Category Archives: Healthcare

Consumerism via IoT @ IT2I in Munich

We buy things we don’t need
with money we don’t have
to impress people we don’t like

Tyler Durden
Fight Club

 

Consumption sucks

That sucks. That got to be changed. Fight Club changed it that violent way… Thanks God it was in book/movie only. We are changing it different way, peacefully, via consumerism. We are powerful consumers in new economy – Experience Economy. Consumers don’t need goods only, they need experiences, staged from goods, services and something else.

EE

Staging experience is difficult. Staging personal experience is a challenge for this decade. We have to gather, calculate and predict about literally each customer. The situation gets more complicated with growing Do It Yourself attitude from consumers. They want to make it, not just to buy it…

If you have not so many customers then staging of experience could be done by people, e.g. Vitsoe. They are writing on letter cards exclusively for you! To establish realistic human-human interface from the very beginning. You, as consumer, do make it, by shooting pictures of your rooms and describing the concept of your shelving system. New Balance sneakers maker directly provides “Make button”, not buy button, for number of custom models. You are involved into the making process, it takes 2 days, you are informed about the facilities [in USA] and so on; though you are just changing colors of the sneaker pieces, not a big deal for a man but the big deal for all consumers.

There are big etalons in Experience Economy to look for: Starbucks, Walt Disney. Hey, old school guys, to increase revenue and profit think of price goes up, and cost too; think of staging great experiences instead of cutting costs.

 

Webization of life

Computers disrupted our lives, lifestyle, work. Computers changed the world and still continue to change it. Internet transformed our lives tremendously. It was about connected machines, then connected people, then connected everything. The user used to sit in front of computer. Today user sits within big computer [smart house, smart ambient environment, ICU room] and wears tiny computers [wristbands, clasps, pills]. Let’s recall six orders of magnitude for human-machine interaction, as Bill Joy named them – Six Webs – Near, Hear, Far, Weird, B2B, D2D. http://video.mit.edu/embed/9110/

Nowadays we see boost for Hear, Weird, D2D. Reminder what they are: Hear is your smartphone, smartwatch [strange phablets too], wearables; Weird is voice interface [automotive infotaintent, Amazon Echo]; D2D is device to device or machine to machine [aka M2M]. Wearables are good with anatomical digital gadgets while questionable with pseudo-anatomical like Google Glass. Mobile first strategies prevail. Voice interop is available on all new smartphones and cars. M2M is rolling out, connecting “dumb” machines via small agents, which are connected to the cloud with some intelligent services there.

At the end of 2007 we experienced 5000 days of the Web. Check out what Kevin Kelly predicts for next 5000 days [actually less than 3000 days from now]. There will be only One machine, its OS is web, it encodes trillions of things, all screens look into One, no bits live outside, to share is to gain, One reads it all, One is us…

 

Webization of things

Well, next 3000 days are still to come, but where we are today? At two slightly overlapping stages: Identification of Everything and Miniaturization & Connecting of Everything. Identification difficulties delay connectivity of more things. Especially difficult is visual identification. Deep Neural Networks did not solve the problem, reached about 80% accuracy. It’s better than old perceptrons but not sufficient for wide generic application. Combinations with other approaches, such as Random Forests bring hope to higher accuracy of visual recognition.

Huge problem with neural networks is training. While breakthrough is needed for ad hoc recognition via creepy web camera. Intel released software library for computer vision OpenCV to engage community to innovate. Then most useful features are observed, improved and transferred from sw library into hw chips by Intel. Sooner or later they are going to ship small chips [for smartphones for sure] with ready-made special object recognition bits processing, so that users could identify objects via small phone camera in disconnected mode with better accuracy than 85-90%, which is less or more applicable for business cases.

5WIoT

As soon as those two IoT stages [Identification and Miniaturization] are passed, we will have ubiquitous identification of everything and everyone, and everything and everyone will be digitized and connected – in other words we will create a digital copy of us and our world. It is going to be completed somewhere by 2020-2025.

Then we will augment ourselves and our world. Then I don’t know how it will unfold… My personal vision is that humanity was a foundation for other more intelligent and capable species to complete old human dream of reverse engineering of this world. It’s interesting what will start to evolve after 2030-2040. You could think about Singularity. Phase shift.

 

Hot industries in IoT era

Well, back to today. Today we are still comfortable on the Earth and we are doing business and looking for lucrative industries. Which industries are ready to pilot and rollout IoT opportunities right away? Here is a list by Morgan Stanley since April 2014:

Utilities (smart metering and distribution)
Insurance (behavior tracking and biometrics)
Capital Goods (factory automation, autonomous mining)
Agriculture (yield improvement)
Pharma (critical trial monitoring)
Healthcare (leveraging human capital and clinical trials)
Medtech (patient monitoring)
Automotive (safety, autonomous driving)

 

What IoT is indeed?

Time to draw baseline. Everybody is sure to have true understanding of IoT. But usually people have biased models… Let’s figure out what IoT really is. IoT is synergistic phenomenon. It emerged at the interaction of Semiconductors, Telecoms and Software. There was tremendous acceleration with chips and their computing power. Moore’s Law still has not reached its limit [neither at molecular nor atomic level nor economic]. There was huge synergy from wide spread connectivity. It’s Metcalfe’s Law, and it’s still in place, initially for people, now for machines too. Software scaled globally [for entire planet, for all 7 billions of people], got Big Data and reached Law of Large Numbers.

IoT

As a result of accelerated evolution of those three domains – we created capability to go even further – to create Internet of Things at their intersection, and to try to benefit from it.

 

Reference architecture for IoT

If global and economic description is high-level for you, then here you go – 7 levels of IoT – called IoT Reference Architecture by Cisco, Intel and IBM in October 2014 at IoT World Forum. A canonical model sounds like this: devices send/receive data, interacting with network where the data is transmitted, normalized and filtered using edge computing before landing in databases/data storage, accessible by applications and services, which process it [data] and provide it to people, who will act and collaborate.

ref_arch

 

Who is IoT?

You could ask which company is IoT one. This is very useful question, because your next question could be about criteria, classifier for IoT and non-IoT. Let me ask you first: is Uber IoT or not?

Today Uber is not, but as soon as the cars are self-driven Uber will be. An only missing piece is a direct connection to the car. Check out recent essay by Tim O’Reilly. Another important aspect is to mention society, as a whole and each individual, so it is not Internet of Things, but it is Internet of Things & Humans. Check out those ruminations http://radar.oreilly.com/2014/04/ioth-the-internet-of-things-and-humans.html

Humans are consumers, just a reminder. Humans is integral part of IoT, we are creating IoT ourselves, especially via networks, from wide social to niche professional ones.

