Ridesharing

This week I have been reflecting on healthcare's infatuation with "Uberization." Our organization has not been shy about embracing this new innovation as something that will revolutionize our work. Just imagine the hoards of physicians clutching their black bags, driving their Escalades and watching their smartphones as they rush towards the waiting patient with a sprained ankle. (Actually, they probably will be driving beater Honda Civics after the economics of Uberization take effect...) 

But, before we blindly embrace the gig economy as the default future of healthcare delivery maybe a little skeptical analysis is in order. This article asks some fairly rational questions wrapped around a blog post from Jay Parkinson, MD (the guy who who was the hipster equivalent of Uber Healthcare back in 2007 before Uber was cool.)

(For balance, you might want to explore the Libertarian view of the magical way market discipline will reduce costs and improve healthcare delivery by unleashing the superpowers of consumerism. Did that last sentence come across as a bit too sarcastic?) 

The reality is that we're not even sure that Uber is a "good thing" on the whole. It certainly is a good thing for the folks who own the platform - like a lot of powerful technological platforms that aggregate the power to control and broker supply and demand in the digital world. Maybe a broader understanding of what is actually going on in the background is useful? This guy's new book might be worth reading. And, my favorite Russian has a few things to say as usual. 

At the end of the day, I am a realist and firmly believe that the combination of data, connectivity and algorithmic processing power will fundamentally change the role of healthcare providers. But, I tend to believe that it will be the virtualization of the services that we deliver as providers that will be our path forward. Much of the cognitive work performed by providers distills down to information exchange: collecting information from the patient, analyzing the information and pushing a synthesis of that information back to the patient to act on. This work can (and will) be automated and virtualized as a self service.  

And, the vast majority of preventative health maintenance falls in this category... (I tend to think we should be partnering with Jiffy Lube instead of Uber.)

What do you get when you combine 100 drones, a symphony orchestra, some computers and Beethoven?

This week's drone mashup, of course!

(I suspect there are a few algorithms involved as well.)

Have a great weekend!

Randale

The Games We Play

For all of you who fled to Go after Deep Blue beat Gary Kasparov in Chess, thinking you would be safe from embarrassment at the hands of a machine…

…sorry.

I will share this eulogy to human Go players. Here are a couple of other points of view on the milestone if you are very interested.

This distinction around "narrow AI" is interesting in that, once again, we see the two competing pathways forward: AI (Artificial Intelligence) versus IA (Intelligence Augmentation.) It seems that the consensus is that the short term commercial value favors IA and the long term challenge is a "general purpose" AI that tries to mimic human capabilities - including consciousness. (I suppose that the one we have to worry about destroying the human race is the later.)

One of the other debates around predicted tectonic shifts that I try to follow is the one about how consumerism is poised to remake healthcare. The digital transition of healthcare is intimately intertwined; it is the vehicle that, presumably, will finally allow this shift to be realized. Here are two recent resources that I found useful in evaluating how much hype surrounds this driver of healthcare transformation.

Looking back over the last 30 years, it seems clear that the provider-patient relationship has moved from a relationship that is perceived as primarily fiduciary in nature to a relationship that more resembles a service transaction that is dictated by the ethos of the market. The idea that we will ultimately become another market based commodity seems entrenched in our current strategic thinking about the future; that we must respond to consumerism seems to be an unquestionable assumption. (Given that our entire culture has been heavily influenced by this neoliberal transformation, I guess it would be hard to refute...)

Regardless, we are certainly investing heavily in that strategy.

What do you get when you do a mashup of NASCAR, YouTube, Drones and $8 million in Venture Capital?

Have a great weekend!

Randale

Market Driven Compliance

This week, I've been pondering what the word "compliance" will mean in the future.

Imagine all those people who are non-compliant taking their medications, following their provider's instructions or maintaining ideal body weight. (I'm 3 for 3...)

Do they not understand the risks they are taking?

Do they not understand they are letting other people down in their risk pool?

Do they not understand what this is costing the pharmaceutical industry in lost revenue?

Well, in the future there will be technologically driven solutions to those problems...

This approach essentially turns the individual into a risk pool of one. Individual behavior becomes a market commodity that has a projected monetary value attached to your potential risk. Given that our financial scheme for healthcare is primarily an employer based insurance model, you might risk becoming a "cost center" with a discrete number attached... That should provide some incentive to all us laggards.

