HealthComm LLC

We all know that medical records will be moving into the electronic realm. This isn’t specific to medical records; it could be restated as “all data will be moving into the electronic realm.” There are many advantages to this migration: Data can be munched up, parsed, viewed from all angles, and compared against other data; trends can be discovered and analysed with far greater speed; anomalies and errors can be ferreted out; and the list goes on. There are also many disadvantages, and they’re largely the same things I’d list as advantages!

How can this be?

It depends on who has the data and how they are using it. Do I want an ER doctor to be able to rapidly build a health profile on me while he’s determining how to treat my failing heart? Sure I do! Do I want the state, the federal government, insurance companies, criminals, my neighbor, basically anyone but my healthcare professional to know my entire health history? No. You may want to share your information, but I don’t and won’t; I’d like to keep it as my choice.

For that matter, I don’t want my healthcare professional to have it any old day, either. What if a pharmaceutical company pays him several heaps of money to hand over my data — even blinded, aggregated patient data? For one thing, the doctor shouldn’t do it without my consent! For another, if that data is valuable, and it’s MY data, I want a say — and the money. It’s valuable right? That’s what I keep hearing.

Have you been reading the news for the past few years and seeing the many cases of massive data breaches? Millions of records exposed at any one time? Aha! This wouldn’t happen if my records were on paper in a filing cabinet! And you’d be absolutely correct, but the basic underlying technology of ink and paper versus bits and magnetic storage are not really the issue; they’re beside the point. There are really two problems, as I see it, that make data susceptible to theft: 1) centralization of data, and 2) the people who are handling this data are not computer or security experts, and I don’t think we should expect them to be.

So what am I suggesting?

My suggestion is one that is unlikely to be palatable to many because they will fear it, but i’m not terribly interested in people’s responses; my interest lies in minimizing security risk and ensuring that you are in control of your data. So in addition to some sort of standard of data and data exchange, I’d be in favor of rules and regulations about retention and visibility data between parties (i.e., you and your doctor) that primarily make you the guardian of your own data. I know this sounds scary. Print off your data if you like. Back it up in some encrypted format in some faraway place. By all means maintain the safety of your information, but also by all means YOU maintain the safety of YOUR information.

Afraid yet? So let’s look at some scenarios.

When the government mandates all centralized electronic medical records and our neither-computer-scientist-nor-security-expert federal employee somehow lets hundreds of millions records loose in the wild, how many people are affected? I think I already said it! Hundreds of millions. Do you even have a copy of this record? What does it even say about you? Do you know if your information was exposed or not?

Now let’s see what happens when you lose your fully encrypted electronic fob/doohickey in the parking lot at the grocery store. How many people are affected? Just one, and likely only zero: since it’s encrypted and unreadable to anyone else and you have likely printed it out and kept it in a fire safe, or have a duplicate encrypted fob in a fire safe as well, and possibly pay $5 per month to some service to store your information in encrypted form somewhere else (and while i’m dreaming, the cost of the storage is tax-deductible since this whole electronic migration was federally mandated and they are nice guys).

You may ask, “Well, smarty pants, how do I share the info with my doctor if the data is encrypted?” Suffice it to say there are numerous real, present-day security mechanisms that work just fine for this, things like public-key sharing (which I use daily). But dont be distracted from the main point: who is responsible for your information anyway?

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A popular term in the IT sector is “cloud computing” or, more simply, The Cloud. But what exactly is The Cloud? The direct answer to the question is actually quite simple, but what people really mean is, “What can I do with The Cloud?” I will go into both.

First and foremost, it’s entirely misleading to say the cloud. It is not singular. There are any number of clouds. It’s not a specific implementation so much as it is an idea that multiple companies have implemented. So from here on out we can either say a cloud, your cloud, cloud computing, or just cloud. The idea of a cloud is really quite simple — it is a group of computers all networked together. The Internet is a cloud. In more recent years, it has come to mean a group of networked computers all working toward a common goal and exposed through programmatic interfaces.

So how are clouds used? Well, that depends greatly on what each cloud is designed to accomplish. Just as your computer can do many things, clouds can do many things; however, clouds are much more specifically purpose-driven when the rubber meets the road. Some clouds are used to handle very computationally intensive tasks, some for acting as large remote databases, and some others for file storage. Anything for which you might use headless servers (servers without connected monitors) is likely a good candidate for cloud computing.

As with any technical or business decisions, there are pros and cons to clouds.

Let’s start with some of the pros. One of the big deals with cloud computing is that you are taking advantage of someone else’s infrastructure. There is an implication that the cloud of choice will have better redundancy, less failure rate (higher uptime), and less cost than you could ever do yourself for a competing cost. And in many instances, this is absolutely true. Depending on your given task, clouds make a lot of sense from both a business perspective and a technical perspective.

Clouds are no panacea, however. No regular person actually uses a cloud directly. It’s not some magical computer in the sky ready to do your bidding inexpensively. Depending on your task, retooling a project for cloud service integration can be fairly minor; but a complete retooling of your project can also lead to even more vendor lock-in as well as less flexibility. Additionally, not all clouds offer real service level agreements (SLAs). If they go down, you have no guarantee of timely support or timely restoration of service. Although this situation appears to be improving, SLAs cost money, and they are typically the first victims of cost-reduction. Additionally, the very nature of clouds means that your data or resources are “not in your house,” so to speak. You will not have access to your cloud if it goes down, unless you took the time, money, and expertise to build in some local redundancy. Some laws may also prevent you from storing files or data offsite and out of your locally audited infrastructure as well.

