Thoughts

You can always count on pride

On DC’s beltway, you can easily spot trucks carrying concealed military equipment. All you have to do is to go about your business, and you will pass one or two semi trucks every day, each carrying some big payload wrapped in canvas. While the trucks are generic, the canvas isn’t. You will almost certainly find some logo or initials on it.

If you’re diligent, you can trace that logo back to the company, then find out what contract they were awarded, by whom, and finally, what concealed equipment you might have seen. It’s not hard to do this if you have a somewhat basic knowledge of how government/military contracts work.

I’m not saying this because I want to divulge any government secrets or put anyone at risk. I simply want to point out that most people can’t keep their mouth shut when it comes to bragging about their work, particularly when they’re proud of what they’re doing.

Remember Napster back in its golden days (circa 1997)? You could log on and download music all day long. College students everywhere were doing it. I did it too, for a while, until I realized it was wrong to rob artists of their hard work like that. Later, I even deleted most of the music I’d downloaded, and since then, I’ve been buying my music.

I’m not sure how online music sharing works today, but back then, most hardcore music sharers would mark their files by putting some sort of identifier (such as a nickname) inside the meta data. Some even put site URLs in the meta data. I’m sure that as music labels clamped down on file sharers, these nicknames and site URLs made it easier for them to find the culprits.

These file sharers and the military contractors are just two examples of how one can always count on pride to get at some information. Like most things in this world, this is nothing new, but it’s something to keep in mind if you’re working on something you’d like to keep under wraps.

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Reviews

Google Health is a good thing

When it launched a few weeks ago, Google Health received fairly lackluster reviews. Privacy issues and lack of features were the main complaints. Well, I’m here to tell you those initial views are wrong.

Even if you’re a long-time reader of my site, you may not know what qualifies me to make that statement, so let me tell you a bit about myself.

My background

A few years ago, I was Director of Health Information Systems at a South Florida hospital, where I implemented an electronic medical records system. My job was fairly unique, because I not only wrote the policies and procedures for the system and oversaw its implementation, but I also rolled up my sleeves and built the various screens and forms that made it up. I, along with my staff, also built and maintained the servers and databases that housed it.

As far as my education is concerned, I hold a Master’s Degree in Health Services Administration (basically, hospital administration). I was also admitted to two medical schools. I ended up attending one for almost a year until I realized being a doctor wasn’t for me, and withdrew.

For plenty of years, I’ve been a patient of various doctors and hospitals, as have most, if not all of you, for one reason or another.

Furthermore, my father is a doctor: a psychiatrist. He has a private practice, and also holds a staff job at a hospital. My mother handles his records and files his claims with the insurance companies, using an electronic medical records system. I get to hear plenty of stories about insurance companies, billing ordeals, hospitals and the like.

So you see, I’ve seen what’s involved with medical records and access to said records from pretty much all sides of the equation. Again, I say to you, Google Health is a good thing, and I hope you now find me qualified to make that statement.

The benefit of aggregation

Just why is it such a good thing? Because I wish I could show you your medical records — or rather, their various pieces — but I can’t. That’s because they exist in fragments, on paper and inside computer hard drives, spread around in locked medical records facilities or in your doctors’ offices, all over the place. If you endeavored to assemble your complete medical history, from birth until the present time, I dare say you’d have a very difficult time getting together all of the pieces of paper that make it up — and it might not even be possible. That’s not to mention the cost involved in putting it together.

A few of the problems with healthcare data sharing

Do you know what my doctor’s office charges me per page? 65 cents, plus a 15 cent service fee. For a 32 year old male (that’s me) it would take a lot of pages (provided I could get a hold of all of them) and a lot of money to put my medical record together.

