The Future of the Internet

The following story was published in the April 2012 issue of  Sun and Surf Magazine

The Future of the Internet
By John R. Patrick

The future of the Internet in our lives is very positive but we are only about 10% of the way there. Of all the things that could be done online that would save us time and simplify our lives, only 10% of them are there. Travel and banking web sites are getting better, but we are still at the early stages of what is possible. Consider retail e-commerce. Although there has been continuous and steady growth of retail e-commerce, it still represents just 5% of total retail sales. Why isn’t it 25% or more? Much is written about that here at patrickWeb but the short version is that there are still a lot of lame web sites. “Click here for the location of our nearest dealer where you can visit” or “call to get a price on the product you just found” or “Click here to download this form, fill it out, and fax it to us”. It is no wonder that Amazon captured 28% of all online sales in the fourth quarter of 2011. One company out of 4 million retailers got more than a quarter of all the sales. Have you ever heard a friend complain about poor customer service at Amazon? They walk in the customer’s shoes and deliver a terrific experience. Most of the rest of the e-businesses in the world have a long way to go. And in the physical world, there are the ubiquitous clipboards at doctor offices where we take a pen and provide a lot of information that they already have.

The changes in Internet technology have been continuous for decades and there is no end in sight. For the past fifteen years, I have been writing about the evolution of the Internet by describing developments in seven key areas: Fast, Always On, Everywhere, Natural, Intelligent, Easy, and Trusted. In the following paragraphs, I will hit the highlights of some of the more important trends and developments.

Fast
Broadband in the U.S. is not a pretty story compared to other parts of the world. We are second after China in the number of broadband users, but 28th in the world in the number of broadband users as a percentage of our population. The problem is that there are too many lobbyists, and the FCC is a political organization. The new FCC head is a very smart guy with technology and business experience. He totally gets it. The only problem is that AT&T, Comcast, and Verizon have more lawyers than the FCC does. Meanwhile France is offering 100 megabit access for $90 per month and rolling out WiFi throughout the country. Thanks to the telco lobby, many states have banned the offering of WiFi by municipal entities. Every citizen in Greenland has Internet access. We have 31,000 post offices.

Always On
WiFi is part of the fabric of the world. The big shift is the streaming of data — not just tweets, but data from *things* — bridges, toll booths, traffic lights, buildings, cars, iPhones, Androids, handheld GPS devices, weather instruments, and health monitoring devices attached to people. The growth in creation of data is staggering. Of all the data in the world, 90% of it was created in the last two years. YouTube receives 60 hours of new video every hour – an hour every minute. Wikipedia has 4 million articles and 8,000 editors. Hospital physicians will soon be adjusting the drip rate on infusion pumps in the hospital from their office based on real-time data from the patient. WiFi-enabled infusion pumps will enable hospital administrators to know where the pumps are (they never have enough of them) and which ones need maintenance.

Everywhere
There are one billion computers (including tablets), one billion cars, 1.5 billion televisions, and 2 billion Internet users. Small numbers compared to cell phones — 5.2 billion paid subscribers. The Internet used to be where your PC is, but now the Internet is where you are.  Most of the cell phones are dumb but soon most of them will be smart and they will all have Internet access. The mobile web is unfolding and is taking part in creating data by streaming data to the Cloud and then consuming data by streaming it from the Cloud. When you take a picture on your iPhone, it goes into the photostream and from there to iCloud and from there to all of your other devices and, if you choose, to the devices of your friends and family.

Natural
Social networking has become fundamental to all aspects of our economy and society. Integration of social networking with a full range of web applications will evolve to become the primary means of finding jobs, finding employees, finding business partners, and collaborating on projects. The emerging issue is that many people, especially young ones, are a bit liberal with sharing their every movement — what they are eating, listening to, where they are headed, their current latitude and longitude, and where they slept last night. They are not thinking that some day they may run for office or interview for a job. A new protocol will emerge to enable people to “erase” things they placed on the Internet. The Europeans may legislate it. OpenSocial is an important new standard that will enable social media apps that work across all of the social media sites.