So as with any choice, be aware of the benefits and pitfalls.

Posted in Labs| 1 Comment

I’m going to talk about a subject near and dear to my heart – web development and browser support. – specifically Internet Explorer 6. Internet Explorer 6 was released in August of 2001, yet still commands 20-25% of the browser market in the United States. In internet terms, 2001 is an extremely long time ago. That’s even a long time for an Operating System these days.

As in many fields, legacy support is a necessary, but costly aspect to business. But there comes a point where the cost is too great and support must be severed. And nowhere but in information technology is this process so accelerated.

The point at which legacy support must be cut is different in every case, but the types of costs associated with support is fairly common across the board. I’m going to outline a few of the costs in web development and why it’s so important to understand the tradeoffs you make when you aim to support dinosaurs.

So let’s see how this all impacts a client.

1. Time is Money.

   The more browsers you support, the more time it takes to produce your site, plain and simple.
   It takes more time to make it visually, it takes more time to make it function properly and it takes more time to test and verify. ALOT more time. Back around 2000-2001, I would charge four times the base cost to support Netscape Navigator 4. It was that bad, and still not a very profitable venture, if at all. Internet Explorer 6 is the new Navigator 4.

2. Not all toys are yours to play with.

   In addition to taking more time – some cool features you want may simply be out of reach. Not all browsers have the same abilities, so choose wisely based on your target audience. How you handle these disparities can also increase the cost of your site. Do you present different content for different levels of functionality? Do you let people know why they cannot access something? Or do you simply take that option off the table for everyone. These can be tough choices and some cost more than others.

3. Perception.

   Depending on how you handle the above – the perception that your site is broken, damaged, or old and stale can be a result. None of these options are good. It’s not easy to make sure that you are perceived in a positive light through all the major browsers and versions. And the older your support window is, the more hacks, work-arounds, and limitations you impose on how you convey a message.

4. Security.

   Are you asking for legacy support because of your viewership or because you yourself support a legacy infrastructure? The leading cause for continued Internet Explorer 6 usage that I hear has to do existing IT infrastructure. Not only does IT not wish to invest the time into upgrading (infrastructure people are interested in status quo once things are working, and rightly so), but in many cases, some ‘core’ internal web application is IE6-only due to all sorts of good and mostly bad technology decisions. The problem here is that Microsoft has made huge investments in closing up web-based security holes – and to be sure that you’re reaping the benefits of this work, you must be more current in your choice of technology. Otherwise your own company is bearing the cost of dealing with anti-virus, malware, scams, and other attacks which seek to bypass the outer wall and enter in through browsers.

It would be no exaggeration to say that since the browser wars began, that billions of dollars have been spent not on moving forward – but on incompatibility support. Anyone who has built a site, or commissioned site has had a part in paying that bill.

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Recently there has been an exploding market of devices to keep us connected in an ever-growing world of information. People are getting used to the convenience of information on the internet, but we lack truly ubiquitous convenience of access to that information. I’m of the opinion that touchscreen subnotebooks will be the big hit for this type of casual and easy access largely due to form-factor.

First we had laptops. Laptop have proven to really be solid work-horses. You can get things done on them, but they are not too casual. You still end up needing to get comfortable with them and typically you have to tote some sort of carry bag and accessories with them, like the essential power connector.

On the other end of size and usefulness were phones. initially quite limiting but very small and comparatively long battery life. You throw them in your pocket an go.

Since then, there has been a large amount of convergence, though heavily weighted towards phones, which i really oppose for a variety of reasons. These convergence devices started with features, and not as an actual small computer. Think of Blackberries – it was all about email access. And phones started getting IM-like touches such as text messaging. Even today’s much more advanced devices such as Smart Phones and iPhones are quite limiting – partially due to overall size of screen real-estate to the raw (lack of) horsepower, to the controlling interests in maintaining their own experience (iPhone) to other artificial lock-ins like a lack of device portability tied to a carrier.

I find all of the above to be unacceptable – both from a hardware form-factor stance as well as freedom stance.

Ideally, i see things moving toward a subnotebook that lands somewhere between the size of a magazine and a book for both handling and viewing. It must be durable and readily handled as if you were carrying around a book. There should be some pretty easy touchscreen interface (think iPhone) for both drag-and-drop and manipulation as well as more traditional inputs like typing. it would be nice to have either the lid or the bottom infused with solar cells and/or have a pull-string operation for recharging- ala OLPC. Other portability aspects would include your choice of data carrier (this is YOUR device afterall, not AT&T’s).

Thankfully it appears that we are moving in this direction. The subnotebook market is exploding with competition, technologies like printable solar cells, plastic cells, hydrogen cells, etc are aiming toward longer portable ‘battery’ life, and other energy-saving technologies like OLED’s are coming. Increasingly there is a focus on low-wattage processors, solid state drives, RAM with partial sleep options – all of which gears toward lower power consumption. Data carriers are slowly getting a clue, and the technology exists for mesh networks, wifi, WiMAX and other forms of widespread data transmission.

The future looks good for information access.

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i can’t say that i find the results of google search any better than, say, MS Live search, but i keep using google. why?

laziness, familiarity, ease. i don’t go to search engine pages. i do however frequently use the search box in the upper right hand corner of Firefox and that doesn’t have Live. and while live is far more attractive and less distracting to look at, there is less friction getting to google for me. and while i’m sure that i could shoehorn in a live search, let’s face it – MS made Internet Explorer – the bane of my front-end development existence for years. They might be different teams and initiative at MS, but mentally i tie the two together.

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