There is also the somewhat ephemeral approach to behavioral modification that has been in vogue for some time - "the nudge" - where a sophisticated "choice architecture" is created to influence the end user to do the right thing. This is not a technological solution, but rather a combination of policies and incentives designed to stack the deck a bit towards the preferred solution (i.e., the solution of whomever establishes what should be preferred.)

The problem is that there is a lively ethical debate around nudging; is it benevolent paternalism or creepy manipulation in disguise?

Someday, maybe we'll ponder on whether we really have anything like "free will" at all or are simply rats in a Skinner box responding to environmental cues... But, for today, let's just ask ourselves where we will strike a balance in our choice architecture. Incentives and outcomes fall into a utilitarian's quantitative rubric - neat and tidy. Compassion and tolerance fall into the deontologist's qualitative framework - a bit more messy.

How ready (and willing) are you to become a responsible member of the collective?

If you would prefer to distract yourself from all this pondering, you could download a drone racing simulator and join this virtual racing league:
 
Have a great weekend mastering the simulator!

Randale

The Gift of Experential Learning

I am just beginning to understand the concept of "balance" as it pertains to a moving race car. Don't get me wrong, I understood the concept theoretically speaking. But after this last year of racing, I am finally understanding balance in a whole new way - maybe as something that approaches "embodied learning" of some sort.

It's one thing to understand the physics of car balance; it's quite another thing to be able to feel it, manipulate it and begin to refine it.

Matthew Crawford spends an entire book (The World Outside Your Head) trying to explain the difference between conceptual knowledge that comes from an intellectual understanding and the knowledge that comes through participating in a "practice." I think he has something interesting to say about how this practical knowledge is worth preserving (not that it is any real danger of disappearing...) But the knowledge that we tend to value these days is getting to be a bit more abstract.

It's time we revisited Aristotle's concept of "techne."

The bottom line is that learning to balance the car using the three inputs at your disposal (steering, brake and throttle) is not something you do with your head. You might explain it after the fact using your head. But, actually doing it requires much too fast a response to think about it at the time. In fact, some of the things you are required to do to balance the car are somewhat counter intuitive to the way you probably learned to drive a car on the street. (I don't know about you, but I can't remember anyone ever suggesting that hitting the gas as you entered a curve was a "good thing." Who knew...)

There is something that is deeply satisfying in nurturing techne - whether it is in a race car or some other embodied practice.

Human Computer Interaction - or Relationship?

I’m sitting in the therapeutic Nevada sunshine working on my Seasonal Affective Disorder this weekend. I’ll let you know on Monday morning whether its working out the way I would hope…

So far, I've watched a brand new Corvette get totaled in a tire wall. (No physical injuries - just financial.) I have one front wheel bearing that went bad and needed replacing. But the sunshine definitely beats the grey skies and slushy snow on the ground back in Montana.

In my day job, I hear a lot from physicians about how much the "story" about a patient means. We're all about the narrative.

But, the quest to turn everything about the patient into structured data has given us the EHR we have today that is heavily infiltrated with small square text boxes, pick lists and mouseclicks. We now have a competing ideology that promises to deliver us from that Purgatory (Hell?) through the use of Natural Language Processing (NLP) that will extract structured data from our unstructured musings. We'll see how that works out...

But, what about the inverse of that paradigm? What if, instead of looking at graphs and dashboards of all that structured data, the computer just told you what was going on?

Well, that would be Natural Language Generation (NLG) and that is probably one more component of the human-computer interaction puzzle.

Here is a 15 minute podcast that you might find interesting.

The company website is probably worth a click or two as well.

(I guess if I was a patient attached to a bunch of sensors, I could just login to MyChart and ask the computer to tell me what was going on... and skip the appointment altogether.)

My boss shared this recent article that takes a bit more nuanced view of human computer relationship from (of all places...) The Oxford Research Centre in the Humanities at Oxford University.

Maybe our exploration of the relationship we are going to develop with our machines is just beginning?

Finally, something to ponder for all of the Narcissists out there looking to have a drone "entourage" in the future.

Have a great weekend!

Randale

Friday IoT

I have a simplistic view of the world we are headed towards:

1)    Ubiquitous sensors, big data and algorithms will increasingly replace human cognition
2)    Robotics will increasingly replace human action.

The guy that some think is primarily responsible for the Internet as we know it today is probably a good source of prognostication.

We will truly live in the best of all possible worlds! What could possibly go wrong?

Well, it’s probably worth pondering the implications of living this dangerous world (where is Voltaire when we need him most?)

And, these implications don’t even begin to address the issues around always on surveillance.

