Tech Takes On Healthcare

Healthcare Cost

The Wall Street Journal reported this week major tech companies have signed a commitment to, “share the common quest to unlock the potential in health care data, to deliver better outcomes at lower costs.” The companies, convened at a Trump administration event focused on healthcare technology, included Amazon, Google, IBM, Microsoft, Oracle, and Salesforce. Apparently, Apple was not at the meeting, but is quite active in healthcare, much of it centered around its cardiac monitoring program with the Apple Watch.  

The promise the   companies made should help accelerate the emergence of a data-driven revolution in healthcare. Patients, providers, payers, and researchers all need easier and more compatible access to health records in order to enhance patient safety and lower the cost of healthcare. Unfortunately, healthcare data today is stored in silos at providers and payers. 

In theory, patients have access to their health data since the Obama administration distributed $30+ billion in incentives for the creation of patient portals and electronic health records (EHRs). The reality is quite different. Most people over 65 have multiple providers. Consolidation has occurred and many hospital networks have a range of services. However, some of the sub-specialty providers, such as urology and dermatology, remain outside of the networks. In addition, standalone practices in orthopedics and radiology have their own EHRs and portals. Another factor adding to the complexity is many people choose to get a second opinion or comparison shop on services such as radiology. The result of all this fragmentation is patients don’t have one patient portal, they have multiple. I have 13. None of the healthcare records are compatible. Even worse, you can look at test results at one provider, but you can’t download or email it to another provider. You also can not sort or search your health data. The bottom line is EHRs have become a train wreck. It is a tie between patients and providers as to who dislikes EHRs the most. EHRs are a failed promise. We can’t live without them, we can’t live with them.

G. W. Bush hired a Chief Information Officer to fix this problem ten years ago. The CIO knew how to fix the problem but could not pierce the armor of special interest groups who wanted government to stay away from the issue. The CIO resigned in frustration. Bottom line is government has been completely ineffective in solving the healthcare data problem. Now lets see what the tech giants can do.

I am optimistic the promise made by the companies mentioned above will be successful. There are two reasons for my optimism. First is healthcare cost has risen out of control to the point where it is nearly 20% of the economy. The tech companies are not startups. They have hundreds of billions in revenue and millions of employees which cost the companies billions of dollars for healthcare. They are motivated to solve the healthcare problem. The second reason for my optimism is technology. Cloud computing has risen like a rocket ship. It can bridge the silos and make data access easier for all. Security technology has evolved to provide anonymity and protection of the data. Equifax and others have shown their incompetence in this regard, but the tech giants know how to do it. Lastly, mobile technology has advanced rapidly. With finger prints and face prints, they offer strong authentication. Mobile apps are easier to use. Banks, travel companies, food services, and many other segments have developed mobile apps which are easy to use and way better than their websites, except in healthcare. I expect Atul Gawande, CEO of the new Amazon/JP Morgan/Berkshire Hathaway healthcare company, to become a shining light to help rally all the tech companies to work together. They are fierce competitors, but their motivation to solve the problems is huge. 

The Wall Street Journal said, “The Trump administration sees better use of health-care data as a key to unlocking savings and holding down costs while improving outcomes.” Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, said .“We want to lean into technology and use it as a potent force to create more efficiencies in our system.” The tech giants will help make this happen.

To read more about EHRs, take a look at Health Attitude: Unraveling and Solving the Complexities of Healthcare.

Tanglewood by Tesla

Tanglewood

The Tanglewood Music Center is located in the Berkshire Mountains of Massachusetts. The drive as 181 miles and we arrived with 80 miles of reserve on the Tesla. The Boston Symphony Orchestra has great concerts there in the summer in the Koussevitzky Music Shed. We get there at least once per year. The shed seats 5,700, but up to 10,000 additional concert goers set up chairs and umbrellas on the lawn.

The guest conductor was the amazing Michael Tilson Thomas, Music Director of the San Francisco Symphony. The concert opened with him conducting one of his own compositions called Agnegram. The 1998 work is described as “alternately jazzy, elegant, humorous, and direct”. Next was an incredible performance by a brilliant young Russian pianist, Igor Levit, who played Rachmaninoff’s virtuosic Rhapsody on a Theme of Paganini. After the intermission, Thomas conducted Mahler’s Symphony No. 1. All of Mahler’s symphonies are vigorous to say the least. No. 1 was powerful and Thomas displayed an amazing amount of energy.

After a ride around Lenox, MA, we headed to Lee, MA where there are eight Tesla Superchargers in the rear of a BigY Supermarket parking lot. We did some shopping while the Model S slurped up nearly 90,000 watt-hours of energy. The Tesla consumes 300 watt-hours per mile. Think of five 60 watt light bulbs turned on for an hour. That is what it takes to go one mile, and the range is approximately 300 miles without a charge. Tesla says 99 Percent of the United States Population is within 150 Miles of a Tesla Supercharger. You can get to and from just about anywhere, but it does take some planning. The car does most of the planning for you, but it is still good to have some situational awareness. For my first trip in the Tesla back in 2015, I went from CT to Washington, D.C. I returned to CT and arrived at home with 5 miles left. That is not good planning. I learned my lesson and have never had a close call since.

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Training Robots

Robots are dumb. They have no intelligence until a human gives them some. The most used robotic automation is in the automobile manufacturing industry where robots are used extensively for spot welding and painting. The intelligence needed is very basic. Go to location x,y,z and weld for x fractions of a second. Go to location A and spray. When at location B, stop spraying. 

