacies, payers, public health offices, and physicians. Progress is being made. A presentation was made by John Blair, MD, who is CEO of Taconic Healthcare Information Network, a RHIO just west of the Hudson River. They have connected practices, hospitals, labs and payers and have developed standardized electronic health records, e-mail access to physicians, and e-prescriptions. The NHIN has asked four IT companies to work on interconnection of the RHIO's. Part of IBM's NHIN architecture will be based on royalty-free health care information systems patents (discussed in the IP meeting earlier that day) which give priority access to requests for patient information coming from emergency rooms vs. routine office requests.

From a purely heath point of view, the biggest transformation will come from information based medicine that bridges healthcare and life sciences. Molecular level understanding of disease is being made possible, in part by supercomputers such as BlueGene, and the result will be the development of targeted drugs. In other words, based on a DNA sample and genomic analysis, a diagnosis and treatment can be based on our individual medical history and genetic predispositions. Whole new fields are opening up including pre-emptive medicine, pharmacogenomics and clinical decision intelligence. A small device the size of a cell phone can take a sample of your blood and determine your rate of metabolism which in turn affects how much of a drug you need to provide optimal results. It will soon be possible to predict the likelihood of a person getting something deadly but yet preventable.

Advanced analytics are beginning to provide the ability to run complex algorithms to answer complex questions. For example, there is a 100 page document that provides guidelines on how to perform a particular surgical procedure. It is based on the "average" person. Nobody is average so would it be nice to be able to have a system which can provide specific recommendations based on many variables that are particular to an individual -- providing the surgeon with a "how to" guide unique to each patient.

Molecular Profiling Institute is creating tools for genomic and proteomic profiling and treatment of cancers. Seventy of our 40,000 genes can predict breast cancer accurately. Dr. Robert Penny showed incredible examples. A particular gene that is missing or not working can tell the cause of a particular disease and a drug that can attack that specific gene can fix it and the patient can be cured. This is called "jumping diseases" -- using a cure for disease xyz to treat disease abc. Dr. Penny showed before and after images of a dying cancer patient. After the application of a drug that attacked the targeted gene, the cancer disappeared. It gave the audience a lump in their throats.

There are many new issues arising along with the breakthroughs. For example, being able to know you have high odds of getting xyz disease for which there is no prevention and no cure after getting it, is questionable. The trend from physician centric to payer centric to patient centric is accelerating. It is likely that what will be accomplished in the next ten years will be vastly more than what has been accomplished in the last one hundred.

Other patrickWeb healthcare related stories

Healthcare May 17, 2006 09:15 AM

Tuesday, April 25, 2006

Demos and Podcast From Rome

April 8, 2006

Rome IBM had some demonstrations set up in the breakout areas at the Auditorium Parco della staffed by researchers and experts in various areas. There was a lot of interest during coffee breaks. After lunch before the final session of the forum got started I had interview with Chris Barger from IBM to talk about the demonstrations and also a few thoughts on the future of healthcare and the Internet. Here is the transcript and here is the podcast.

Intro to Roman Rendezvous Stories
Index to Roman Rendezvous stories
Podcast
Transcript of podcast

Conferences, Healthcare, IBM, Internet Technology, Travels April 25, 2006 12:49 PM

Saturday, March 18, 2006

RHIO's Are Coming

Heart One of the focus areas of PC Forum was healthcare. Scott Cook, Co-founder of Intuit, which makes Quicken, talked about the importance of quality control in hospitals in order to reduce medical errors which lead to unnecessary deaths. He also talked about Intuit's hope for Quicken Medical Expense Manager, a new tool to allow individuals to track and manage their healthcare expenses. J.D. Kleinke, Vice Chairman at HealthGrades talked about they are shifting emphasis to consumers and providing them with comparative information about doctors and hospitals. You can visit Healthgrades and see how your local hospital stacks up. J.D. is also Executive Director of Omnimedix Institute where they are hoping to create a non-profit organization where you can get your healthcare data. The concept is that laboratories, pharmacies and healthcare providers would upload (with your permission) all the data relevant to you. You and other healthcare providers (with your permission) would have access to the information. This is a really good idea but there are many obstacles to making it happen. Ironically, even though the benefits to consumers would be huge, there is little apparent demand.

A woman in the audience made an emotional plea to one of the panels to make software available to consumers that want to track their healthcare issues. There are actually are a number of such programs already available. I use Healthfile and I think of it as "Quicken for my body". It allows you to enter doctor visits, medications, tests, vaccinations and much more. Healthfile can run on your PC but also on a Palm or Pocket PC. This makes it easy to enter information while you are in a waiting room and then synchronize it with your desktop when you get home. Even better will be the day when you don't have to enter any data other than how you feel today. The rest will be tied together through Omnimedix or your local RHIO. There are already one hundred Regional Health Information Organizations in operation. Soon they will be exchanging data within and between other RHIOs so that when someone moves or has a medical emergency, providers will have access to data that can save their life. Much more to come on this subject.

Other patrickWeb healthcare related stories

Healthcare March 18, 2006 06:06 PM

Friday, March 3, 2006

Open and Closed

Open sign The central theme at the IBM Open Source IT Analyst Conference in Stamford, Connecticut this week revolved around the word "open". The term is used with "open source" and also with "open standards" and there is often confusion about the meaning of the two terms. A standard is like a blueprint. An open standard is one that is freely available. Open source is software that is freely available and which may implement open standards. The two terms are independent.