The sad part is that this is MY medical information we’re talking about. It’s information that health services workers obtained from MY body. It’s MY life and MY record, yet I can’t have access to it unless I fill in a special form at every doctor’s office I’ve ever visited, and pay for the privilege. Is that fair? NO. Can something be done about it? YES, and so far, Google Health is the only service I’ve seen that is trying to pull together all of the various pieces that make up my medical record, for my benefit and no one else’s. Sure, the system is in its infancy, and there’s a lot of work to be done to get it up to speed, but that’s not Google’s fault.

I’ve been inside the healthcare system, remember? I know how things work. I know how slowly they work, to put it mildly. I know how much resistance to change is inherent in the system. Just to get medical staff to use an electronic medical records system is still a huge deal. The idea of giving the patient access to the records, even if it involves no effort on the part of the medical staff (but it does, as you’ll see shortly) is yet another big leap.

Let’s also not forget to consider that medical records systems are monsters. Each is built in its own way. There are certain lax standards in place. Certain pieces of information need to be collected on specific forms. The documentation needs to meet certain coding standards as well, or the hospitals or doctors’ offices or pharmacies won’t get reimbursed. There are also certain standards for data sharing between systems, and the newer systems are designed a little better than older ones.

Yet the innards of most medical health systems are ugly, nasty places. If you took the time to look at the tables and field names and views and other such “glamorous” bits inside the databases that store the data, you’d not only find huge variations, but you’d also find that some systems still use archaic, legacy databases that need special software called middleware just so you can take a peek inside them, or form basic data links between them and newer systems. It’s a bewildering patchwork of data, and somehow it all needs to work together to achieve this goal of data sharing.

The government is sort of, kind of, pushing for data sharing. There’s NHIN and the RHIOs. There are people out there who want to see this happen and are working toward it. Unfortunately, they’re bumping up against financial and other barriers every day. Not only are they poorly funded, but most healthcare organizations either do not want or cannot assign more money to either getting good record systems or improving their existing ones to allow data sharing.

Add to this gloriously optimistic mix the lack of educated data management decisions made in various places — you know the kind of decisions that bring in crappy systems that cost lots of money, so now people have to use them just because they were bought — and you have a true mess.

Oh, let’s also not forget HIPAA, the acronym that no one can properly spell out: Health Insurance Portability and Accountability Act. The significant words here are Insurance and Accountability. That’s government-speak for “CYA, health organizations, or else!” There’s not much Portability involved with HIPAA. In most places, HIPAA compliance is reduced to signing a small sticker assigned to a medical records folder, then promptly forgetting that you did so. Your records will still be unavailable to you unless you pay to get them. Portability my foot…

Benefits trump privacy concerns

Alright, so if you haven’t fallen asleep by now, I think you’ve gotten a good overview of what’s out there, and of what’s involved when you want to put together a system like Google Health, whose aim is to pull together all the disparate bits of information that you want to pull together about yourself. Personally, I do not have privacy concerns when it comes to Google Health. There are more interesting things you could find about me by rummaging through my email archives than you could if you went through my health records. If I’m going to trust them with my email, then I have no problems trusting them with my health information, especially if they’re going to help me keep it all together.

Not sure if you’ve used Google Analytics (it’s a stats tool for websites). Not only is it incredibly detailed, but it’s also free, and it makes it incredibly easy to share that information with others — should you want to do it. You simply type in someone’s email address in there, and you grant them reader or admin privileges to your stats accounts. Instantly, they can examine your stats. Should you prefer not to do that, you can quickly export your stats data in PDF or spreadsheet format, so you can attach it to an email or print it out, and share the information that way.

I envision Google Health working the same way. Once you’ve got your information together, you can quickly grant a new doctor access to your record, so they can look at all your medical history or lab results. You’ll be able to easily print out immunization records for your children, or just email them to their school so they can enroll in classes. A system like this is priceless in my opinion, because it’ll make it easy to keep track of one’s health information. Remember, it’s YOUR information, and it should NOT stay locked away in some hospital’s records room somewhere. You should have ready access to it at any time.