Many assembly operations are much more complicated. For example, take a bundle of cables which are connected to a plug, grasp the plug, rotate the plug so it can fit in a socket which has a notch where the pin on the plug is to fit, and insert the plug. An operation such as this could be programmed into a robot, but the programming and testing could take a very long time and may not be precise because the exact position of the wire bundle can vary. An emerging technology in the world of robots includes the ability for humans to train robots.

The new technique is not programming, it is training. Watch the first video and you will see a human holding the robot arm and guiding to do the desired action. The robot will remember what it learned and over time, robots will be able to learn on their own once they are given a goal.

Some very interesting work on robot training is being done at OpenAI. OpenAI is a non-profit AI research company. Their main focus is discovering and enacting the path to safe artificial general intelligence (AGI). AGI is a deep subject. It has to do with when AIs are at least as smart as humans. OpenAI was formed by Elon Musk and a handful of other really smart and wealthy people who are worried about the dark side of AI. OpenAI aims to make it safe so that humans don’t get wiped out by robots in the future. I will be writing more about this in Robot Attitude later. In the meantime, back to training robots.

OpenAI researchers have trained a human-like robot hand to flip a cube with amazing dexterity. Their robot hand system, called Dactyl, is trained entirely from simulation. In other words, the researchers created a computer model to simulate finding the right position of a cube based on a goal. For example, a goal might be flip the cube in the hand until it displays the letter O on the front of the cube and the letter A to the right as shown in the YouTube image above. The result of the simulation is transferred to the robot hand. The hand was effectively given the result of 100 simulated years of training. The implication of this amazing project shows it will be possible to train robots to solve real-world tasks without physically-accurate modeling of the real world. Watch the YouTube video above. Take note of the goals as they pop up on the lower right and then how the robot hand flips the cube to achieve the goal.

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Book Parties

Net AttitudeHealth AttitudeElection AttitudeHome Attitude

Three more book parties are coming up over the next few weeks. The theme will be “Its All About Attitude”. As you know from reading this blog, I believe many large opportunities and problems in the world have their roots in attitude. I also believe the solutions and ways forward to the future are based on attitude. I hope to deliver a revealing talk, and offer a positive perspective on how an attitude change can reap major improvements in key areas which affect all of us, including the evolution of the Web, our healthcare system, how we will vote in the future, the emergence of the smart home.

Needless to say, my comments will relate to Net Attitude, Health Attitude, Election Attitude, and Home Attitude. I will also offer some hints about my work in progress: Robot Attitude. All four books will be available for sale at the book parties, and 100% of the proceeds will go to a charity named by the host organization. If you are like me, when you buy a print book with proceeds to charity, you then go to Amazon and get the Kindle version. All four books are available on Kindle, and Health Attitude and Election Attitude are available in Audible for your listening pleasure. 

Following are the upcoming book parties.

August 30, 2018   5 PM Cocoon Coffee House Bellemonte Ave, Hawley, PA
September 5, 2018  11AM Ridgefield Men’s Club 103 Main St., Ridgefield, CT
September 7, 2018   1 PM Founders Hall 193 Danbury Rd, Ridgefield, CT

Any questions, send me email to [email protected]

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Amazon Growing Seattle

The population of Seattle was 609 thousand in 2010, and the population now is 746 thousand. Much of the growth is accounted for by Amazon, which now has 40,000 employees in the city. We left for our family cruise to Alaska a day early to spend some time with a family member who lives in Seattle and works at Amazon. As we walked around the city, we saw construction everywhere. Much of it will be new Amazon buildings. By 2022, when construction is expected to be complete, Amazon could occupy about 12 million square feet of real estate in Seattle, which is more than 20% of the city’s current total office inventory, according to GeekWire. That square footage will be spread out among more than 40 buildings.

One of the building sites we toured was The Spheres, a place where employees can think and work differently surrounded by plants. The Spheres are home to more than 40,000 plants from the cloud forest regions of over 30 countries. Not many urban offices have such a direct link to nature. 

Another building had an interesting physical collage on the lobby wall. It included 16 Kindles from the first one to the latest one. I think I have owned all of them (and later sold on eBay to upgrade to the newer one).

 

The most interesting building to me was the Amazon Go Store. As you enter, you open your Amazon Go app and let it be scanned at a turnstile. When you enter you see a very well organized, clean, and full store. One of the differences between a normal convenience store is the behind the scene kitchen which makes ready-to-eat food, and keeps the shelves shelves stocked with food, wine, and a large number of miscellaneous items.

What is most different is there are no check out lanes or cashiers. The Amazon Go store provides a shopping experience with no lines and no checkout. The experience is made possible by many of the same types of technologies used in self-driving cars: computer vision, sensor fusion, and deep learning. I looked up at the ceiling and saw a maze of sensors, cameras, and other devices I did not recognize. Although I did not recognize all the devices on the ceiling, they recognized me. The scan on the way in tells the Amazon Go system I am in the store. If I pick up an item from a shelf, the item is automatically put in a virtual shopping card. If I change my mind and put it back, the system removes the items from my virtual cart. When I was finished shopping, I just walked out of the store. A little later, Amazon sends a receipt and makes the charge to my Amazon account. The Just Walk Out Shopping experience feels strange. If the technology becomes mainstream, I guess we will get used to it.

Watch the video to see a real Amazon Go store in action. See some pictures from Seattle here.

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