 

Software is eating the world

Chips and networks are good, let’s look at booming software, because technological process is depending vastly on software now, and it’s accelerating. Each industry opens more and more software engineering jobs. It started from office automation, then all those classical enterprise suites PLM, ERP, SCADA, CRM, SCM etc. Then everyone built web site, then added customer portal, web store, mobile apps. Then integrated with others, as business app to business app aka B2B. Then logged huge clickstreams and other logs such as search, mobile data. Now everybody is massaging the data to distill more information how to meet business goals, including consumerism shaped goals.

  1. Several examples to confirm that digitization of the world is real.
    Starting from easiest example for understanding – newspapers, music, books, photography, movies went digital. Some of you have never seen films and film cameras, but google it, they were non-digital not so long ago. Well, last example from this category is Tesla car. It is electrical and got plenty of chips with software & firmware on them.
  2. Next example is more advanced – intellectual property shifts to digital models of goods. 3D model with all related details does matter, while implementation of that model in hard good is trivial. You have to pay for the digital thing, then 3D print it at home or store. As soon as fabrication technology gets cheaper, the shift towards digital property will be complete. Follow Formula One, their technologies are transferred to our simpler lives. There is digital modeling and simulations, 3D printed into carbon, connected cars producing tons of telemetry data. As soon as consumer can’t distinguish 3D printed hard goods from produced with today’s traditional method, and as soon as technology is cheap enough – it is possible to produce as late as possible and as adequate as possible for each individual customer.
  3. All set with hard goods. What about others? Food is also 3D printed. First 3D printed burger from Modern Meadow was printed more than year ago, BTW funded by googler Sergey Brin. The price was high, about $300K, exactly the amount of his investment. Whether food will be printed or produced via biotech goo, the control and modeling will be software. You know recipes, processes, they are digital. They are applied to produce real food.
  4. Drugs and vaccines. Similar to the food and hard goods. Just great opportunity to get quick access to the brand new medications is unlocked. The vaccine could be designed in Australia and transferred as digital model to your [or nearby] 3D printer or synthesizer, your instance will be composed from the solutions and molecules exclusively, and timely.

So whatever your industry is, think about more software coding and data massage. Plenty of data, global scale, 7 billions of people and 30 billions of internet devices. Think of traditional and novel data, augmented reality and augmented virtuality are also digitizers of our lives towards real virtuality.

 

How  to design for IoT?

If you know how, then don’t read further, just go ahead with your vision, I will learn from you. For others my advice will be to design for personal experience. Just continue to ride the wave of more & more software piece in the industries, and handle new software problems to deliver personal experience to consumers.

First of all, start recognizing novel data sources, such as Search, Social, Crowdsourced, Machine. It is different from Traditional CRM, ERP data. Record data from them, filter noise, recognize motifs, find intelligence origins, build data intelligence, bind to existing business intelligence models to improve them. Check out Five Sources of Big Data.

Second, build information graphs, such as Interest, Intention, Consumption, Mobile, Social, Knowledge. Consumer has her interests, why not count on them? Despite the interests consumer’s intentions could be different, why not count on them? Despite the intentions consumer’s consumption could be different, why not count on them? And so on. Build mobility graph, communication graph and other specific graphs for your industry. Try to build a knowledge graph around every individual. Then use it to meet that’s individual expectations or bring individualized unexpected innovations to her. Check out Six Graphs of Big Data.

As soon as you grasp this, your next problem will be handling of multi-modality. Make sure you got mathematicians into your software engineering teams, because the problem is not trivial, exactly vice versa. Good that for each industry some graph may prevail, hence everything else could be converted into the attributes attached to the primary graph.

concept

 

PLM in IoT era

Taking simplified PLM as BEFORE –> DURING –> AFTER…

BEFORE.
Design of the product should start as early as possible, and it is not isolated, instead foster co-creation and co-invention with your customers. There is no secret number how much of your IP to share publicly, but the criteria is simple – if you share insufficiently, then you will not reach critical mass to trigger consumer interest to it; and if you share too much, your competitors could take it all. The rule of thumb is about technological innovativeness. If you are very innovative, let’s say leader, then you could share less. Examples of technologically innovative businesses are Google, Apple. If you are technologically not so innovative then you might need to share more.

DURING.
The production or assembly should be as optimal as possible. It’s all about transaction optimization via new ways of doing the same things. Here you could think about Coase Law upside down – outsource to external patterns, don’t try to do everything in-house. Shrink until internal transaction cost equals to external. Specialization of work brings [external] costs down. Your organization structure should reduce while the network of partners should grow. In the modern Internet the cost of external transactions could be significantly lower than the cost of your same internal transactions, while the quality remains high, up to the standards. It’s known phenomenon of outsourcing. Just Coase upside down, as Eric Schmidt mentioned recently.

Think about individual customization. There could be mass customization too, by segments of consumers… but it’s not so exciting as individual. Even if it is such simple selection of the colors for your phones or sneakers or furniture or car trim. It should take place as late as possible, because it’s difficult to forecast far ahead with high confidence. So try to squeeze useful information from your data graphs as closer to the production/assembly/customization moment as possible, to be sure you made as adequate decisions as could be made at that time. Optimize inventory and supply chains to have right parts for customized products.

AFTER.
Then try to keep the customer within experience you created. Customers will return to you to repeat the experience. You should not sit and wait while customer comes back. Instead you need to evolve the experience, think about ecosystem. Invent more, costs may raise, but the price will raise even more, so don’t push onto cost reduction, instead push onto innovativeness towards better personal experiences. We all live within experiences [BTW more and more digitized products, services and experiences]. The more consumer stays within ecosystem, the more she pays. It’s experience economy now, and it’s powered by Internet of Things. May be it will rock… and we will avoid Fight Club.

 

PS.

Visuals…

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A Story behind IoE @ THINGS EXPO

This post is related to the published visuals from my Internet of Everything session at THINGS EXPO in June 2014 in New York City. The story is relevant to the visuals but there is no firm affinity to particular imagery. Now there story is more like a stand alone entity.

How many things are connected now?

Guess how many things (devices & humans) are connected to the Internet? Guess who knows? The one who produces those routers, that moves your IP packets across the global web – Cisco. Just navigate to the link http://newsroom.cisco.com/ioe and check the counter in right top corner. The counter doesn’t look beautiful, but it’s live, it works, and I hope will continue to work and report approximate number of the connected things within the Internet. Cisco predicts that by 2020, the Internet of Everything has the potential to connect 50 billion. You could check yourself whether the counter is already tuned to show 50,000,000,000 on 1st of January 2020…

Internet of Everything is next globalization

Old good globalization was already described in The World is Flat. With the rise of smart phones with local sensors (GPS, Bluetooth, Wi-Fi) the flatness of the world has been challenged. Locality unflattened the world. New business models emerged as “a power of local”. The picture got mixed: on one hand we see same burgers,  Coca-Cola and blue jeans everywhere, consumed by many; while on the other hand we already consume services tailored to locality. Even hard goods are tailored to locality, such as cars for Alaska vs. Florida. Furthermore, McDonald’s proposes locally augmented/extended menu, and Coca-Cola wraps the bottles with locally meaningful images.