Intelligent
The Semantic Web is the next big turn of the crank for the evolution of the World Wide Web. Most web pages have links but do not have context. The words on the web page do not necessarily mean anything — but they could. For example, if a web page said “Join us for a concert by The Eagles at Kimmel Center in Philadelphia next Tuesday” that set of words could have a lot of context. Clicking on it could add the concert to your calendar, knowing what “next Tuesday” means. It would also know exactly where the Kimmel Center is and provide a map. The Eagles is a performing group that performs a particular genre and your music player would receive a list of suggestions of music they have recorded or links to live concerts under way at the moment and make recommendations about their music to your friends. This is the tip of the iceberg. The semantic web will lead us to a point where most of the interactions of web pages will be between computers, not between computers and people. The biggest growth of intelligence is occurring in the field of analytics. Exabytes of data are being stored. A byte is 8 bits (a bit is a zero or a 1) and represents one character. An exabyte is a 1 followed by 18 zeroes! Business Intelligence and analytics are poised to enable new insight into the mounds of data – “Big Data” — that are being accumulated. Analytics will enable businesses to make sense of the explosion of data, develop digital models of their business, and continuously adapt it to what is going on. IBM’s Watson successfully challenged humans on the Jeopardy Show, but what is more interesting is the ability for a primary care physician to call and get a recommendation based on patient symptoms and measurements they describe to Watson. Within a couple of seconds Watson technology will be able to review all available medical information in the world and make a useful suggestion.

Easy
Technology is not the easiest thing at times. There are many dimensions to “easy” but one good example is the Nintendo Wii. At a local senior center, members find the Wii to be their exercise coach. It is not just for kids! The iPhone and iPad have shown how easy it can be to get applications on a handheld computer. Amazon has done the same with the Kindle. Most companies still don’t get the idea that the Internet is about power to the people. If you can’t make it simple, people won’t buy it. Cloud computing has become the mainstay for me and for millions. The ease, convenience, and reliability of the Cloud is compelling. Add Dropbox to your laptop and your iPad and your iPhone and you have a completely replicated set of data – all of your data at your disposal wherever you are and with whatever device you may be using. How about the future of TV? Three of the most common remotes — BlueRay, Cable box, and TV — include 151 buttons. Even a savvy child could not possibly master this impossible user interface. Boxee TV has produced a good model of the future of TV – think of it like TV Guide on the web — but I suspect that an upcoming Apple TV will be what finally provides the needed regime change.

Trusted
This is the big one. Can we trust the Internet? Security technology is available to achieve much higher levels of security than is presently deployed both at enterprise and consumer levels. It is a constant battle and requires significant budgets and a lot of talented people to maintain the needed security. The equally important issue is privacy. The good news is that there are some good technology solutions available to help us control access to our Internet habits. The bad news is that politicians have gotten interested in the subject. Banks have our personal information and they are using it. Healthcare insurers have more information about our health than our doctors do. Nevertheless, there is much to be optimistic about when it comes to electronic medical records. Perhaps 25% of doctors and hospitals use them but they are not easily interchangeable and accessible. 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. And, fewer clipboards.

In January, I gave a talk about the Future of the Internet and Healthcare at the SIIA Conference in New York. The slides and a video of the presentation can be found here.

About the author

John R. Patrick (john@patrickweb.com) is president of Attitude LLC and former vice president of Internet technology at IBM. Mr. Patrick was a founding member of the World Wide Web Consortium at MIT in 1994 and of the Global Internet Project. He is a fellow of the Institute of Electrical and Electronic Engineers and a member of the American College of Healthcare Executives.  He is a director of Knovel Corporation, WebMediaBrands, Inc., and Western Connecticut Health Network. He is the author of Net Attitude: What It Is, How to Get It, and Why Your Company Can’t Survive Without It (Perseus, 2001).

