About electronic patient record systems

Existing solutions for electronic patient record systems fail because they begin with a wrong assumption. As I understand it, the original patient record system was invented by Mayo clinic in 1907. The idea is that for each patent, the hospital would create and maintain a central dossier folder for all medical records for an individual patient. Contemporary electronic patient record system is not much different from this ancient way of managing documents. We create an electronic repository for all patients in electronic form. Such records are however currently owned and managed by hospitals who created them. When patients do not move and keep their relationship with the same hospital for a long time, it may work just fine. However, as the patients mobility grows and they have to interact with so many different specialists, the old hospital centric patient record system must be replaced with a patient centric system. 

So, it looks like this. After each visit, the doctor will generate some type of record. Patients will collect that information (either via in paper or in digital) and store them in a cloud service in digital form. Hospitals and doctorals must request access to the patient data. Patients can also grant access to whomever they am willing to grant access to the data. It is maintained by a trusted third-party company who is primarily working for patients, not doctoral or hospitals. Patients’ subscription to the service can be covered by the insurance and more accurate information sharing can reduce the overall cost of healthcare service. Right now, if a patient want to move her doctor or hospital, the patient have pay a fee to get “her own data”. If she am in an emergency room in a remote country, there is very little chance that the doctors and hospitals there can access her medical information. Just like many other data from my life, medical data should be mine and primarily serve my interests. 

What is needed is not mere electronic replica of century old paper-based system, but rather new type of digital vault of personal data. The ownership of the data should be exclusively to the patients and their immediate family members. In old days, storing and maintaining large-volume of medical records at home was not safe or practical. With today’s digital technology, it is time to rethink about patient records and design a new system. 

The vision of City as an Operating System

Last spring, we ran a design challenge for "North Broadband". The idea was to prototype a digital ecosystem that leverages various digital, physical, intellectual and financial resources that are already in place in North Philadelphia to transform the neighborhood. Ninety students in 15 teams, representing five schools and colleges participated in the challenge

The winning idea came from a team with the first-year full-time MBA students at Fox School. Their idea was to leverage digital infrastructure to transform local salons into edges of banking services for local neighbors. Here's how their idea works. During their research, they observed that there were more hair salons than bank offices in the neighbor. They also was told that one of the major challenges of local urban community is the lack of saving culture. Many families live from paycheck to paycheck, without having a bank account. When they receive a paycheck, they often use local payday loan services or other private financial services that charges a hefty service fee. At the same time, students noticed that there are many hair salons where many female members of the community visit on a regular basis (typically every other week).

Combining these two observations, they designed a powerful idea of "a hair salon as a bank office concept". By using broadband infrastructure and owner training (provided through the participating banks), a hair salon can serve as a bank branch where its customers can cash their paychecks and deposit money into their own bank account. In order to encourage saving behavior, the students proposed a "forced saving model" in which a fixed percentage of the price will be automatically saved into the customer's bank account. Therefore, the customers can not only cash their paychecks at a much affordable rate, each they make a visit to the hair salon to do their hair, they end up saving money into their bank account. Using a smart phone app, customers can watch their money growing, serving as a powerful incentive for them to continue to save. This is a win-win-win model. Customers get cheaper check-cashing service, do their hair and build their savings. Salon owners get a free customer relationship management system. Each customer's information will be saved and made available to the salon owners. They will also have locked-in customers. Finally, banks will expand their customer base and being able to penetrate the market that they were not able to access.

This is where the students idea ended. However, their idea serves as a powerful example of the vision of a digital city as a computing platform. Here, a local hair salon with a digital infrastructure can be conceptualized as a platform. The banking service is an app. And we can design other type of apps. Consider the following idea. Many of the salon customers have school-age children. What do their kids do while their moms are doing their hair? What if moms bring their kids to the salon? Temple University's Honors Program require students to serve the community at least 50 hours a semester and some of the students have hard time finding appropriate opportunities. What if we have a set of apps that allow parents to sign up for free tutoring sessions for their kids while they are at the hair salon and another app where Temple students can sign up for tutoring opportunity by indicating subjects and availability? That is another app that can be plugged into the city as an operating system.

We can continue to expand this idea in the domain of public health. Already the idea of using barber shops and hair salons as the community outreach centers for public health education programs. Again, we can use digital tools to provide necessary information and contents to shop owners (all HIPPA compliant). So, that is yet another app.