Location itself is insufficient for the next big shift in biz and lives. A context is a breakthrough personalizer. And that personal experience is achievable via more & smaller electronics, broadband networks without roaming burden, and analytics from Big Data. New globalization is all about personal experience, everywhere for everyone.

Experience economy

Today you have to take your commodities, together with made good, together with services, bring it all onto the stage and stage personal experience for a client. It is called Experience Economy. Nowadays clients/users want experiences. Repeatable experiences like in Starbucks or lobster restaurant or soccer stadium or taxi ride. I already have a post on Transformation of Consumption. Healthcare industry is one of early adopters of the IoT, hence they deserved separate mentioning, there is a post on Next Five Years of Healthcare.

So you have to get prepared for the higher prices… It is a cost of staging of personal experience. Very differentiated offering at premium price. That’s the economical evolution. Just stick to it and think how to fit there with your stuff. Augment business models correspondingly. Allocate hundreds of MB (or soon GB) for user profiles. You will need a lot to store about everybody to be able to personalize.

Remember that it’s not all about consumer. There are many things around consumer. They are part of the context, service, ecosystem. Count on them as well. People use those helper things [machines, software] to improve something in biz process or in life style, either cost or quality or time or emotions. Whatever it is, the interaction between people and between people-machine is crucial for proper abstraction and design for the new economy.

Six Webs by Bill Joy

Creator of Berkeley Unix, creator of vi editor, co-founder of Sun Microsystems, partner at KPCB – Bill Joy – outlined six levels of human-human, human-machine, machine-machine interaction. That was about 20 years ago.

  • Hear – human & intimate device like phone, watch, glasses.
  • Near – human & personal while less intimate device like laptop, car infotainment.
  • Far – human & remote machines like TV panels, projections, kiosks.
  • Weird – human-machine via voice & gesture interfaces.
  • B2B – machine-machine at high level, via apps & services.
  • D2D – machine-machine as device to device, mesh networks.

About 10 years ago Bill Joy reiterated on Six Webs. He pointed to “The Hear Web” as most promising and exciting for innovations.

“The Hear Web” is anatomical graphene

The human body is anatomically the same through the hundreds of years. Hence the ergonomics of wearables and handhelds is predefined. Braceletswristwatchesarmbands are those gadgets that could we wear for now on our arms. The difference is in technology. Earlier it was mechanical, now it is electrical.

Vitruvian

We are still not there with human augmentation to speak about underskin chips… but that stuff is being tested already… on dogs & cats. Microchip with information about rabies vaccination is put under the skin. Humans also pioneer some things, but it is still not mainstream to talk much about.

For sure “The Hear Web” was a breakthrough during recent years. The evolution of smartphones was amazing. The emergence of wrist-sized gadgets was pleasant. We are still to get clarity what will happen with glasses. Google experiments a lot, but there is a long way to go until the gadget is polished. That’s why Google experiments with contact lenses. Because GLASS still looks awkward…

The brick design of touch smartphone is not the true final one. I’ve figured out significant issue with iPhone design. LG Flex is experimenting with bendable, but that’s probably not significantly better option. High hopes are on Graphene.    Nokia sold it’s plastic phone business to Microsoft, because Nokia got multi-billion grant to research in graphene wearables. Graphene is good for electricity, highly durable, flexible, transparent. It is much better for the new generation of anatomically friendly wearables.

BTW there will be probably no space for the full-blown HTML5/CSS3/JavaScript browsers on those new gadgets. Hence forget about SaaS and think about S+S. Or client-server which is called client-cloud nowadays. Programming language could be JavaScript, as it works on small hardware already, without fat browsers running spreadsheets. Check out Tessel. The pathway from current medium between gadgets & clouds is: smartphone –> raspberry pi –> arduino.

D2D

D2D stands for Device-to-Device. There must be standards. High hopes are on Qualcomm. They are respected chipset & patents maker. They propose AllJoyn – open source approach for connecting things – during recent years. All common functionality such as discovery/onboarding, Wi-Fi comms, data streaming to be standardized and adopted by developers community.

AllSeen Alliance is an organization of supporters of the open source initiative for IoT. It is good to see there names like LG, Sharp, Haier, Panasonic, Technicolor (Thomson) as premier members, Cisco, Symantec and HTC as community members. And really nice to see one of etalons of Wikinomics – Local Motors!

For sure Google would try to push Android onto as many devices as possible, but Google must understand that they are players in plastic gadgets. It’s better to invest money into hw & graphene companies and support the alliance with money and authority. IoT needs standards, especially at D2D/M2M level.

How to design for new webs?

If you know how – then go ahead. Else – design for personal experience. Internet of Everything includes semiconductors, telecoms and analytics from Big Data.

IoT

 

Assuming you are in software business, let semiconductors continue with Moore’s Law, let telecoms continue with Metcalfe’s Law, while concentrate on Big Data to unlock analytics potential, for context handling, for staging personal experience. Just consider that Metcalfe’s Law could be spread onto human users and machines/devices.

Start design of Six Graphs of Big Data from Five Sources of Big Data. The relation between graphs and sources is many-to-many. Blending of the graphs is not trivial. Look into Big Data Graphs Revisited. Conceptualization of the analytics pipeline is available in Advanced Analytics, Part I. Most interesting graphs are Intention & Consumption, because first is a plan, second is a fact. When they begin to match, then your solution begin to rock. Write down and follow it – the data is the next currency. 23andme and Uber logs so much data besides the cap of service you see and consume…

Where we are today?

There are clear five waves of the IoT. Some of those waves overlap. Especially ubiquitous identification of people or things indoors and outdoors. If the objects is big enough to be labeled with RFID tag or visual barcode than it is easy. But small objects are not labeled neither with radio chip nor with optical code. No radio chip because it is not good money-wise. E.g. bottles/cans of beer are not labeled because it’s too expensive per item. The pallets of beer bottles are labeled for sure, while single bottle is not. There is no optical code as well, to not spoil the design/brand of the label. Hence it is a problem to look for alternative identification – optical – via image recognition.

Third wave includes image recognition, which is not new, but it is still tough today. Google has trained Street View brain to recognize house numbers and car plates at such high level of accuracy, that they could crack captcha now. But you are not Google and you will get 75-78% with OpenCV (properly tuned) and 79-80% with deep neural networks (if trained properly). The training set for deep learning is a PITA. You will need to go to each store & kiosk and make pictures of the beer bottles under different light conditions, rotations, distances etc. Some footage could be made in the lab (like Amazon shoots the products from 360) but plenty of work is your own.

