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When writing Net Attitude back in the summer of 2001, one of the topics I included was netiquette, a set of social conventions I learned from David Singer and a few other IBMers who were steeped in Internet history.  They taught me to not use ALL CAPS because in the culture of the Internet that meant you were YELLING. They taught me that when using a picture of yourself to make it small. Another dimension of netiquette — unsubscribe — emerged in the mid to late 1990s after web e-commerce was invented.  The concept was and still is very simple. — make it easy for people to unsubscribe to your email list. It may not be immediately intuitive but the rationale is simply that if you make it easy, the person unsubscribing may remember you favorably and come back at some point. Make it difficult and they will definitely remember you and they likely will not come back. That point of no return is where I have reached with drugstore.com.

The health and beauty Internet retailer, headquartered in Bellevue, Washington, was launched in February, 1999. One would think by now they would have figured out how to make unsubscribe easy. Perhaps they don’t yet get it that this is important. At the bottom of their email it says “click here to unsubscribe or change your subscription settings”. That is mistake #1 — there should be a link to unsubscribe. Not “unsubscribe and” or “unsubscribe or”. One click on unsubscribe and maybe one more click to confirm and you should be finished. When you click the link at the bottom of the drugstore.com email, you end up at a page that has 9 different things you may be subscribed to. Still no plain old “unsubscribe”. You have to pick what you are subscribed to and then “update”. I have tried it multiple times and I am still getting their mailings. This is the part people do not forget. I will eventually get so annoyed that I will have to find a way to email them — something else drugstore.com makes difficult — and once I finally get off their list I will not return. There are plenty of online merchants that sell what drugstore.com sells.

Smart e-tailers, like amazon.com, make things easy. They know the consumer has a long memory and a short tolerance. They know that their competitor is a mouse click away. Power to the People still prevails on the Internet.

Tags: amazon.com, drugstore.com, e-commerce, netiquette, unsubscribe

Batteries that Breath and Holographic Phone Calls

For many years IBM developed a ten year outlook every year and proudly presented it to executives inside and outside of the company. The TYO was a high-level glimpse into the future of technology. About ten years ago the TYO was stopped because the pace of technology evolution had reached the stage where the future that far out became very difficult to predict. As Yogi Berra said, “The future isn’t what it used to be.” Not that IBM is any less focused on creating the future. The company earned 4,186 U.S. patents in 2008, becoming the first company ever to earn more than 4,000 U.S. patents in a single year. IBM’s 2008 patent issuances exceed those of Microsoft, Hewlett-Packard, Oracle, Apple, EMC, Accenture and Google — combined. IBM now issues a five-year forecast annually of five specific technology shifts that 3,000 of its researchers see coming. The International Business Times reported briefly on IBM’s “Next Five in Five” list of five innovations expected over the next five years.

3-D images will not be limited to action movies on TV. A cell-phone call from a friend may be accompanied by a 3-D image of your friend. Videoconferencing is already gaining a lot of traction but when they can be conducted through holographic cameras that fit into cell phones, the virtual reality will become much closer to real reality.
Advances in transistors and battery technology will accelerate — potentially allowing electronic devices to function without charging 10 times longer than currently. Today’s lithium-ion batteries could be replaced by batteries “that use the air we breath to react with energy-dense metal, eliminating a key inhibitor to longer lasting batteries,” IBM said. The amount of energy needed by electronic circuits may be reduced to such a degree that a modest amount of physical motion may create sufficient energy to power them. Wrist watches exist that have no batteries and get their energy from movement of our wrists. Within five years, the same concept may be used to charge mobile phones.
Personalized commutes are another advancement seen by IBM scientists. New mathematical models and predictive analytics technologies will produce the best routes for daily travel. The models will take into consideration the patterns of travelers and various conditions to predict where traffic congestion is going to occur and then give you the fastest and safest route to your destination.
Human beings will also increasingly become “walking sensors,” IBM said. Within five years, sensors in your phone, your car, your wallet plus your texts and tweets will create data that will give scientists a real-time picture of the environment around you. A whole class of ‘citizen scientists’ will emerge using their sensors to create massive data sets for research. The result will be more effective efforts to fight global warming, save endangered species and track invasive plants or animals that threaten ecosystems around the world.
Finally, IBM said, scientists will find better ways to recycle heat and energy from the huge data centers that power the millions of web sites around the world. Up to 50 percent of the energy consumed by data centers goes toward cooling air. Most of the heat extracted is then wasted because it is just dumped into the atmosphere. New technologies, such as novel on-chip water-cooling systems developed by IBM will provide heat for buildings in the winter and air condition them in the summer.