The idea of a city as an operating system is not just a conceptual idea. It needs to be technically implemented as well. The communication network bandwidth has now exceeded some of the old data bus speed. For example, USB 2.0 transmits data 480 mbps, about half of the speed of gigabit ethernet. We can literally architect an operating system by connecting buildings, sensors, and cars. In order turn a city as operating system where others can build apps, we need to design APIs and SDKs. Again, these are not just idea and metaphors. They need to be actual APIs and SDKs. By doing so, we can build an open, vibrant ecosystem, as opposed to vendor-centric closed system.

There are many digital city initiatives led by many vendors. What we need is a version of an internet for the city — perhaps we can call it "Urbanet". Following the same principles that were used for the design of the Internet, one can begin to sketch out a new infrastructure that connects physical buildings, spaces and objects with digital worlds.

Social media and revolution

I finally had a chance to read Malcolm Gladwell’s article on social media. He argues that social media cannot revolutionize the world. He disputes a popular beliefs that social media is a new tool for social activism. He points out two specific reasons why social media cannot be a tool for social revolution. First, he correctly points out that a key characteristics of social media is “not asking too much.” As we often hear, instead of asking million dollar donation from five wealthy donors, a politician now can ask for a dollar from five million people. Popularity in YouTube, the “Like” button on Facebook, and “RT” of Twitter are all examples of not-asking-too-much. Gladwell notes that “[A]tivism that challenges the status quo — that attacks deeply rooted problems — is not for the faint of heart.” In other words, a real revolution requires sacrifice and dedication. He further argues that such dedication can only come from a strong-tie, formed in real friendship. Second, according to Gladwell, a revolution requires disciplines and strategy, which he argues social media cannot provide. He argues that discipline and strategy can only come from a hierarchy.

Despite some obvious flaws in his arguments (for example, the notion that discipline and strategy cannot come from social media, thus, a revolution requires a hierarchy, is simply not true. One should not treat all networks as equal. Some networks, particularly with a strong central node, can have characteristics that resemble a hierarchy. It is just that the commands are not coming from the top; they are coming from the center of the network), I am intrigued by his bigger point: social media will not revolutionize the status quo. He ends his essay by quoting a story from a book, “Here Comes Everybody”. In that story, a Wall Streeter used social media on the Internet to track down, shame, and eventually catch a teenager from Queens who stole his smart phone.

Shirky ends the story of the lost Sidekick by asking, portentously, “What happens next?”—no doubt imagining future waves of digital protesters. But he has already answered the question. What happens next is more of the same. A networked, weak-tie world is good at things like helping Wall Streeters get phones back from teen-age girls. Viva la revolución.

The story reminds me of a panel that I was on with a CIO of a large multinational company a couple years ago. A person from the audience asked, “When are we going to see the use of social media, like Facebook and Twitter, in Corporate America?” Without a missing a beat, the CIO responded, “Oh, yeah. It is coming. We are working on it. We are testing all forms of new technologies.” However, I was much more skeptical. I responded to that reply by noting that the use of social media in an organization should be likened to the political revolutions in the 18th century that ended monarchy and led to the emergence of democracy. Just like democracy was a different kind of idea on how to govern people, social media represents a different kind idea on how to share information and knowledge. Therefore, one cannot and should not expect to see the proliferation of the real use of social media without expecting the transfer of power. That means, those who are in power will feel threatened; they will try to block the free flow of information and persecute those who promote the free flow of information through the use of social media. Just like people shed blood and lost their lives then, people will loose their jobs and careers will be ruined now. Only if those who challenge the powerful succeed, only then will we see the real revolution in organizations with social media. Until then, social media will be only used to re-affirm the current power structure. Those who are already in power will continue to exercise their power, using newly acquired propaganda machine — social media — only to re-affirm the current social structures.

p.s. I wrote this one last November only never to publish it as I was hoping to revise it further. Since then, we had Wikileaks, Tunisia and Egypt. Here are couple of my random reactions to those events.

Thought 1: What happened with Wikileaks shows that those in power will persecute those who try to use the power of social media to challenge the status quo.

Thought 2: What Egyptian government did with the Internet shows that no government should be allowed to control the Internet.