 

FiveWavesIoT

Fourth wave is about total digitization of the world, then newer world will work with digital things vial telepresence & teleoperations. Hopefully we will dispense with all those power adapters and wires by that time. “Software is eating the World”. All companies become software companies. Probably you are comfortable with digital music (both consuming and authoring), digital publishing, digital photos and digital movies. But you could have concerns with digital goods, when you pay for the 3D model and print on 3D printer. While atomic structure of the printed goods is different, your concern is right, but as soon as atomic structure is identical [or even better] then old original good has, then your concern is useless. Read more in Transformation of Consumption.

With 3D printing of hard goods it’s less or more understandable. Let’s switch tp 3D printed food. Modern Meadow printed a burger year ago. It costed $300K, approximately as much as Sergei Brin (Googler) invested into Modern Meadow. Surprised? Think about printed newest or personal vaccines and so forth…

Who is IoT? Who isn’t?

Is Uber IoT or not? With human drivers it is not. When human-driven cabs are substituted by self-driving cabs, then Uber will become an IoT. There is excellent post by Tim O’Reilly about Internet of Things & Humans. CEO of Box.com Levie tweeted “Uber is a $3.5 billion lesson in building for how the world *should* work instead of optimizing for how the world *does* work.” IoT is not just more data [though RedHat said it is], IoT is how this world should work.

How to become IoT?

  • Yesterday it was from sensors + networks + actuators.
  • Today it becomes sensors + networks + actuators + cloud + local + UX.
  • Tomorrow it should be sensors + networks + actuators + cloud + local + social + interest + intention + consumption + experience + intelligence.

Next 3000 days of the Web

It was vision for 5000 days, but today only 3000 days left. Check it out.

Next 6000 days of the Web

Check out There will be no End of the World. We will build so big and smart web, that we as humans will prepare the world to the phase shift. Our minds are limited. Our bodies are weird. They survive in very narrow temperature range. They afraid of radiation, gravity. We will not be able to go into deep space, to continue reverse engineering of this World. But we are capable to create the foundation for smarter intelligence, who could get there and figure it out. Probably we would even don’t grasp what it was… But today IoT pathway brings better experiences, more value, more money and more emotions.

PS.

Let’s check Cisco internet of things counter. ~300,000 new things have connected to the Internet while I wrote this story.

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On the Internet of Everything

Five Waves of the “Internet of Things” on its Way of Transforming into “Internet of Everything”

http://united.softserveinc.com/blogs/software-engineering/may-2014/internet-of-things-transforming/

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Transformation of Consumption

Some time ago I’ve posted on Six Graphs of Big Data and mentioned Consumption Graph there. Then I presented Five Sources of Big Data on the data-aware conference, mentioned how retailers track people (time, movement, sex, age, goods etc.) and felt the keen interest from the audience about Consumption Data Source. Since that time I’ve thought a lot about consumption ‘as is’. Recently I’ve paid attention to the glimpses of the impact onto old model from micro-entrepreneurs, who 3D-prints at home and sell on Etsy. Today I want to reveal more about all that as consumption and its transformation. It will be much less about Big Data but much more about mid term future of Economics.

The Experience Economy

It was mentioned 15 years ago. The experience economy was identified as the next economy following the agrarian economy, the industrial economy, and the most recent service economy. Here is a link to 1998 Harvard Business Review, “Welcome to the Experience Economy”. Guys did an excellent job by predicting the progression of economic value. The experience is a real thing, like hard goods. Recall your feelings when you are back to the favorite restaurant where you order without looking into the menu. You got there to repeat the experience. Hence modern consumption is staged as experience, from the services and goods. Personal experience is even better. Services and goods without staging are getting weaker… Below is a diagram of the progression of economic value.

ExperienceEconomy

It would be useful to compare the transformation by multiple parameters such as model, function, offering, supply, seller, buyer and demand. The credit goes to HBR. I have improved the readability of the table in comparison to their. There is a clear trend towards experience and personalization. Pay attention to the rightmost column, because it will be addressed in more details later in this post.  To make it more familiar and friendly for you, I’ll appeal to your memories again: recall your visits to Starbucks or McDonalds. What is a driving force behind your will? How have you gained that internal feeling over past periods? Multiple other samples are available, especially from the leisure and hospitality industry. Pioneers of new economics are there already, others are joining the league. And yes… people are moving towards those fat guys from WALL-E movie…

comparizon

The Invisible Economy

Staging experience is not enough. Starbucks provides multiple coffee blends, Apple provides multiple gadgets and even colors. But it is not enough. I am an example. I need curved phone (suitable for my butt shape, because I keep it in the back pocket). Furthermore, I need a bendable phone, friendly for sitting whet it’s in the pocket. While majority of manufacturers-providers are ignoring it, LG is planning something. Let’s see what it will be, there is evidence of curved and flexible one. But I am not alone with my personal [strange?] wills. Others are dreaming of other things. Big guys may not be nimble enough to catch the pace of transforming and accelerated demand. It’s cool to be able to select colors for New Balance 993 or 574, but it’s not enough. My foot is different that yours, I need more exclusivity (towards usability and sustainability) than just colors. Why not to use some kind of digitizer to scan my foot and then deliver my personal shoes?

“The holy place is never empty” is my free word translation of Ukrainian proverb. It means that opportunity overlooked by current guys is fulfilled by others, new comers. There is a rising army of craftsmen and artists producing at home (manually of on 3D printers) and selling on Etsy. Fast Company has a great insight on that: “… Micro-entrepreneurs are doing something so nontraditional we don’t even know how to measure it…” There are bigger communities, like Ponoko. It is new breed of doers, called fabricators. And Ponoko is a new breed of the environment, where they meet, design, make, sell, buy and interact. The conclusion here is straightforward – our demand is fulfilled by new guys and in different way we used to. You can preview 3D model or simulation being thousand miles away and your thing will be delivered to your door. You can design your own thing. They can design for you and so on. And this economy is growing. Hey, big guys, it’s a threat for you!

The most existing in economy transformation is a foreseen death of banks. Sometimes banks are good, but in majority of modern cases they are bad. We don’t need Wells Fargo and similar dinosaurs. Amazon, Google, Apple, PayPal could perform the same functions more efficiently and make less evil to the people. There are emerging alternatives [to banks] how to fund initiatives, exchange funds between each other. Kickstarter and JumpStartFund are on the rise. Even for very serious projects like Hyperloop. Those things are still small (that’s why the section is called Invisible), but they are gaining the momentum and will hit the overall economy quite soon and heavy, less than in five years.