About SUN and SURF

SUN and SURF Magazine is published quarterly and mailed to all property owners in Hammock Dunes in Palm Coast, Florida. The magazine currently has a circulation of approximately 1,000.

Tags: analytics, big data, cardionet, corventis, IBM, internet, Internet Technology, ipad, patientslikeme, social media, telemonitoring

Big Data

The storage capacities of laptop and desktop computers has been growing rapidly, but the growth may not be fast enough. According to IBM, we create 2.5 quintillion bytes of data every day. Perhaps quintillions of bytes are not meaningful to most of us, but it is the growth rate that is staggering — 90% of all the data in the world has been created in the last two years. Where does all the data come from? Data comes from everywhere: from sensors used to gather climate information, physiological readings taken 1,000 times per second from a patient, posts to social media sites, digital pictures and videos posted online, transaction records of online purchases, and cell phone GPS coordinates to name just a few. Collectively, the phenomenon is called “big data”. (See  IBM Big data and information integration for smarter computing).

Note: Data is plural. The singular term is datum. Should we say data is or data are? There are many views on which is right.

 IBM describes big data as spanning three dimensions: Variety, Velocity and Volume.  Variety refers to the fact that big data extends beyond structured data like we might find in a spread sheet. It includes unstructured data such as text documents, email, audio and video recordings, click streams from the web, log files that record financial and business transactions, and much more. Velocity of data refers to the fact that data can be time-sensitive such as bid and ask data in a financial market or physiological data that affect the lives of patients. In these cases, historical data is interesting but real-time data is critical. The third parameter is volume. IBM says that big data comes in one size: large. Organizations are flooded with data — terabytes, petabytes, or even yottabytes.

Big data is a challenge in various technical ways, but more importantly, it is an opportunity to find insight in new and emerging types of data and to answer questions that, in the past, were not possible to analyze effectively. Data that has been hidden can be surfaced and acted upon. The result can be a more agile organization or in the case of health care, better outcomes for patients.  Picture a hospital neonatal environment where a plethora of medical monitors connected to babies are used to alert hospital staff to potential health problems before patients develop clinical signs of infection or other issues. There are breakthroughs on the horizon for how this will be done. Today the instrumentation generates huge amounts of information — up to 1,000 readings per second — which is summarized into one reading every 30 to 60 minutes. The information is stored for up to 72 hours and is then discarded. If the stream of data could be captured, stored and analyzed in real-time there could be a huge opportunity to improve the quality of care for special-care babies.

The Hospital for Sick Children in Ontario, Canada developed such a vision and is acted on it. Dr. Carolyn McGregor, Canada research chair in health informatics at the University of Ontario Institute of Technology visited researchers at the IBM T. J. Watson Research Center who are working on a new stream-computing platform to support healthcare analytics. A three-way collaboration was established, with each group bringing a unique perspective — the hospital focus on patient care, the university’s ideas for using the data stream, and IBM providing the advanced analysis software and information technology expertise needed to turn the vision into reality. The result of the collaboration was Project Artemis which pairs IBM scientists with clinicians and`researchers to explore how emerging technologies can solve real-world business problems, in this case developing a highly flexible platform that aims to help physicians make better, faster decisions regarding patient care for a wide range of conditions. At the Children’s hospital the focus is real-time detection of the onset of nosocomial infection (often called hospital-acquired infection). Regulatory, ethical, privacy, and safety issues were addressed and then two infant beds were instrumented and connected to the system for data collection. The team then created an algorithm that deciphered the streaming data. By establishing the impact of moving a baby or changing its diaper, those things can be filtered out to help spot the telltale signs of nosocomial infection.

Dr. Andrew James, staff neonatologist, at the Hospital for Sick Children is optimistic that as they learn more they will be able to account for variations in individual patients and eventually be able to integrate data inputs such as lab results and observational notes. In the future, any condition that can be detected through subtle changes in the underlying data streams can be the target of the system’s early-warning capabilities. It is likely that sensors attached to or even implanted in the body will allow monitoring of important conditions from home or anywhere. Big data has the potential to improve the health of patients whever they may be.