They were not mentioned in IBM’s “Next Five in Five” list, but the company is making large investments in multiple dimensions of healthcare. Breakthroughs are a certainty and technology will play a major role in containing healthcare cost while improving outcomes for patients. Stay tuned at healthdiscussions.net for updates on this topic.

Tags: batteries, data center, energy, green, hologram, holographic, hvac, IBM, research, traffic

My Doctoral Journey – Part 2

I really appreciate the support from my friends and family for my decision this past August to begin the doctoral journey. After the first four courses it was time to attend the first residency in Atlanta this past week.

I have been an Internet advocate for almost twenty years. My basic tenet has been that the Internet provides “power to the people” and one of the many areas in which this is true is education. Whether you call it computer assisted instruction, e-learning, or distance learning, the concept is the same—to enable people anywhere in the world to learn what they want to learn, when they want to learn it, and what device they want to learn it on. While evangelizing the power of the on-line environment, I also embrace the validity and need for meeting in person. There is no substitute for what occurred in PHL700 (CREATIVE AND CRITICAL THINKING) this past week in Atlanta. Webcams and various forms of virtual reality can enhance an on-line experience, but no virtual capability can replicate the emotion behind the stories shared by learners in the class. I learned a lot about diversity, teams, dissertations, the Scholar-Practitioner-Leader model, doctoral degrees, and information technology.

Appreciation for diversity

I worked at IBM Corporation for 38 years and am proud that the company took diversity very seriously in thought, word, and deed. I have also been active in various non-profit organizations such as the Opportunities Industrialization Corporation and Habitat for Humanity, both of which featured diversity as a model. The University of Phoenix has brought my awareness and appreciation of diversity to a new level. Diversity is not simply black and white or male and female. Diversity includes cultural background, work experience, education, family, upbringing, experiences, and philosophy, to name a few areas that I observed in the classroom. I was particularly impressed with the drive to achieve exhibited by learners who at the same time have childcare, eldercare, and job responsibilities. It was also impressive to hear of the goals the learners expressed. Nearly all of them contained an altruistic element that motivates them. The diverse backgrounds provide diverse perspectives and these in turn provide a broader and deeper insight into the subject matters being learned. I feel fortunate to have learned a lot in my life, but relative to the breadth and depth of my fellow learners, I humbly realize that I have a lot to learn.

Value of Team

I must confess that I was skeptical about the team assignments in the first couple of classes. The on-line tools are not as advanced as they could be and some learners are not adept at using them. On the surface, the team assignments looked like they would take more time, but not produce better results. For team assignments this past week, that was definitely not the case. In part because it was in person and in part due to the strength of my team members, I feel this was one of the best team experiences I have had in many years. Even in areas where I have considerably more experience than my team members, they found oversights in some of my thinking and added some thinking of their own that enhanced what I was thinking. The bottom line is that although there may have been a small premium in the time spent, the collaborative efforts of the team produced a higher quality and more scholarly paper than I could have produced on my own.

Dissertation Planning

The goal that every learner shares is to successfully complete a doctoral dissertation. The checklist and blueprint are helpful, but what was really helpful was to hear the first hand experiences of Dr. Witchel and Dr. Bridgewater, our faculty for the class. I came to the residency with a dissertation focus area in mind. After discussing it with Dr. Witchel, Dr. Davidson, and two health administration doctoral learners, I feel that my initial idea is now enhanced by at least an order of magnitude.

Deeper insight to the SPL model

At first I did not see a deep or special relationship between scholar, practitioner, and leader. After each class, I see the relationship more clearly, and I am confident that my insight on the subject will continue to improve. The SPL model exercises gave me a clear example of how scholarship and practicing work together. The problem intervention the team developed was supported by scholarly work. That provided two legs to the stool. No stool can stand on two legs, and it is leadership that makes the stool stable and useful. It is leadership that allows the practitioner to take the intervention to the next situation and apply the model they have developed to solve a problem or to inspire others to solve a problem.

The Role of the Degree

Both instructors gave the class excellent insight about the role of the degree. They shared their personal experiences and provided useful guidelines for how to leverage the knowledge gained while avoiding the appearance or reality of arrogance. I was also impressed with the advice to think of the doctorate as a way to help others, whether it is solving a problem or helping someone to learn. In the long term it is the network of doctoral learners–and later doctors—that will provide leverage to all the members of the network.