3D Printing

Here we are, taking digital goods and printing them into hard goods. Still early stage, but very promising and accelerating. MakerBot Replicator costs $2,199 which is affordable for personal use. There is a model priced at $2,799, which is still qualified for personal use. What does it mean for consumption? The World is being digitized. We are creating a digital copy of our world, everything is digitized and virtualized. Then digital can be implemented in the physical (hard good) on 3D printer. There are very serious 3D printers by Solid Concepts, that are capable to print the metal gun, which survives 500 round torture test. As soon as internal structure at molecular level is recreated and we achieve identical material characteristics, the question left is about cost reduction for the technology. As soon as 3D printing is cheap, we are there, in new exciting economy.

Let’s review other, more useful application of technology than guns. We eat to live, entertain to live good, and we cure diseases (which sometimes happen because of lifestyle and food). So, food first. 3D printed meat is already a reality. Meat is printed on bioprinter. Guess who funded the research? Sergey Brin, the googler. Modern Meadow creates leather and meat without slaughtering the animals. Next is health. The problem of waiting lists for organ exchange is ending. Your organs will be 3D printed. It is better than transplant because of no immune risks anymore. And finally, drugs. Recall pandemic situations with flue. Why you have to wait for vaccine for a week? You can 3D print your drugs from the digital model instantly, as soon as you download the digital model over the Internet. Downloaded and printed drugs is additional argument for Personalized Medicine in my recent post on the Next Five Years of Healthcare. I assume that answering essential application of technology to the basic aspects of life such as food, lifestyle and healthcare is sufficient to start taking it [technology] seriously. You can guess for other less life-critical applications yourself.

4D Printing

3D printing is on the rise, but there is even more powerful technology, called 4D printing. Fourth dimension is delayed in time and is related to the common environment characteristics such as temperature, water or some more specific like chemical. When external impact is applied, the 3D-printed strand folds into new structure, hence it uses its 4th dimension. It is very similar to the protein folding. There are tools for design of 4D things. One of them is cadnano for three-dimensional DNA origami nanostructures. It gives certainty of the stability of the designed structures. Another tool is Cyborg by Autodesk. It’s set of tools for modeling, simulation and multi-objective design optimization. Cyborg allows creation of specialized design platforms specific for the domains, from nanoparticle design to tissue engineering, to self-assembling human-scale manufacturing. Check out this excellent introduction into self-assembly and 4D printing by Skylar Tibbits from MIT Media Lab:

Forecast [on Consumption]

We will complete digitization of everything. This should be obvious for you at this stage. If not, then check out slightly different view on what Kevin Kelly called The One. No bits will live outside of the one distributed self-healing digital environment. Actually it will be us, digital copy of us. Data-wise it will be All Data together. Second reference will be to James Burke, who predicted the rise of PCs, in-vitro fertilization and cheap air travel in far 1973. Recently Burke admitted: “…The hardest factor to incorporate into my prediction, however, is that the future is no longer what it has always been: more of the same, but faster. This time: faster, yes, but unrecognisably different…” And I see it in same way, we are facing different future than we used to. It’s a bit scary but on the other hand it is very exciting. In 30 years we will have nano-fabricators, which manipulate at the level of atoms and molecules, to produce anything you want, from dirt, air, water and cheap carbon-rich acetylene gas. As you may already feel, those ingredients are virtually free, hence production of the goods by fabricator is almost free. Probably food will be a bit more expensive, but also cheap. By the way, each fabber will be able to copy itself… from the same cheap ingredients. We will not need plenty of wood, coal, oil, gas for nanofabrication. This is good for ecology. But I think we will invent other ways how to spoil Earth.

The value will shift from equipment to the digital models of the goods. Advanced 3D (and 4D models) will be not free; the rest will be crowdsourced and available for free. Autodesk, not a new company, but one of those serious, is a pioneer there with 123D apps platform. They are moving together with MakerBot. You can buy MakerBot Replicator on Autodesk site and vice versa, you will get Autodesk software together with MakerBot you bought elsewhere. It’s how it all is starting. In few years it will take off at large scale. Then we will get different economy, with much personal, sustainable and sensational consumption.

It would be interesting to draw parallels with the creation of Artificial Intelligence, because in 2030 we should have human brain simulated on non-biological carrier. Or may be we will be able to 4D or 5D-print more powerful brains than human on biological, but non-human carrier? Stay tuned.

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Next Five Years of Healthcare

This insight is related to all of you and your children and relatives. It is about the health and healthcare. I feel confident to envision the progress for five years, but cautious to guess for longer. Even next five years seem pretty exciting and revolutionary. Hope you will enjoy they pathway.

We have problems today

I will not bind this to any country, hence American readers will not find Obamacare, ACO or HIE here. I will go globally as I like to do.

The old industry of healthcare still sucks. It sucks everywhere in the world. The problem is in uncertainty of our [human] nature. It’s a paradox: the medicine is one of the oldest practices and sciences, but nowadays it is one of least mature. We still don’t know for sure why and how are bodies and souls operate. The reverse engineering should continue until we gain the complete knowledge.

I believe there were civilisations tens of thousands years ago… but let’s concentrate on ours. It took many years to start in-depth studying ourselves. Leonardo da Vinci did breakthrough into anatomy in early 1500s. The accuracy of his anatomical sketches are amazing. Why didn’t others draw at the same level of perfection? The first heart transplant was performed only in 1967 in Cape Town by Christiaan Barnard. Today we are still weak at brain surgeries, even the knowledge how brain works and what is it. Paul Allen significantly contributed to the mapping of the brain. The ambitious Human Genome project was performed only in early 2000s, with 92% of sampling at 99.99% accuracy. Today, there is no clear vision or understanding what majority of DNA is for. I personally do not believe into Junk DNA, and ENCODE project confirmed it might be related to the protein regulation. Hence there is still plenty of work to complete…

But even with the current medical knowledge the healthcare could be better. Very often the patient is admitted from the scratch as a new one. Almost always the patient is discharged without proper monitoring of the medication, nutrition, behaviour and lifestyle. There are no mechanisms, practices or regulations to make it possible. For sure there are some post-discharge recommendations, assignments to the aftercare professionals, but it is immature and very inaccurate in comparison to what it could be. There are glimpses of telemedicine, but it is still very immature.

And finally, the healthcare industry in comparison to other industries such as retail, media, leisure and tourism is far behind in terms of consumer orientation. Even automotive industry is more consumer oriented than healthcare today. Economically speaking, there must be transformation to the consumer centric model. It is the same winning pattern across the industries. It [consumerism] should emerge in healthcare too. Enough about the current problems, let’s switch to the positive things – technology available!

There could be Care Anywhere

We need care anywhere. Either it is underground in the diamond mine, or in the ocean on-board of Queen Mary 2, or in the medical center or at home, at secluded places, or in the car, bus, train or plane.

