Digital Medical Records, A Modest Proposal

For years and years (and years) there has been talk about the digitalization of medical records to enable portability. There are three primary problems that obstruct this vision, the first being a somewhat murky legal and regulatory environment with regard to what are the implications of the many laws dealing with privacy, data, and medical records, the second is a process issue dealing with how doctors work and their reluctance to embrace technology solutions that they perceive as inefficient, and lastly, it’s not clear that once you have your medical records how you will benefit from them.

On the last topic, one thing that should be obvious on its face is that walking into a ER with a few hundred megabytes of medical records on a flash drive is a non-starter… what would they do with them? I wonder if most doctors would want to have these records either, the burden of storing them and/or manipulating the unstructured text would be prohibitive. This issue speaks directly to the digital detritus problem I wrote about a while back, we have an exploding corpus of unstructured text data and the solution seems to be building bigger storage arrays… at some point we have to start getting rid of data that ends up not being useful.

I have a modest proposal to put forward that provides great utility, few objections, and achieves the goal of portability and digitalization of a specific kind of medical record, child immunization histories.

My idea is for an healthcare provider organization like the American Academy of Pediatrics (AAP) to sponsor an open source project to deliver a simple immunization database on a USB flash drive, with a simple but secure app that enables the printing of that record in a format that schools and other interested parties can accept. For the care provider side the app pairs to an app in the doctors office and allows for updating.

Rather than a boil the ocean approach this provides parents and other interested parties access to comprehensive immunization data for a child while not risking privacy or placing burden on care providers or parents, while doing away with the silly immunization cards that every parent has to deal with.

As a society we fail on the big things… let’s take small bites and build momentum that leads to additional progress on problems that we can solve.

Accidental Awesomeness

Props to Coté for a coining a great term. His post on TechEd ’07 CommunityDay is interesting on a couple of levels, this caught my attention:

For me, the most interesting aspect of the sessions was the hunger the audience generally had to get the code. For example, Thomas Jung demo’d a way to build Flex applications in the SAP editor [I’ve forgotten the name], doing away with the need to use FlexBuilder. Audience members kept asking him when SAP would release and where they could get it, and does it come in JSP flavor? The answer was that Thomas had worked on this after hours, that it was his code, and soon to up on Google Code as an open source offering.

I am hoping we see more of this, the unchaining of smart people hidden behind firewalls is nothing but goodness not just for the tech industry but for people everywhere. Open source means has ripple effects, the ripples that travel the farthest are the ones that begin with people doing things they are passionate about because it seems like a good thing to do rather than someone telling them to do it.

BTW, Coté wonders about SAP and Adobe, suggesting that their closeness is something more than just a good working partnership. These two companies have been close for years, and arguably SAP was the most important partner that Adobe had when they wanted to get into enterprise IT shops, much like SAP did more for Microsoft than any other company to legitmize SQL Server as a "real database". I wouldn’t read too much into the Apollo development work, we heard Vishal Sikka say without hesitation that they will work with Silverlight as well.

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Microsoft Cuts Vista Price in Half

But only in China.

The price cut is the company’s latest effort to tackle the rampant software piracy in China, according to The Wall Street Journal. The theory is that if legitimate software costs less, people will be less likely to turn to pirated versions.

Or it could be an effort to thwart the rise of Linux in China.

China would like to force Chinese to pay full price for Microsoft products, thus forcing more people to use Linux.

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An Alternate Look at Platform Selection

It’s not often that you find such a remarkably well constructed discussion about making a platform selection that doesn’t actually have much to do with the technical aspects of the topic.

"While I’d love to make a recommendation for one of these sexier frameworks, ultimately I’m going to recommend PHP and WordPressMU in this particular case. I’ve talked about some of the strengths of Rails and Django and for somewhat peripheral issues I’ve discounted both (not to mention completely dismissed .NET for similar and worse issues). I’d like to talk about why I think building a social network application in WordPressMU and PHP makes sense and how I came to this conclusion, keeping in mind that you should be comparing this list primary against .NET’s offerings rather than the other two frameworks."

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BT Acquires TiddlyWiki, Name Change Imminent

Jeremy Rustin sold his company to British Telecom, which at first glance may seem an improbable fit but when you consider the BT Workspace initiative it makes a lot of sense. Also, the fact that the team he will no doubt be a part of is based here in Palo Alto, well it’s actually a very good fit.

