Stanford Center for Clinical Informatics: Seminar series

2004-05 Seminars - Stanford Center for Clinical Informatics (SCCI) - Stanford University School of Medicine

This is a remarkable resource for medical computing/health informatics folks. Admittedly it's a small audience, but the collection of resources and speakers is remarkable. Kudos to Stanford for putting it online.

Our first interstellar probe - leaving the solar system

NASA - Voyager Enters Solar System's Final Frontier

Heading for the stars.

The consensus of the team now is that Voyager 1, at 8.7 billion miles from the Sun, has at last entered the heliosheath, the region beyond the termination shock," said Dr. John Richardson from MIT, Principal Investigator of the Voyager plasma science investigation.

Why did Palm Fail? A Slashdot thread.

PalmOne to become Palm Again; PalmSource & Linux

I wrote this comment in a very interesting Slashdot discussion. Lately Slashdot discussions have been quite boring; but this one has good comments (other than mine of course!). This comment from a Palm developer is particularly interesting.

When I teach about data interfaces in healthcare systems, and the complexity of integration, I compare Palm original representation of a 'contact' (address book entry) with Outlook/Exchange server's contact representation. The complexity (non-computable complexity in some areas) of synchronizing between these two was a huge problem for Palm. I'm not sure when they figured out how much trouble they were in, but once Microsoft took over the enterprise with Exchange server Palm's fate was pretty much sealed.

In later versions of the OS they tried to better match Outlook's data models, but they botched the software layer that provided some backwards compatibility (arguably they should have given up on the backwards compatibility, they ended up with the worst of two options).

Linux on the Palm is not as important, really, as matching the Exchange server data model.

More broadly, synchronization is a problem that's been grossly underestimated in many quarters. It often requires a fuzzy non-deterministic reconciliation of semantic models; the same challenge that Berners-Lee addresses in the context of the semantic web. This issue is a major part (along with some perverse economics) of why healthcare IT projects are so difficult.

I hope Palm now understands these issues, I fear that much of their intellectual capital may have moved on...

The immense power of denial: one handed professional ball players

...But I Went Out and Achieved Anyway! | MetaFilter

One hand. No arm. No leg. Lots of denial. Never underestimate the power of denial.

Action Squad: Minneapolis Urban Adventurers

Action Squad: Minneapolis Urban Adventurers

This was featured on metafilter, but they didn't mention this is a Minneapolis street gang! I may have met some of these guys. Reminds me of exploring steam tunnels at college -- but in those days Caltech allowed undergrads to have keys to many buildings, so it wasn't even trespassing (though it wasn't approved either).

My personal experience with urban adventures was limited to rooftop camping in the ancient days when I had far more time than money.

The treadmill desk -- coming soon to an office near you

New Weight-Loss Focus: The Lean and the Restless - New York Times

A researcher studying idiosyncratic non-exercise activity and weight loss installs a treadmill desk:

... At meetings, he stands instead of sitting. Talking on the telephone, he paces around. In his office he has a treadmill in place of a desk. He got it last year when he saw the data from the study comparing lean people and obese ones.

'My computer is stationed over the treadmill,' he said. 'I work at 0.7 miles an hour.'

A stand-up desk might seem simpler, but he prefers the treadmill.

'Standing still is quite difficult,' he said. 'You have a natural tendency to want to move your legs. Zero point seven is the key. You don't get sweaty, you can't jiggle too much. It's about one step a second. It's very comfortable. Most people seem to like it around 0.7.'

I've seen a few people in our office sitting on a large ball while working -- keeping stable would certainly burn calories. This takes things to the next step. I'd read that he'd done this, but I hadn't seen the speed setting -- 1 step a second seems quite pleasant.

All of can practice standing at meetings. Lose weight and get the meeting done faster ..

I wonder how long it will take to turn the "treadmill desk" into a commercial product. When that happens perhaps employers would consider paying for them through employee FlexPlan coverage.

The UK approach to patient privacy with electronic health records

Britain toughens patient privacy

We're unlikely to get such strong protections; historically US law does very little to protect privacy. It's nice to know someone's doing it however. In practice using the full power of these restrictions would be unwise for almost any patient, but it's easier to loosen such rules than to tighten them later. Emphases mine.