There is wireless network (from cell providers), there are wearable medical devices, there is a smartphone as a man-in-the-middle to connect with the back-end. It is obvious that diagnostics and prevention, especially for the chronical diseases and emergency cases (first aid, paramedics) could be improved.

care anywhere

I personally experienced two emergency landings, once by being on-board of the six hour flight, second time by driving for the colleague to another airport. The impact is significant. Imagine that 300+ people landed in Canada, then according to the Canadian law all luggage was unloaded, moved to X-ray, then loaded again; we all lost few hours because of somebody’s heart attack.

It could be prevented it the passenger had heart monitor, blood pressure monitor, other devices and they would trigger the alarm to take the pill or ask the crew for the pill in time. The best case is that all wearable devices are linked to the smartphone [it is often allowed to turn on Bluetooth or Wi-Fi in airplane mode]. Then the app would ring and display recommendations to the passenger.

4P aka Four P’s

The medicine should go Personal, Predictive, Preventive and Participatory. It will become so in five years.

Personal is already partially explained above. Besides consumerism, which is a social or economic aspect, there should be really biological personal aspect. We all are different by ~6 million genes. That biological difference does matter. It defines the carrier status for illnesses, it is related to risks of the illnesses, it is related to individual drug response and it uncovers other health-related traits [such as Lactose Intolerance or Alcohol Addiction].

Personal medicine is an equivalent to the Mobile Health. Because you are in motion and you are unique. The single sufficiently smart device you carry with you everywhere is a smartphone. Other wearable devices are still not connected [directly into the Internet of Things]. Hence you have to use them all with the smartphone in the middle.

The shift is from volume to value. From pay to procedures to pay for performance. The model becomes outcome based. The challenge is how to measure performance: good treatment vs. poor bedside, poor treatment vs. good bedside and so on.

Predictive is a pathway to the healthcare transformation. As healthcare experts say: “the providers are flying blind”. There is no good integration and interoperability between providers and even within a single provider. The only rationale way to “open the eyes” is analytics. Descriptive analytics to get a snapshot of what is going on, predictive analytics to foresee the near future and make right decisions, and prescriptive analytics to know even better the reasoning of the future things.

Why there is still no good interoperability? Why there is no wide HL7 adoption? How many years have gone since those initiatives and standards? My personal opinion is that the current [and former] interoperability efforts are the dead end. The rationale is simple: if it worth to be done, it would be already done. There might be something in the middle – the providers will implement interoperability within themselves, but not at the scale of the state or country or globally.

Two reasons for “dead interop”. First is business related. Why should I share my stuff with others? I spent on expensive labs or scans, I don’t want others to benefit from my investments into this patient treatment. Second is breakthrough in genomics and proteomics. Only 20 minutes needed to purify the DNA from the body liquids with Zymo Research DNA Kit. Genome in 15 minutes under $100 has been planned by Pacific Biosciences by this year. Intel invested 100 million dollars into Pacific Biosciences in 2008. Besides gene mechanisms, there are others, not related to DNA change. They are also useful for analysis, predicting and decision making per individual patient. [Read about epigenetics for more details]. There is a third reason – Artificial Intelligence. We already classify with AI, very soon will put much more responsibility onto AI.

Preventive is very interesting transformation, because it is blurring the boarders between treatment and behaviour/lifestyle/wellness and between drugs and nutrition. It is directly related to the chronic diseases and to post-discharge aftercare, even self aftercare. To prevent from readmission the patient should take proper medication, adjust her behaviour and lifestyle, consume special nutrition. E.g. diabetes patients should eat special sugar-free meal. There is a question where drug ends and where nutrition starts? What Coca Cola Diet is? First step towards the drugs?

Pharmacogenomics is on the rise to do proactive steps into the future, with known individual’s response to the drugs. It is both predictive and preventive. It will be normal that mass universal drugs will start to disappear, while narrowly targeted drugs will be designed. Personal drugs is a next step, when the patient is a foundation for almost exclusive treatment.

Participatory is interesting in the way that non-healthcare organisations become related to the healthcare. P&G produce sun screens, designed by skin type [at molecular level], for older people and for children. Nestle produces dietary food. And recall there are Johnson & Johnson, Unilever and even Coca Cola. I strongly recommend to investigate PWC Health practice for the insights and analysis.

Personal Starts from Wearable

The most important driver for the adoption of wearable medical devices is ageing population. The average age of the population increases, while the mobility of the population decreases. People need access to healthcare from everywhere, and at lower cost [for those who retired]. Chronic diseases are related to the ageing population too. Chronic diseases require constant control, interventions of physician in case of high or low measurements. Such control is possible via multiple medical devices. Many of them are smartphone-enabled, where corresponding application runs and “decides” what to tell to the user.

Glucose meter is much smaller now, here is a slick one from iBGStar. Heart rate monitors are available in plenty of choices. Fitness trackers and dietary apps are present as vast majority of [mobile health] apps in the stores. Wrist bands are becoming the element of lifestyle, especially with fashionably designed Jawbone Up. Triceps band BodyMedia is good for calories tracking. Add here wireless weight… I’ve described gadgets and principles in previous posts Wearable Technology and Wearable Technology, Part II. Here I’d like to distinguish Scanadu Scout, measuring vitals like temperature, heart rate, oxymetry [saturation of your hemoglobin], ECG, HRV, PWTT, UA [urine analysis] and mood/stress. Just put appropriate gadgets onto your body, gather data, analyse and apply predictive analytics to react or to prevent.

anything_s

Personal is a Future of Medicine

If you think about all those personal gadgets and brick mobile phones as sub-niche within medicine, then you are deeply mistaken. Because the medicine itself will become personal as a whole. It is a five year transition from what we have to what should be [and will be]. Computer disappears, into the pocket and into the cloud. All pocket sized and wearable gadgets will miniaturise, while cloud farms of servers will grow and run much smarter AI.

Everybody of us will become a “thing” within the Internet of Things. IoT is not a Facebook [it’s too primitive], but it is quantified and connected you, to the intelligent health cloud, and sometimes to the physicians and other people [patients like you]. This will happen within next 5-10 years, I think rather sooner or later. The technology changes within few years. There were no tablets 3.5 years ago, now we have plenty of them and even new bendable prototypes. Today we experience first wearable breakthroughs, imagine how it will advance within next 3 years. Remember we are accelerating, the technology is accelerating. Much more to come and it will change out lives. I hope it will transform the healthcare dramatically. Many current problems will become obsolete via new emerging alternatives.

Predictive & Preventive is AI

Both are AI. Period. Providers must employ strong mathematicians and physicists and other scientists to create smarter AI. Google works on duplication of the human brain on non-biological carrier. Qualcomm designs neuro chips. IBM demonstrated brainlike computing. Their new computing architecture is called TrueNorth.