I’m delighted to announce that the mighty BT has acquired my tiny little company Osmosoft Limited. I’m joining BT as Head of Open Source Innovation, and I’ll be building a crack open source web development team called BT Osmosoft. To say the least, this is big news for me personally, and I hope will have a positive and lasting impact on the future of TiddlyWiki.

Congratulations are well deserved, Jeremy did a great job building something that when you looked at Tiddlywiki closely is very disruptive. Jeremy really is a pioneer in the space of microcontent and the concept of a fully self contained hypertext document that could posted to a webserver or emailed around is pretty nonlinear.

PS- regarding my name change imminent comment… you really don’t expect a company as old school as British Telecom would keep a name as cool as TiddlyWiki.

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OpenID at Work

ongoing · OpenID at Work:
OpenID (see my previous write-up) is a cheap-and-cheerful easy-to-implement way to bind an identity to a URI. It allows a Web site talking to a browser to look at the URI and reliably ask its server to confirm (or not) that the person behind the browser has OpenID rights to the URI. It’s simple, straightforward, and it works.

As much as I’m a fan of OpenID, I just don’t see enterprise IT adopting it. I don’t even see non-enterprise services adopting it with any degree of increasing momentum. Software developers like the idea but believe it falls far short of their requirements, so they aren’t investing much in the way of supporting it, and I don’t see Sun making a big impact.

We talked about this at the IBM mashup summit… it’s worth discussing further but it’s not going to solve the identity problem we have today.

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Why Can the Open Source Car Be Open AND Cool Too?

“The goal was to produce a simple, sturdy, easily-maintained, multi-functional, modular vehicle that was truly international.”

Apparently the other goal of the OScar project was also to create a car that makes you feel like a complete frickin dork.

Guess it was too much work to make it look like this?



The Great Identity Wars of 2007

When I was with SAP Ventures we invested in Ping Identity with the very simple investment thesis that 1) identity technologies were on a path to identity federation simply to reduce the complexity that users have to deal with across systems, and 2) the line between consumer and enterprise technology was blurring as business users (consumers themselves) would ultimately demand the kind of convenience with their business systems that they were getting from consumer technology.

The thesis was and is still sound but we missed one important element, openness. I’ve been a fan of OpenID for a while, starting with my first experience with it when I signed up for a MyOpenID URI as part of signing up for a Zooomr account. Ping and Sxip are still great solutions for enterprise deployments, but how do I get an identity on Ping or Sxip and use it for my business and my personal use?

Sure, I can use Sxipper if I use Firefox, and get an OpenID to boot, but simply remembering passwords is not enough to be a convenience for consumers and business users alike, and neither is a form filler. More to the point, my identity information has already been created online, it’s in the bits and pieces that exists across all the services I already use. How do I vacuum up all these bread crumbs and present it in unified form as my identity, without asking me to recreate it as a deliberate act?

A drivers license is a universally accepted ID and it’s completely self contained, I carry it with me and whenever I hold it for display it is accepted as a bona fide credential. What is the equivalent of a drivers license on the web? It would appear that AOL is aiming to be an identity authority and given their footprint in the market I would suggest they have a credible shot at it. Yahoo! is also making a big push with BBAuth in an attempt to leverage the massive amount of user information they have in their database, but AOL’s embrace of OpenID is smart because it makes a bet that an open identity technology will ultimately be the one most adopted by websites and systems, and it doesn’t require them to develop a lot of technology from scratch.

I think it’s pretty safe to say we’re going to see all the major consumer players adopt similar strategies as a means of securing a corner at an important intersection in the market.

Why AOL Created 63 Million New OpenIDs:
How does it affect AOL/AIM users? With the OpenID integration, an AOL user will be able to login to a service provider that accepts OpenID, using their AOL/AIM username/password, without needing to create a new service-specific username/password. This is a great way for AOL to try and retain its once formidable (and still significant) user base, by providing an OpenID-based solution to the knotty problem of web single sign-on. So AOL user names will potentially be an entry into hundreds of different web sites and services, thanks to OpenID.

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MySQL shuns GPL version 3

I pointed to this issue of religious purification in an earlier post. It’s called “open” source and not “free software” for a reason, open source is supposed to be about the fair sharing of code as opposed to stripping away anyone’s rights to assert ownership over something.

MySQL shuns GPL version 3 –

MySQL’s reasons for opting out from GPL3 are different from those of many Linux distributors, some of which have criticised the licence for its “religious” battle against digital rights management (DRM) technology.

In addition to banning DRM, the GPL3 is deemed controversial because it plans to prevent users and developers of software governed by the licence from launching any patent claims against open source.

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