Information Technology Tips

Information technology plays a key role in e-learning; without IT there would be no learning. All the learners are busy people and, although IT can be a productivity booster, it can also be a productivity detractor if systems and procedures do not work efficiently and effectively. I have many tools that I find helpful and I make it a point to learn of some new ones at every conference or class that I attend. I have been seeking a method to be able to read e-books on the iPad and this week I learned a solution. I will now be able to read course assignments on the treadmill each day. Many educators are not known for their embrace of technology. The PHL700 faculty and visiting instructor all were technology advocates. This was refreshing.

Summary

Supplementing the e-learning program with periodic residencies provides an excellent way to enhance the learning process, leverage the learning, and extend the network of fellow learners and faculty. I gained increased respect for the value of diversity and the power of teams. I increased my knowledge of the scholar, practitioner, and leader model and how it works, and learned about the pathway to my dissertation and the role of the doctorate. I picked up a few IT techniques that I will immediately deploy for increased productivity. The instructors were wise, selfless, and caring. They shared personal perspectives that I will remember. The first year residency was an important milestone and I feel that it has added clarity and momentum to help me achieve my goals.

Index of stories about My Doctoral Journey

Tags: doctorate, e-learning, scholar

Health Discussions Forum

I am grateful to the readers of patrickWeb for years of visits to the blog and providing excellent feedback to me. I especially appreicate hearing about a typo or bad link or something that improves the site for everyone. As you may have detected, I have developed a strong interest in healthcare.  The interest in healthcare is not new — there are currently 54 posts in patrickWeb that are healthcare related. The involvement on the board and committees of Western Connecticut Healthcare has intensified the interest. I am also working on a doctorate in health administration.

About six months ago I learned about Dr. Eric Lutker, a retired psychologist who is my neighbor in Florida. Eric developed a learning institute at the club we belong to where he invites various resident speakers to make a presentation. I was one of his invited speakers and on election day last month I gave a talk about, guess what, the Future of the Internet. Much of my view about the future of the Internet correlates strongly with the future of healthcare, and my talks have gravitated toward the intersection of information technology and clinical technology. The Q&A session after the talk was 75% healthcare related, and afterward Eric suggested we start a blog on the subject. Hence, the Health Discussions Forum was born. Our goal is simple. We plan to post short healthcare related stories about things we read or opinions and reflections we may have. We have opened up the commenting feature of the blog to allow others to comment on what we write or on the comments other readers have written. We are not sure where it will lead but hopefully, it will be the beginning of a dialog on the important issues and innovations emerging in a very important part of all of our lives.

Now for the true confessions part of this posting. Most readers of patrickWeb visit the blog with Google Reader or other blog readers but there are approximately 300 readers who subscribe via email, receiving the entire post by email whenever a new story is created. I outsource this service through a provider called Feedblitz. In my enthusiasm for the new healthcare blog, I configured Feedblitz to send Health Discussion Forum postings to the patrickWeb subscribers. Less than 5% have unsubscribed so I hope that is because the posts were appreciated or at least tolerated. If you are a subscriber and prefer not to get the healthcare posts, you can unsubscribe at the bottom of one of the emails or if you prefer, just let me know and I will take care of it for you. I apologize to anyone that feels they got opted in unknowingly. If you are not a subscriber to Health Discussions Forum and want to give it a try, feel free to subscribe using the form below.

Tags: blogging, forum, health, health care, health discussions, Healthcare, patrickWeb

OCLC Annual Report

It is a privilege to be able to participate and contribute
to various boards.  It is also 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 (press release). 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 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 can get along together quite well.

The month after I graduated from Lehigh University in 1967, OCLC — Online Computer Library Center, Inc. –  was founded  in Dublin, Ohio as a nonprofit, membership, computer library service and research organization dedicated to the public purpose of furthering access to the world’s information and reducing information costs for libraries. More than 72,000 libraries in 170 countries and territories around the world use OCLC services to locate, acquire, catalog, lend and preserve library materials. Each of these five verbs has special and profound meaning to a very large number of librarians and library visitors.

WorldCat allows you to search for books, music CDs and videos — all of the physical items you’re used to getting from libraries — but you can also discover downloadable audiobooks, article citations with links to their full text, authoritative research materials, and digital versions of rare items that aren’t available to the public. Some libraries allow you to join a waiting list, reserve the item, check it out or even have it shipped or delivered. WorldCat also leverages the social computing model by allowing you to enter ratings and reviews and contribute factual notes. The more people enter the more useful WorldCat becomes. That is their model — enhancing the sharing of information on a global basis. The vision is “The world’s libraries. Connected.” To learn more about OCLC, take a look at their new Annual Report.