Other healthcare participatory providers [technology companies, ISVs, food and beverage companies, consumer goods companies, pharma and life sciences] must adopt strong AI discipline, because all future solutions will deal with extreme data [even All Data], which is impossible to tame with usual tools. Forget simple business logic of if/else/loop. Get ready for the massive grid computing by AI engines. You might need to recall all math you was taught and multiply it 100x. [In case of poor math background get ready to 1000x efforts]

Education is a Pathway

Both patients and providers must learn genetics, epigenetics, genomics, proteomics, pharmacogenomics. Right now we don’t have enough physicians to translate your voluntarily made DNA analysis [by 23andme] to personal treatment. There are advanced genetic labs that takes your genealogy and markers to calculate the risks of diseases. It should be simpler in the future. And it will go through the education.

Five years is a time frame for the new student to become a new physician. Actually slightly more needed [for residency and fellowship], but we could consider first observable changes in five years from today. You should start learning it all for your own needs right now, because you also must be educated to bring better healthcare to ourselves!

 

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Wearable Technology. Part II

This story is a logical continuation of the previously published Wearable Technology.

Calories and Workouts

Here I will show how two different wearable gadgets complement each other for Quantified Self.  For the beginning we need two devices, one is wearable on yourself, second is wearable by your bike.

First device is called BodyMedia, world’s most precise calories meter. It measures 5,000 data snapshots per minute from galvanic skin response, heat flux, skin temperature and 3-axis accelerometer. You can read more about BodyMedia’s sensors online. BodyMedia uses extensive machine learning to classify your activity as cycling, then measuring calories burned according to the cycling Big Data set used during learning. Check out this paper: Machine Learning and Sensor Fusion for Estimating Continuous Energy Expenditure for excellent description how AI works.

Second device is called Garmin Edge 500, simple and convenient bike computer. It has GPS, barometric altimeter, thermometer, motion detection and more features for workouts. You can read more about Garmin Edge 500 spec online. My gadgets are pictured herein.

04_gadgets

On the Route

The route was proposed by Mykola Hlibovych, a distinguished bike addict. So I put my gadgets on and measured it all. Below is info about the route. Summary info such as distance, time, speed, pace, temperature, elevation is provided by Garmin. it tries to guess about the calories too, but it is really poor at that. You should know there is no “silver bullet” and understand what to use for what. Garmin is one of the best GPS trackers, hence don’t try to measure calories with it.

Juxtaposition of elevation vs. speed and temperature vs. elevation is interesting for comparison. Both charts are provided by distance (rather than time). 2D route on the map is pretty standard thing. Garmin uses Bing Maps.

02_map_elev_speed_temp_dist

Burning Calories

Let’s look at BodyMedia and redraw Garmin charts of speed, elevation and temperature along the time (instead of distance) and stack them together for comparison/analysis. All three charts are aligned along the horizontal time line. Upper chart is real-time calories burn, measured also in METS. The vertical axis reflects Calories per Minute. Several times I burned at the rate of 11 cal/min with was really hot. The big downtime between 1PM and 2:30PM was a lunch.

An interesting fact is observable on Temperature chart – the Garmin was warm itself and was cooling down to the ambient temperature. After that it starter to record the temperature correctly. Another moment is a small spike in speed during downtime window. It was Zhenia Novytskyy trying my bike to compare with his.

01_calories_elev_speed_temp_time

Thorough Analysis

For detailed analysis of the performance on the route there is animated playback. It is published on Garmin Cloud. You just need to have Flash Player. Click this link if WordPress does not render the embedded route player from Garmin Cloud. There is iframe instruction below. You may experience some ads from them I think (because the service is free) …

The Mud

Wearable technology works in different conditions:)

03_mad

 

 

 

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Mobile EMR, Part V

Some time ago I’ve described ideation about mobile EMR/EHR for the medical professionals. We’ve come up with tablet concept first. EMR/EHR is rendered on iPad and Android tablets. Look & feel is identical. iPad feels better than Samsung Galaxy. Read about tablet EMR from four previous posts. BTW one of them contains feedback from Edward Tufte:) Mobile EMR Part I, Part II, Part III, Part IV.

We’ve moved further and designed a concept of hand-sized version of the EMR/EHR. It is rendered on iPhone and Android phones. This post is dedicated to the phone version. As you will see, the overall UI organization is significantly different from tablet, while reuse of smaller components is feasible between tablets and phones. Phone version is totally SoftServe’s design, hence we carry responsibility for design decisions made there. For sure we tried to keep both tablet and phone concepts consistent in style and feel. You could judge how good we accomplished it by comparing yourself:)

Patients

The lack of screen space forces to introduce a list of patients. The list is vertically scrolled. The tap on the patient takes you to the patient details screen. It is possible to add very basic info for each patient at the patient list screen, but not much. Cases with long patient names simply leave no space for more info. I think that admission date, age and sex labels must be present on the patient list in any case. We will add them in next version. Red circular notification signals about availability of new information for the patient. E.g. new labs ready or important significant event has been reported. The concept of interaction design supposes that medical professional will click on the patient marked with notifications. On the other hand, the list of patients is ordered per user. MD can reorder the list via drag’n’drop.

Patient list

Patient list

MD can scan the wristband to identify the patient.

Wristband scanning

Wristband scanning

Patient details

MD goes to the patient details by tapping the patient from the list. That screen is called Patient Profile. It is long screen. There is a stack of Vital Signs right on top of the screen. Vital Signs widget is totally reused from tablets on the phones. It fits into the phone screen width perfectly. Then there is Meds section. The last section is Clinical Visits & Hospitalization chart. It is interactive (zoomable) like on iPad. Within single patient MD gets multiple options. First options is to scroll the screen down to see all information and entry points for more info available there. Notice a menu bar at the bottom of the screen. MD can prefer going directly to Labs, Charts, Imagery or Events. The interaction is organized as via tabs. Default tab is patient Profile.

Patient profile

Patient profile

Patient profile, continued

Patient profile, continued

Patient profile, continued

Patient profile, continued

Labs

There is not much space for the tables. Furthermore, labs results are clickable, hence the size of the rows should be relative to the size of the the finger tap. Most recent labs numbers are highlighted with bold. Deviation from the normal range is highlighted with red color. It is possible to have the most recent labs numbers of the left and on the right of the table. It’s configurable. The red circular notification on the Labs menu/tab informs with the number how many new results available since last view on this patient.

Labs

Labs

Measurements

Here we reuse ‘All Data’ charts smoothly. They perfectly fit into the phone screen. The layout is two-column with scrolling down. The charts with notifications about new data are highlighted. MD can reorder charts as she prefers. MD can manage the list of charts too by switching them on and off from the app settings. There could be grouping of charts based on the diagnosis. We consider this for next versions. Reminder about the chart structure. Rightmost biggest part of the chart renders most recent data, since admission, with dynamics. Min/max depicted with blue dots, latest value depicted with red dot. Chart title also has the numeric value in red to be logically linked with the dot on the chart. Left thin part of the chart consist of two sections: previous year data, and old data prior last year (if such data available). Only deviations and anomalies are meaningful from those periods. Extreme measurements are comparable thru the entire timeline, while precise dynamics is shown for the current period only. More information about the ‘All Data’ concept could be found in Mobile EMR, Part I.