At one extreme, open means you can take my idea and do whatever you want with it and you don't even have to tell me you did so. At the other extreme, closed means my idea is mine and you can not use it or even see it. In a practical sense there is a wide spectrum in between open and closed. There are many factors in the debate but long term it is breakaway innovation among communities of developers and inventors that share a common vision that is the most important argument in favor of the expansion of open source software. The downside for entrenched monopolies or those resistant to change is that open source can cause disruption and a ton of incremental competition in markets. IBM's Dr. Bob Sutor, vp for standards and open source, says "tough". Only the greatest sinners of the past can truly repent.

The most visible example of the open standards debate is what is going on in Massachusetts. (see prior story). Some people are calling the state's decision to separate data formats from applications a "Bill of Rights" around information. A gentleman from Boston University told me he not only is confident the decision will stick but that it will be a model for the free world. A Norwegian official said that proprietary data will no longer be acceptable. It is a struggle against existing ways of doing things but long term there are huge benefits for all of us if open document forms proliferate resulting in consistent, error-free, structured ways of doing things. Electronic physician notes about our healthcare would be a good example. IBM has targeted healthcare and education as two industries that can benefit from open documents and the company is opening up it's intellectual property treasure trove to help enable these two industries to make a quantum leap.

What about patents? Similar to open vs. closed, patents are not all good or all bad. It is quite impressive to see how IBM has been able to balance it's proprietary products and it's open source solutions. They are building proprietary code and innovation on top of the open source base. At the same time they are giving patents away that have the potential to accelerate the quality of healthcare and education. In parallel they are leading an effort to improve the quality and integrity of the patent process that all companies use. The patent process has been like the jury system -- not perfect but nobody has come up with a better way. In the case of the patent system, while many companies complain about the system, IBM is taking the lead to do something about it.

Other patrickWeb stories about open standards
Bob Sutor's blog

Conferences, Healthcare, IBM, Internet Technology, Public Policy March 3, 2006 10:40 AM

Monday, February 20, 2006

Check-mate

Toolbox Pandemic viruses are one of the most threatening things that most of us can contemplate. Fortunately, some big guns are aimed at the potential problem. The Scripps Research Institute and IBM have announced a new collaboration called "Check-mate" which will capitalize on Scripps Research's world class research in biochemical modeling and drug discovery and IBM's expertise in computational biology and supercomputing. The joint research team will use IBM's Blue Gene supercomputer, the world's fastest supercomputer to simulate how the potential pandemic virus ticks and devise models of containment.

The joint team will leverage their expertise in bioinformatics, structural biology, life sciences, functional genomics, systems biology, and medical informatics to accelerate an understanding of infectious diseases such as Avian Influenza. Rather than wait for a crisis and then try to figure out what happened, the team will build digital representations of these complex viruses pro-actively. The initial efforts will focus on the genetic variations of the viruses and potential methodologies to anticipate and contain the disease. Hopefully, the result will be an improved way to fight pandemic viruses before they become a plague -- "Checkmate".

patrickWeb stories about computational biology

Healthcare, IBM February 20, 2006 11:31 PM

Sunday, February 12, 2006

The MooBella Demo

People at a conference It was such an exciting week at Demo that it is hard to summarize. There are many reviews of the conference on the web and you can find some of them at Kaboodle (one of the companies that debuted at Demo). There were sixty-eight companies showing off their latest and greatest -- the Demo site has the full list with links to the companies, so if you want to know what is hot take a look here and click the + sign next to Demo 2006 at the top right of the page.

The product least expected but perhaps most enjoyed by the 700+ attendees was the MooBella virtual ice cream vending machine. After attendees made touch-panel choices from up to 96 combinations of flavors and mix-ins, the machine mixed and instantly froze fresh ingredients to produce a delicious scoop of ice cream within 45 seconds. The only drawback I could see was that there was no chocolate. Apparently, that flavor (favorite of 20% of the market) poses special challenges due to the viscosity of cocoa powder.

There were a number of themes that emerged at DEMO. Collaboration was one. Chris Shipley said that 2006 will be the year of collaboration. Demos included virtual meeting platforms, tools that in effect allow people to act as librarians and share their findings with others, and tools for collaborative software development. Another theme was vertical search. Google and Yahoo! are great but highly specialized searches offer much better results. Examples shown included shopping, entertainment, software code, healthcare, and politics.

Mobile applications are still somewhat limited by tiny screens but innovative new ideas were shown that make cell phones more useful than ever. One company showed a phone being used as a personal trainer during exercise. It kept track of your pace and location and plotted results on the screen. Another small device was shown that allows complete control over the phone, music, and every aspect of things going on in the house.

Security solutions were shown to protect our identity, protect our networks, stop spam and viruses at the door, and diagnose Internet traffic and catch malware before it gets to our systems. Biometric technologies were shown to allow secure payment and authentication. I look forward to some of these technologies being used in healthcare.

Through two FutureScan panels I attempted to help the audience see the future of security and computational biology. On the security panel we discussed the general state of Internet security (not healthy) but more importantly some of the research that may lead to a healthier net. To me the most promising thing is PKI. I have written much about this here. The computational biology panel was mind-blowing for most of us. Systems biology models, redesigning proteins, and learning about our genetic history will affect all of our lives. There was a great deal of interest in The Genographic Project. (A dozen DNA kits were given to the audience -- you can get your own here). If you are interested in learning more about the human genome, the panelists recommended Genome by Matt Ridley. I am reading it now. We were all extremely fortunate to have had some of the world's leading experts share their thoughts on the panels. You can find links to all the panelists here.

The most asked question between Demo attendees at breaks and meals is "See anything interesting?". Chris Shipley, Executive Producer of the DEMO Conferences, introduced sixty-eight companies -- there was definitely something for everybody. I was not able to visit all the companies or hear all of their pitches, but at the end of this story I will mention eleven companies that I found most int