Other healthcare-related stories on patrickWeb

Tags: analytics, big data, health, Healthcare, hospital, IBM, monitoring, neonatal

Smarter Cardio Care

More than 25% of deaths in the United States are caused by heart disease. There are many statistics on the subject but to me the stunning one is that between 1,500 and 2,000 people die of heart disease every day. Most people would assume that heart disease is the leading cause of death for men but many are surprised to learn that it is also the number cause of death for women.  In fact, half of the deaths due to heart disease in 2006 were women. In 2010, heart disease will cost the United States $316.4 billion including the cost of health care services, medications, and lost productivity. In China the numbers are even bigger and this is why Beijing Goodwill and IBM have launched a joint effort to improve detection of cardiovascular diseases.

Although great strides have been made in the understanding and treatment of heart disease, there is much more that can be done. We all learned that the heart is a pump. If NASA had a pump that was experiencing difficulties it would put the pump in a lab, connect it to various sensors and testers and study it until the issue was resolved or the pump replaced.  In some cases a similar regimen is followed with humans but in most cases the analysis of a heart is done on a much more distributed basis. A primary care physician may look at a routine electrocardiogram done in the office. If anything in the ECG looks suspicious, you may be referred to a cardiologist for further examination. A second ECG is likely to be obtained. The specialist may have you wear a holter for a week or so. A cardiac stress ECG may also be requested. If some special testing is required you may be sent to the hospital. Then back to the cardiologist who does his or her best to integrate all the data and determine what is going on.

The model I described is not ideal. Part of the problem is that the reimbursement model provides an incentive for more visits and more tests. Physicians are not paid to cure you — they are paid to see you, to test you, to see you again, to re-test you, etc. Part of the problem is that the data is distributed among multiple technologies and locations. That is the problem that IBM and Beijing Goodwill are working on.

The joint project will launch an all-in-one electronic cardiogram management system in China. The idea is to achieve smarter healthcare by helping hospitals analyze real-time patient information generated from electrocardiography (ECG) examinations thereby getting better insight and a better ability to detect cardiovascular diseases with more accuracy.   The project will also empower doctors with mobile devices to monitor heart patients rather than wait until a holter is returned and a report is created from the data it contains. Physicians will be able to review test results from a single databank of centralized ECG information available to them anywhere.

Doctors will now be able to retrieve patient’s current and past cardiogram data, medical reports, and relevant scientific research. The integrated analytics tools of the system will automate the examination and diagnosis of results in real time, helping physicians increase the speed and accuracy of their diagnosis. As a result of this high-level of integration, the system will help hospitals to diagnose more effectively, eliminate human errors, reduce cost, optimize resources, and enhance research and educational capabilities.

IBM is investing heavily in Healthcare Industry Solutions Labs in Beijing and around the world and hiring doctors to work with IBM researchers to speed the evolution from anecdotal medicine to smarter information based medicine. There is a lot to be said for the laying on of the hands and comforting words of a physician but to make great strides in reducing the loss of life from curable diseases and conditions, we need to supplement emotion with more integrated data and collaboration in the healthcare model. With the efforts of IBM and many other technology companies focused on healthcare in partnership with providers and payers, I believe we will see tremendous progress in this regard over the next few years. We have many reasons to be optimistic.

Tags: analytics, cardio, cardiovascular, china, ecg, Healthcare, healthcare it, healthcare solutions, holter, hospital, IBM

IBM Happenings: March – April 2010

The months of March and April were busy ones at IBM with the usual flurry of announcements in hardware, software, services, acquisitions, and strategic alliances. See the list of the current press releases and also an index for prior months here. The major focus of the company remains on a “smarter planet” and the dimensions of this thrust continue to expand. An area of personal interest to me is aviation so I was pleased to learn about a joint project between IBM and the U.S. Federal Aviation Administration (FAA) working on a Research and Development project to protect the nation’s civilian aviation system from the ever-growing threat of cyber attacks.