Measurements in 'All Data' charts

Measurements in ‘All Data’ charts

Tapping on the chart brings detailed chart.

Measurement details

Measurement details

Imagery

There was no a big deal to design entry point into the imagery. Just two-column with scroll down layout, like for the Measurements. Tap on the image brings separate screen, completely dedicated to that image preview. For the huge scans (4GB or so) we reused our BigImage solution, to achieve smooth image zoom in and zoom out, like Google Maps, but for medical imagery.

Imagery

Imagery

Tissue scan, zoom in

Tissue scan, zoom in

Significant events & notes

Just separate screen for them…

Significant events

Significant events

Conclusion: it’s BI framework

Entire back-end logic is reused between tablet and phone versions on EMR. Vital Signs and ‘All Data’ charts are reusable as is. Clinical Visits & Hospitalization chart is cut to shorter width, but reused easily too. Security components for data encryption, compression are reused. Caching reused. Push notification reused. Wristband scanning reused. Labs partially reused. Measurements reused. BigImage reused.

Reusability is physical and logical. For the medical professional, all this stuff is technology agnostic. MD see Vital Signs on iPad, Android tablet, iPhone and Android phone as a same component. For geeks, it is obvious that reusability happens within the platform, iOS and Android. All widgets are reusable between iPad and iPhone, and between Samsung Galaxy tab and Samsung Galaxy phone. Cloud/SaaS stuff, such as BigImage is reusable on all platforms, because it Web-based and rendered in Web containers, which are already present on each technology platform.

Most important conclusion is a fact that mEMR is a proof of BI Framework, suitable for any other industry. Any professional can consume almost real-time analytics from her smartphone. Our concept demonstrated how to deliver highly condensed related data series with dynamics and synergy for proper analysis and decision making by professional; solution for huge imagery delivery on any front-end. Text delivery is simple:) We will continue with concept research at the waves of technology: BI, Mobility, UX, Cloud; and within digitizing industries: Health Care, Biotech, Pharma, Education, Manufacturing. Stay tuned to hear about Electronic Batch Record (EBR).

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Mobile EMR, Part IV

This is continuation of Mobile EMR, Part III.

It happened to be possible to fit more information to the single pager! We’ve extended EKG slightly, reworked LABs results, reworked measurements (charts) and inserted a genogram. Probably the genogram brings majority of new information in comparison to other updates.

v4 of mEMR concept

Right now the concept of mobile EMR looks this way…

Mobile EMR v4

Mobile EMR v4

New ‘All Data’ charts

Initially the charts of measured values have been from dots. Recent analysis and reviews tended to connect the dots, but things are not so straightforward… There could be kind of sparkline for the current period (7-10 days). Applicability of sparkline technique to represent data from the entire last year is suspicious. Furthermore, if more data is available from the past, then it will be a mess rather than a visualization, because there is so narrow space allocated for old data. Sure, the section of the chart could be wider, but does it worth it?

What is most informative from the past periods? Anomalies, such as low and high values, especially in comparison with current values. Hence we’ve left old data as dots, previous year data as dots, and made current short period as line chart. We’ve added min/max points to ease the analysis of the data for MD.

Genogram

Having genogram on the default screen seems very useful. User testing needed to test the concept on real genograms, to check the sizes of genograms used most frequently. Anyhow, it is always possible to show part of the genogram as expanded diagram, while keep some parts collapsed. The genogram could be interactive. When MD clicks on it, she gets to the new screen totally devoted to the genogram with all detailed attributes present. Editing could be possible too. While default screen should represent such view onto the genogram that relates to the current or potential diagnosis the patient has.

In the future the space allocated for the genogram could be increased, based on the speed of evolution of genetic-based treatments. May be visualization of personal genotyping will be put onto the home screen very soon. There are companies providing such service and keeping such data (e.g. 23andme). Eventually all electronic data will be integrated, hence MDs will be able to see patients genotyped data from EMR app on the tablet.

DNA Sequence

This is mid term future. DNA sequencing is still a long process today. But we’ve got the technology how to deliver DNA sequence information onto the tablet. The technology is similar to BigImage(tm). Predefined levels of information deliver could be defined, such as genes, exoms and finally entire genotype. For sure additional layers overlays will be needed to simplify visual perception and navigation thru the genetic information. So technology should be advanced with that respect.

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Mobile EMR, Part III

This is continuation of previous posts Mobile EMR, Part I and Mobile EMR, Part II

We’ve met with Mr.Tufte and demo’ed this EMR concept. He played with it for a while and suggested list of improvements, from his point of view.

‘All Data’ charts

Edward Tufte insists that sparklines work better than dots. It is OK that sparklines will be of different sizes. It is natural that each measurement has its own normal range. Initially we tried to switch the charts to the lines, but then we rolled back. Seems that we should make this feature configurable, and use sparklines by default. But if some MD wants dots, she can manually switch it in app settings.

Partially our EMR concept has been switched to sparklines – for display of Vital Signs. Below is a snapshot:

Vital Signs

One more thing related to the Vital Signs, we did great by separating on the widget on top, and grouping them together. It adds much value, because they are related to each other. It is important to see what happened to them at each moment. Our approach, based on user testing, appeared to be a winning one!

Space

Current use of the space could be improved even more. First reason is that biggest value of that research was keeping ‘All Information’ on single screen. Human eye recognizes perfectly which type of information is needed. All space is tessellated into multiple locuses of attention. Then human eye locks the desired locus and then focuses within that locus. Second reason is iPad resolution. We can squeeze more from retina resolution without degradation of usability (like size of labels and numbers). It is possible to scale to the newspaper typography on iPad, hence fit more information into the screen estate.

Genogram

This confirms the modern trend to genetics and genetic engineering. Genogram is a special type of diagram, visualizing patient’s family relationships and medical history. In medicine, medical genograms provide a quick and useful context in which to evaluate an individual’s health risks. Many new treatments are tailored by genotype of the patients. E.g. Steve Jobs’s cancer was periodically sequenced and brand new proteins where applied, to prevent disease spread. All cells are built from the proteins, reading other proteins as instructions. This is true for the cancer cells. Thus if they read instructions from fake proteins, then they can not build themselves properly. We like this idea immediately, because its value is instant and big, its importance is as high as allergy. Below is sample genogram, using special markers for genetically influenced diseases.

Sample Genogram

There are other cosmetic observations which will be improved shortly. We continue usability testing with medical doctors. More to come. It could be Mobile EMR on iPhone. Stay tuned.

UPDATE: Continued on Mobile EMR, Part IV.

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