The United Kingdom's Health Department published tough new rules to guarantee that patients in England can control access to their electronic health care records in a system under development by the National Health Service.

The NHS National Programme for Information Technology kicked off a 10-year, $10 billion project in late 2003 to develop a nationwide e-health record (EHR) system for 50 million patients and 30,000 doctors in England. It would not cover Scotland, Wales or Northern Ireland.

The NHS Care Record Guarantee, published May 23, will allow patients to prevent information in their records from being shared, Health Ministry officials said. But the quality of care could deteriorate if patients block information sharing.

The health record guarantee also states that:

* Patients will be able to obtain a list of everyone who looks at their records.

* NHS will not share information outside the agency, particularly with other government agencies.

* Records will only be shared with health care providers or social service or education organizations with patient permission.

* NHS will take disciplinary action against anyone who accesses health records without permission or a good reason.

The new NHS electronic Care Records Service “has enormous potential benefits for patients," said Lord Warner, UK health minister. The system allows medical staff throughout England to have instant access to patient histories, including allergies, current medications and recent treatment.

Warner said the department developed the new privacy rules to address any patients’ concerns about the confidentiality of their records.

The Care Guarantee clearly establishes the rights of patients to control who has access to their information, Warner said. "These rules will be backed up with tough security measures to prevent unauthorized access to records, ensuring everyone can have confidence in the new system," he said.

National Provider (physician, pharmacist, etc) Identifier assignment system - Not quite ready yet!

National Plan & Provider Enumeration System - Home Page

As of May 23rd physicians and other healthcare "providers" are supposed to start obtaining their unique ID numbers that are the basis for many future healthcare transactions. I figured I'd give it a try.

It didn't work. I entered my UPIN number around step 5 or so and the server crashed (I noticed in the state drop down list that MN was in an odd location, not quite alpha-sorted):

Internal Server Error

The server encountered an internal error or misconfiguration and was unable to complete your request.

Please contact the server administrator, you@your.address and inform them of the time the error occurred, and anything you might have done that may have caused the error.

More information about this error may be available in the server error log.

Additionally, a 500 Internal Server Error error was encountered while trying to use an ErrorDocument to handle the request.

Hmm. A few teething problems! Another bad sign was the initial login. They use the "secret question" method for password recovery, the approach favored by 99/100 crackers and identity thieves.

Evangelical america

False Prophets

Surely there is no subject on which more words are currently being said with less real meaning than that of the intersection of religion and politics in America. And that is why you ought to read a recent New Republic piece by the indispensable Alan Wolfe, who cuts through the fog like a search-light.

In the format of a review of Jim Wallis' much-discussed God's Politics, along with a collection of case studies of religio-political cooperative ventures, Wolfe pens a long, eloquent and often angry essay about the growing willingness of evangelical Christian leaders to reject the liberal principles of tolerance, pluralism and church-state separation that made the growth of their own tradition possible in the first place...

.... As you may know, in the Judeo-Christian tradition one who takes a prophetic stance believes the moral and spiritual conditions of a society have become so depraved that the faithful are obliged to step outside the normal bounds of civility and respect for authority and call down the righteous wrath of God. Taking a prophetic stance is by definition exceptional; occasionally essential, but always spiritually as well as politically dangerous. And that is why true prophets are so greatly honored, and false prophets are so feared and despised...

Two interesting and thoughtful discussions -- both Wolfe's article and the above commentary. Wolfe doesn't mention the history of catholicism as a state religion, but from what he does write I gather he'd agree with me.

Google Earth vs MSN Earth - the next battle in mass market earth imaging

So now it's Google vs. Microsoft to own the earth: MSN Virtual Earth To Take On Google Earth.

To be fair to Microsoft, they've had TerraServer around for ages. They just didn't use it very well. Now they know how.

And where is Amazon's business photo project? I couldn't find any St. Paul business with a neighborhood image.

The Economist's Millenium edition is now available online (five years later)

Reporting on a thousand years

It only took them a few years, but the Economist has put their justly famed 'Millenium Issue' online. I came across it by accident; on review it's even better than I remembered. Well worth a quick browse for fans of history and economics. This was one of my all time favorite articles.