Notice I said “whose aim is to pull together all the disparate bits of information you WANT to pull together” a couple of paragraphs above. That’s because you can readily delete any conditions, medications or procedures you’d rather keep completely private from Google Health. Should you import certain things into it that you don’t feel safe storing online, just delete that specific thing, and keep only the information you’d be comfortable sharing with others. It’s easy; try it and see.

Lots of work has already been done

Another concern voiced by others is that there isn’t much to do with Google Health at the moment — there isn’t much functionality, they say. I disagree with this as well. Knowing how hard it is to get health systems talking to each others, and knowing how hard it is to forge the partnerships that allow data sharing to occur, I appreciate the significant efforts that went on behind the scenes at Google Health to bring about the ability to import medical data from the current 8 systems (Beth Israel Deaconess, Cleveland Clinic, Longs, Medco, CVS MinuteClinic, Quest, RxAmerica and Walgreens).

What’s important to consider is that Google needed to have the infrastructure in place (servers, databases) ready to receive all of the data from these systems. That means Google Health is ready to grow as more partnerships are forged with more health systems.

In order to illustrate how hard it is to get other companies to share data with Google Health, and why it’s important to get their staff on board with this new development in medical records maintenance, I want to tell you about my experience linking Quest Diagnostics with Google Health.

Quest is one of the companies listed at Google Health as having the ability to export/share their data with my Google Health account. What’s needed is a PIN, a last name and a date of birth. The latter two are easy. The PIN is the hard part. While the Quest Diagnostics websites has a page dedicated to Google Health, where they describe the various benefits and how to get started, they ask people to contact their doctors in order to obtain a PIN. I tried doing that. My doctor knew nothing about it. Apparently it’s not the same PIN given to me when I had my blood drawn — by the way, that one didn’t work on Quest’s own phone system when I wanted to check my lab results that way…

Quest Diagnostics lists various phone numbers on their site, including a number for the local office where I went to get my bloodwork done, but all of the phone numbers lead to automated phone systems that have no human contact whatsoever. So Quest makes it nearly impossible to get in touch with a human employee and get the PIN. Several days later, in spite of the fact that I’ve written to them using a web form they provided, I still don’t have my PIN and can’t import my Quest Diagnostics lab results into my Google Health account.

Updated 5/27/08: Make sure to read Jack’s comment below, where he explains why things have to work this way with Quest — for now at least.

That is just one example of how maddening it is to try and interact with healthcare organizations, so let me tell you, it’s a real feat that Google managed to get eight of them to sign up for data sharing with Google Health. It’s also a real computer engineering feat to write the code needed to interact with all those various systems. I’m sure Google is working on more data sharing alliances as I write this, so Google Health will soon prove itself even more useful.

More work lies ahead

I do hope that Google is in it for the long run though, because they’ll need to lead data sharing advocacy efforts for the next decade or so in order to truly get the word out to patients, healthcare organizations and providers about the benefits of data sharing and Google Health.

For now, Google Health is a great starting point, with the infrastructure already in place and ready to receive more data. I’m sure that as the system grows, Google will build more reporting and data export capabilities from Google Health to various formats like PDF, as mentioned several paragraphs above, and then the system will really begin to shine. I can’t stress enough what a good thing this is, because just like with web search, it puts our own medical information at our fingertips, and that’s an invaluable benefit for all.

Join me for a short screencast where I show you Google Health. You can download it below.

Download Google Health Screencast

(6 min 28 sec, 720p HD, MOV, 39.8MB)

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Lists

Condensed knowledge for 2008-03-26

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Lists

Condensed knowledge for 2008-03-07

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Lists

Condensed knowledge for 2008-03-06

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How To

Block anonymous calls with SkypeIn

You may or may not know that Skype offers a service called SkypeIn, which lets you get a local number that people can call to reach you anywhere in the world, provided you’re logged into Skype. I’ve had a SkypeIn number for the past couple of years, and I love it. Want the number? It’s +1 (301) 637-6885.