I would also argue that the primary source contributing to the escalating burnout among physicians that has been in the news so much lately is the erosion of agency. Being a Physician has traditionally been one of the roles in society that allowed an incredible degree of agency. In a world where machines increasingly direct, or actually do most of the thinking and acting, where will humans find a source of value through agency?

Is there any value in nurturing something that doesn’t really fit into our Puritan work ethic?

Have a great weekend!

Randale

Snow in the Mojave

50 degrees and partly sunny beats 12 degrees and gray any day. The car is a bit squirrely due to the cold tires. (But back in Montana, my truck is squirrely every day because of the ice...)

But if oyu look in the distance there is snow surrounding the Pahrump Valley.  It's actually pretty close.

Some folks from the track took their Razer on a 25 minute drive towards the mountains and found about 8 inches of fresh snow to drive around in. Given they are from Los Angeles, this was some pretty brave driving...

No, they did not have to walk home...

Randale

The Upside Of Self Deception

I'm a big fan of self-deception. I suspect it is the only thing that allows us to remain engaged with a meaningless existence in an indifferent universe... But, I digress.

The ruthless objectivity of Big Data promises to deliver us from self-deception - or does it?

http://www.nature.com/news/how-scientists-fool-themselves-and-how-they-can-stop-1.18517

Our knowledge of objective reality has always been mediated through the tools we have developed to extend our senses. Data science is no different; we are putting a great deal of trust in the belief that our black box algorithms are accurately reflecting objective reality.

And, continuing with our rumination on what role humans will ultimately play in the brave new world of artificial intelligence, this concept made quite the splash this past week:

http://www.eurekalert.org/pub_releases/2015-12/hci-hsc121815.php

Is this the "middle way?" I find it fascinating that human brains are being conceived as the "processors" in a massively parallel computing system where the computer is acting as the glue. Maybe the Internet really is the destined to be a form of global consciousness...

Finally, you knew it was going to happen:

http://qz.com/588323/this-self-flying-drone-can-carry-you-to-work/

(I'd be real careful getting out of that giant blender with a seat.)

Have a great weekend!

The Zen of Drones

The affair begins with the arrival of a small parcel in the mail; one that was oddly out of sync with the steady stream of brown corrugated boxes that define the shopping experience in the ecommerce era. Inside the multiple layers of bubble wrap, apparently hand wrapped by another human, are several smallish pieces of carbon fiber that are at the same time delicate and indestructible.

This, in turn, sets in motion a series of events: Google searched, websites consulted, videos watched, plans hatched, choices made; and a steady stream of additional small packages begin to arrive. 

Finally, the question of "what if?" must collapse into reality and become what is - replete with all the compromises that creation requires.  

The initial skills required in the creative effort are relatively straightforward: manipulating precision 3mm screws to construct a futuristic looking carbon fiber frame. So far, so good.

From there, things get a bit more challenging: a basic understanding of electricity, wiring diagrams - and soldering.

Soldering is as much a practice as it is a skill. Using the proper technique, a strand of silver metal becomes liquid in an instant, flowing effortlessly around the various components destined to be wedded together. Just as quickly, the metal hardens and converts the construct into something new, greater than the sum of the parts. The quest for the perfect solder joint has a spiritual quality; done well, it is a thing of beauty. Many opportunities to aspire to this perfection present themselves in the course of the creation.

Completing this journey results in a tangled mess of rainbow colored wires connecting a series of small, delicate circuit boards, several deceivingly small electric motors, a video camera and a couple of antennas - all squeezed into the carbon fiber skeleton. This object is not what would typically pass for beauty; it screams function over form. It sits inert waiting for the next stage in its metamorphosis.

My anticipation is palpable as the abstract code of computer software contained to this point in vitro are about to combine with very tangible carbon fiber, small metal screws and electric motors that reek of substantial potential about to be unleashed in vivo. Connecting the creation to the computer ignites a light show as the LEDs come to life and begin to speak and communicate in a language that is understandable to those who care about such things. Connecting the battery creates a cacophony of sounds as the electronics calibrate themselves. The cat is on high alert; the Corgi runs for cover. Settings are tweaked, motors are tested, controls are enabled.

Almost ready, the machine hovers in the middle of the room emitting a high pitched scream that seems to convey its yearning to be free of this cage. 

At the field, I connect the battery. And, once again I am greeted with the sounds and lights that signify the awakening of the synthetic creature that sits before me. I put on my googles, step back and push the throttle forward. 

For the next 7 minutes I merge with my creation, seeing the world through its eyes, flying as if a bird.