Identity theft: almost hopeless

Data at Bank of America, Wachovia, others compromised - May. 23, 2005

Account information on the customers was illegally sold by bank employees to a man identified as Orazio Lembo, whom police said was doing business by illegally posing as a collection agency.

When police in Hackensack, N.J., first announced arrests in the case on April 28, they estimated that more than 500,000 people were affected. That number was raised to 676,000 Friday. Because some people have more than one account, Hackensack Police Chief Charles "Ken" Zisa says the number of accounts breached may top 1 million.

"As this gets going, these numbers are going to go up and up," Hackensack Detective Capt. Frank Lomia told CNN earlier Monday, adding that more arrests may be coming in the case.

One of the most interesting thefts of this kind involved a legal purchase of such information through a legal "front" bank. This is crude by comparison.

It does emphasize, however, how hopeless the situation is. It is not coincidental that fingerprint scanners are being integrated into some supermarket checkouts.

If they were smart, the feds would hire Bruce Schneier to devise a solution.

Revenge of the Sith -- not so bad, really

No really, not so bad. Lucas manages to resolve a few of the gaping holes in the plot of the original series and I found the dialog less painful than expected. It's probably the second best movie of the six, behind The Empire Strikes Back.

No spoilers, but a few side notes. I think I saw the Millenium Falcon in one scene, it's entering a massive docking area towards the lower level. The relationship between Chewbacca and Han Solo is neatly inverted; perhaps Chewie was not on Han's ship by accident. R2D2 knows more than one might suspect. Lastly Lucas compensates a bit for Episode IV's (first movie) dismissive portrayal of adoption; a change possibly related to his own adopted children.

Prior to the movie, I recommend reading this ver well written and amusing blog - The Darth Side: Memoirs of a Monster: 20050403. I'm now convinced the author is not really in the pay of George Lucas, but he seemed to have some advanced knowledge of some of the minor secrets of 'Revenge of the Sith'.

15 answers to creationist nonsense and the outcome of one theocratic sta

Science & Technology at Scientific American.com: 15 Answers to Creationist Nonsense -- Opponents of evolution want to make a place for creationism by tearing down real science, but their arguments don't hold up. (July 2002)

A useful reference if you want to try to fight for the enlightenment. Personally I'd be happy to settle for protecting the teaching of science and introducing an hour a day of mandatory Republican theology. That solution, at least, would have the virtue of honesty. Grrr.

But ...

Much as I may fume about America's latest 'awakening', and our transition towards a theocratic society, it's worth noting that I was born into a true theocratic state. The result should be a warning to American fundamentalists opposing the separation of church and state.

I was born in Quebec, a state-within-a-nation ruled by the Catholic church. Quebec was a true, classic, theocratic state until the 1960s, when church rule collapsed and the province underwent the fastest 'demographic transition' in the history of the west. I think it was called it the 'quiet revolution', but it's largely unknown outside of the province. Except for a convulsive episode of terrorism that killed at least one man the transition was relatively benign.

In my childhood all education was religious, and although they were retiring several of my high school teachers were still priests and nuns. My high school world history text proclaimed the just wonders and miracles of the Children's Crusade -- I was too honest to steal a copy, but I wish I had one now. I did have real science teachers (and good ones too), but my favorite nun knew me (fondly actually) as the 'ape man'.

What was the outcome of this theocratic rule? Empty churches, no priests, and a profound cyncism about religion. Quebec is slowly recovering but the church is still a spent force 40 years after the revolution.

American fundamentalists should take note. Victory may turn sour.

We will have national health insurance in america

Decoding Health Insurance - New York Times

A physician long opposed to both personal health insurance and national health insurance changes his mind thanks to the pending arrival of very inexpensive individual risk measures through genetic testing. He feels that so many people, rich and poor alike, will be unable to obtain health insurance that there will be no alternative to national risk pooling:

... As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction - all of which invariably result in a better outcome.

But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.

On the one hand, it's hard at first to see why bad genes should be much different from all the other bad luck that denies health coverage to many people. The difference is that this 'bad luck' strikes Republicans as well as Democrats. So I agree, there will be some sort of obligatory risk pooling, and it may turn out to be hard to use any criteria but citizenship to define the covered pool.

BTW, I agree with him on the pernicious effects of health insurance on the doctor-patient relationship.