Do you know why I can give it out so freely? First, because all my calls go right to voicemail. I get that bundled with SkypeIn. I screen all my calls that way and delete all of the annoying telemarketing calls. Second, because of a great feature that I’ve discovered yesterday. It’s hidden away in the Advanced settings for Calls, and it blocks most telemarketing calls automatically.

Here’s how it works. Open Skype and go to Tools >> Options. Then click on the Calls icon, located in the sidebar of the Options dialog box. You’ll get the following screen:

Basic call settings in Skype

Now click on the “Show Advanced Options” button. You’ll get this screen:

Advanced call settings in Skype

Now look for the option that says “Allow SkypeIn calls from…” and select “anyone”, then make sure to check the option called “Block calls when number is hidden”.

Doing this will block most telemarketing calls, since they usually hide their numbers. Isn’t that beautiful?

If you want to make sure none of them get through to you, just go to the Voicemail section and look for the “Send calls to voicemail if…” option, then change the number of seconds to 1 or something really small. That way everything that makes it past the initial call filter goes right to voicemail. This allows you to listen to the messages later and hit delete without wasting your time. I have my threshold set to 10 seconds. If I’m logged into Skype, that usually gives me enough time to see who’s calling and decide if I want to take the call or not. If I’m not logged in, then all the calls go directly to voicemail anyway.

Voicemail settings in Skype

Hope this helps!

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Thoughts

A look at culture and technology through sound effects

I was listening to the radio one morning, and realized the sound effects they were using to advertise a website were the clicks of a keyboard likely made in the 80’s — you know, long key travel, spring-loaded action, hard clicks. But it worked.

More importantly, it is the only sound that can approximate a keyboard well, and transmit that action to an audience. Think about where keyboards are going today though. Apple is putting out keyboards that barely make any sounds — for example, see the new slim iMac keyboard, or the MacBook or MacBook Pro keyboards. Other hardware manufacturers are following suit, each advertising softer keys, more muffled sounds, etc. How do you record that? It can’t translate well over radio as a sound effect.

Remember how they used to advertise accessing the internet just a few short years ago? Through the sounds of modems. Tell me, could anyone afford to advertise internet access like that any more? No, they’d get laughed out of business, because most everyone is using high-speed access now. But is there a sound that can represent an Internet connection now? How do you represent it or record it?

What about the sound effects for phone calls? They were the simple, old-fashioned ring, right? Everyone knew what it was, and there was no confusion. Not any more. Although people still recognize the old phone ring, children growing up nowadays have so many choices when it comes to ringtones, that soon enough, the old phone ring will no longer be a recognizable sound effect for phone calls.

In some of the older movies or radio commercials, beeps, flashing lights and loud sounds were used as sound effects for computers. The starts and stops of tape reels were well known as well. What about the sounds of the punch cards, rolling through the machines and getting processed? Those are all things of the past. The only sounds computer hardware makes nowadays is the drone-like noise of the hard drives and cooling fans. It may be the representation of an efficient computing machine, but it’s pretty boring as a sound effect. Desktops or laptops (the newer ones anyway) make no sounds at all. We prize them based on how little sound they make, and rightly so, but we’ve lost the sound effects.

Remember the sound of switching TV channels? There was the manual, hard click of the round knob on the TV set (not many of you know about those anymore). If you were using a remote on older televisions, there was a sound pop, followed by a short period of static and the sound of the new channel that accompanied each channel switch. On newer televisions, that’s no longer the case. There’s no pop, click or jarring sound transition during channel switches. It’s all handled smoothly, and on some, the sound is gradually brought up to listening volume so as not to disturb you. But how do you represent a channel switch in a radio ad? You can’t, not anymore, not unless you use a decades-old sound effect.

The point of all these examples is to illustrate how technology is outpacing culture. I wanted to look at this through sound effects, but there are many ways in which it can be done. Just think of social networking sites, their invasion of privacy, and the new expectations of online behavior if you want to look at another aspect of this same issue.