OCLC Homepage
WorldCat

Tags: board of directors, board of trustees, libraries, library, oclc, worldcat

Home Monitoring

My mother lived to just weeks short of 90. During the first 89 1/2 years she had a good quality of life, but during the last six months it was very difficult for her and her family. Having spent a lot of time with her between the assisted living home and the hospital, I learned a lot about healthcare for patients with chronic heart failure.  For those over 65, somewhere between 6 and 10% have CHF and the estimated annual expenditure for their care and treatment is $35 billion.

A typical scenario would be for an 89 year old person to enter the emergency department with shortness of breath. After a few hours or more in the ED the patient is admitted to the cardiac care unit. The patient is taking a dozen or so medications which are changed by the hospitalist to conform to the hospital formulary. After a week of tests, fluid infusion, and monitoring, the patient is ready to be discharged back to a nursing or assisted living home. The goal is to have the primary care physician see the patient within a week to make sure he or she is on track to stable health. The patient is confused about the new medications they have been discharged with and the appointment with the PCP may or may not happen in a week. Things go fine for a few weeks and then it is back to the ED and a readmission to the hospital. Repeat.

There are many long term solutions involving diet, exercise, and medications, but in the meantime there are millions of people with CHF who will likely follow the scenario above. Is it possible that using home monitoring can have a positive impact on quality of life and reduced healthcare expenditures? The jury is out. Research studies are underway at distinguished medical centers around the country. The idea is that by monitoring weight, blood oxygen, blood pressure and some basic questions like “How do you feel today?”, “Did you take your medications?”, etc., a stream of data is created every day that may be predictive of what is ahead. A recent study by Yale and reviewed in the New England Journal of Medicine concluded there was no difference in outcomes between those under monitoring and those not. I read the study and found that my idea of “monitoring” is different than what their study used. Although many experts were involved in the study, the data collection was done by the patients calling an automated telephone service and entering data. That is not monitoring from my perspective. Apparently it wasn’t for some of the patients in the study either because many did not enter their data.

Major companies including GE, Intel, IBM, and others are putting millions of dollars into research and development in the telemedicine market. I visited a lady in Connecticut that was being monitored by equipment provided by the Visiting Nurses Association. It was basically a PC with plug-in measuring devices. Each day the patient interacts with the PC and answers a couple of dozen questions in addition to providing weight O2, and blood pressure measurements. What struck me about the visit was not the technology but the social aspects of the process. The lady was “attached” to the PC — not technically but emotionally. She was taking responsibility for her health. She had previously been called a “frequent flier” by people at the ED. Now she doesn’t visit so often. Maybe she fears being away from her PC? The PC had become her buddy. It was Facebook to her. Some studies have shown that a person being monitored will fess up to having had a fall which they would not have told a nurse about for fear of being told they would have to go to the ED to be checked.

The data collected by the PC is sent through a dial-up telephone connection to a monitoring center, much like an alarm center. I can envision vast improviements to the system being used today. Instead of a big clunky PC how about something the size of an iPhone? O2, blood pressure cuff, and scale all connected by wireless. Data transmitted via broadband in realtime. Data going to a patient-centered medical home facility where a resident scans the data rather it going to an alarm center. Supercomputer analytics being applied to the data to look for patterns between weight, O2, blood pressure, and answers to various questions with the result being a prediction of fluid buildup that will lead to problems in 6 days unless the intake of diuretics is increased by 50% for ten days. Compared to the monitoring and predictions that are made by NASA for a spacecraft, the monitoring and predictions made for CHF patients is archaic. Skeptics say that there are too many factors involved and that only a doctor can make sense of them. I have the utmost respect for physicians but I also know, as sure as I can spell my name, that a few years from now we will be asking why it took so many years to realize that complications of various chronic diseases are in fact related to data that is collectible and very nicely subject to sophisticated analytics which can improve the quality of life and dramatically lower cost.

Milt Freudenheim at the New York Times summarizes many of the issues with home monitoring in his story Wired Up at Home to Monitor Illnesses. It is an excellent story that I can highly recommend reading.

Tags: chf, chronic heart failure, ge, health care, Healthcare, home monitoring, hospital, IBM, intel, telemedecine