Thought 3: What is happening in Egypt and Tunisia show that social media can challenge the established social structures, even those as powerful as Egyptian government, only when people are willing to risk their lives. Young Egyptians did not just twitted. They marched on the street.

Our country that I desire

I came across a writing of Kim Gu who was a political leader during the Japanese occupation. It was written in 1947, shortly after the end of the occupation. Korea was then already divided between North and South, occupied by the USSR and US with no independent government yet. Although it was written over 60 years ago, the power of his vision and idea still moves me. I am proud that we had such a visionary leader. Yet, I am deeply sad that we have not lived up to his vision. I copied the portion of his essay — Our Country that I Desire — in Korean and then translate it in English. Unfortunately, he was assassinated and never saw his vision to be realized. I hope to see the new generation of Koreans build Korea the most beautiful country in the world.

나는 우리나라가 세계에서 가장 아름다운 나라가 되기를 원한다. 가장 부강한 나라가 되기를 원하는 것은 아니다. 내가 남의 침략에 가슴이 아팠으니, 내 나라가 남을 침략하는 것을 원치 아니한다. 우리의 부력(富力)은 우리의 생활을 풍족히 할 만하고, 우리의 강력(强力)은 남의 침략을 막을 만하면 족하다. 오직 한없이 가지고 싶은 것은 높은 문화의 힘이다. 문화의 힘은 우리 자신을 행복되게 하고, 나아가서 남에게 행복을 주겠기 때문이다. 지금 인류에게 부족한 것은 무력도 아니오, 경제력도 아니다. 인류가 현재에 불행한 근본 이유는 인의(仁義)가 부족하고, 자비가 부족하고, 사랑이 부족한 때문이다. 이 마음만 발달이 되면 현재 물질로도 온 인류가 다 편히 살아갈 수 있을 것이다. 인류의 이 정신을 배양하는 것은 오직 문화다. 나는 우리나라가 남의 것을 모방하는 나라가 되지 말고, 이러한 높고 새로운 문화의 근원이 되고, 목표가 되고, 모범이 되기를 원한다. 그래서 진정한 세계 평화가 우리나라에서, 우리나라로 말미암아 실현되기를 원한다.”

“I want our country to become the most beautiful country in the world. Neither the wealthiest nor the mightiest. Since we suffered deeply from the invasion by another nation, I do not want us to invade others. I will be content if our wealth is sufficient to provide for all of us and our strength enough to protect us from others. The only one do I seek is the power of advanced culture. It is because the power of culture not only makes us happy, but does the same to others. What mankind lacks now is neither the military might nor the economic power. We all suffer because we lack benevolence and justice, mercy, and love. If we have these characters in us, we already have enough to provide sufficiently for all mankind to live well together. Culture is the only way to nurture these characters in us. I do not want us to imitate others’; instead, I want us to become the fountain, the standard, and the role model of the new culture with these ideals. Through this, I hope the permanent world peace will be gained in and by our country.”

Politics of language

In politics, left means liberal or progressive and right means conservative. However, in our everyday use, if you draw a line, left means backward while right means forward. Doesn’t this mean that liberal/progressive should be right and conservative should be left?

twitting from physical artifacts

You are reading an article from Wired or NYT. You like what you read and want to twitt. Alas, you are reading a paper version, not on-line. So, what do you do? You can either give up the idea of twitting or you can go on to your computer to find a digital copy of the article and twitt.

How about if publishers include little 2D bar code at the end of each article that act like “share” tag at the end of digital copy of the same articles? Readers can use the camera on their mobile phone to scan the 2D bar code — depending on the mobile client the reader uses, it will allow you to share it via Twitter, Facebook, or many other social networking tools.

The same idea can be applied for other physical artifacts: books, restaurants, CDs, DVDs, movie & concert tickets, museums, mural arts, etc. Most of these physical artifacts have digital representation somewhere on the net. 2D bar code can simply provide URL for those digital representations so that it can be included in twitt (or whatever form of media the use may choose).

TED Video by John Lloyd

This morning, as I was running on the treadmill, I watched a TED clip by John Lloyd. He talks about importance of things that cannot be seen. Watch it and enjoy. Very funny and clever.

He ends with two really great quotes. “I don’t know why we are here, but I am pretty sure it’s not in order to enjoy ourselves.” — Ludwig Wittgenstein.

“We are here on earth to help others. What others are here for… I have no idea.” — WH Auden.