Faa.gov is the official website for the Federal Aviation Administration. The site deals with many vital aviation topics including flights, airports, policies, news and events affecting aviation, pilot resources, weather, a wealth of safety information, regulations and guidelines, air traffic data, research, licenses and certificates, training and testing, alerts about specific airports, and medical and aircraft certification. The site has approximately a half-million monthly visitors who view an average of two million web pages. Needless to say faa.gov is a vital national resource. It is also a potential target for those who would like to harm it.

The joint project is part of IBM’s First-of-a-Kind (FOAK) program which engages scientists from IBM Research with clients to explore and pilot emerging technologies that address real world problems. In the case of faa.gov the IBM researchers and cyber security experts will design and build a prototype security system capable to accommodate the FAA’s high-speed networks. Building on IBM’s vast experience with analytics, the project will introduce first-of-a-kind security technologies and entirely new approaches to protecting large digital and physical infrastructures from hacking, botnets, malware and other forms of cyber attacks.

The prototype system will go beyond traditional security approaches of encryption, firewalls, intrusion-detection devices and anti-virus software. A flexible model is being designed to look retrospectively at event occurrences and system compromises. It will be able to correlate historical traffic patterns with dynamic data from monitors, sensors and other devices which capture information about network traffic and user activity in real time. Using “streaming analytics” and customized executive-level dashboards, the system will enable the FAA to continually analyze the massive amounts of data flowing through its networks and get instant and accurate insights about possible network threats and anomalies suggesting a possible attack in time to take action. The FAA will also be able to store real-time results in a data warehouse for later analysis and training.

“Cyber attacks have become a global pandemic and no system is immune,” said Todd Ramsey, general manager for IBM’s government business. “Through this collaboration with the FAA, as well as others underway in government and the private sector, we hope to develop comprehensive solutions for protecting the digital and physical infrastructures of critical national networks and enterprise systems.” IBM has also established the IBM Institute for Advanced Security in Washington, D.C., to help government agencies and other institutions gain access to tools, resources and expertise to address cyber security issues.

Complete index of IBM Happenings for 2004-2010

Tags: analytics, Aviation, cyber attack, faa, IBM, IBM Research

Fraud Reduction Could Fund A Chunk Of Healthcare

On February7 we will be discussing Computational Biology at Demo. No doubt we will hear about some potential breakthroughs in healthcare. One thing we know for sure is that new healthcare solutions are costly. How will people afford them? There are many issues associated with this and one of them is the fraud that occurs in today’s system. IBM has been working on this area for years and recently introduced their solution in Rockland County, New York.

The IBM Verify New York Medicaid claims management program has identified $13M in potentially improper Medicaid billing in just 10% of the cases in just one county in just one state. For a modest software and consulting fee, IBM used it’s powerful supercomputers to do a sophisticated statistical analysis of the billing from the top 10% of Medicaid reimbursed pharmacies and general practice doctors in the county during a 21-month period. Seems like a good target since New York’s Medicaid program is the largest in the US, with an annual cost of $44.5 billion — and rising fast.

Rockland County has more than 41,000 residents who use Medicaid and the county spends about $384 million a year on their care. Initial estimates are that as much as $13 million of the billing may be improper. If this turns out to be the case, the nationwide numbers are in the $billions for sure. The IBM system uses thousands of queries to look for anomalies such as suspiciously large numbers of bills for services on a single day, repetitive or duplicate billing or unusually expensive services. Forty-two percent of the ten percent in Rockland County appeared to have discrepancies.

The project doesn’t mean that providers are automatically guilty nor that the money can be quickly recovered but at least it shows the investigators where to look. They have always had the data but with help from IBM they now have the tools. There are obstacles. In New York, the counties are responsible for Medicare but they are not allowed to take action against fraud. Only the state can do that — but they haven’t. The IBM program enables the counties to provide very specific information to the state and press for action to reduce fraud.

Other patrickWeb healthcare related stories

Tags: analytics, fraud, IBM, medicaid, medicare, supercomputers