One thing’s for sure — our culture has some catching up to do. While I love technology and embrace it (for the most part), we have to recognize that we’re in uncharted territory nowadays, in many, many areas of technology, particularly at its intersection with people and general culture. The rules aren’t even getting written, because no one is sure just how to grasp the situation. We each understand but a little portion of what’s going on — and that’s both scary and exciting, depending on your point of view.

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Reviews

Some interesting documentaries

Here are seven interesting documentary-type videos found on YouTube:

You’ve probably heard that Geek Squad technicians snoop around on customers’ hard drives and copy photos and other files for their own use. But have you also heard that they overcharge ridiculously for simple little repairs? Have a look below:

The metro bridge over the river Tyne at Newcastle, UK, was recently outfitted with LED lights that are programmed to never shine in the same sequence. The result is a mesmerizing light show that goes on and on:

Bill Crosby did a documentary in 1968 called “A Boy Like Me”, where he pointed out racial inequalities between black and white children. But he did it in such a poignant way that it’s really, really hard to miss the point. Watch this segment in its entirety, it’s only 3:28 minutes long.

The Falkirk Wheel is an advanced bridge for boats. It connects two bodies of water that are separated by a great height in a very interesting way:

Whether you may or may not agree with this first part of the documentary entitled “The Great Global Warming Swindle” (the other parts can be found on YouTube as well), I think you’ll realize it raises some interesting and valid points. I watched the entire documentary, and if you’ve got the time, I would encourage you to do the same.

The next video is pretty geeky in its approach, but it was made to demonstrate how IT security works for non-techies, and it does a great job of it. It’s entertaining, so you won’t get bored, either.

This last video is controversial, and I don’t know what to make of it. It’s actual news footage aired immediately after the crash of United Flight 93. It shows the crash site and surrounding areas, but the strange thing is that the place looks very much unlike a plane crash site. There are no large pieces of fuselage, no bodies, nothing — just a small hole in the ground, and that’s what makes it unusual. It just doesn’t look like a plane crashed there at all.

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Thoughts

How is your private data getting used?

I read the Red Tape Chronicles over at MSNBC on a regular basis, and one of their latest posts really struck a chord with me. We really have become a nation where everything gets tracked, whether we like it or not. To some extent, I don’t really care. If the government wants to tap into my phone calls, fine. Been there, done that. I grew up in communist Romania, and our phone was tapped. There’s nothing of real interest to strangers in my phone calls anyway. And besides, you’d have to be a sort of a peeping tom to want to listen in on strangers’ conversations, anyway. Not my type of job.

What really irks me is that every little footstep off the beaten path gets documented somewhere. Not that it’s happened to me, but say I get in a brawl and get locked up overnight, then sort things out in the morning. That little brush with the law may affect me for years to come, even though that’s not the type of person I am. I may regret it, I may not usually do those things, it may be that it just sort of happened, but it’s going to stay on my record. And the payback’s brutal. I may not get new jobs, and if I want to attend classes at some school, I may not be able to get in. It may even affect my credit history. It’s all because of a stupid system that tracks one’s every legal move with no discernment.

This whole mess wouldn’t be a bad thing if there were only one system, and updates to that system were handled properly. But no, there are hundreds and thousands of various government databases, and data from those databases flows into private background check databases and clearinghouses, until there are copies of that single incident all over the place. I may be able to get the government to edit out that little troublesome incident, but there’s no way to track down all of the other digital copies of that record and make sure they get changed. That’s VERY disturbing.

Just do a search on Google for background checks. There are a ton of websites where you can check details about anyone. It used to be that only law enforcement officials were able to conduct such searches, but now any Joe Blow with a credit card can find out information about anyone. That really gets my goose! What right does some freak somewhere have to know stuff about me? Exactly how have our public officials let this happen? You can find out anything: properties, debts, criminal record, demographic information and possibly income, address, phone number, marriage and birth information, anything. I find this VERY DISTURBING.

What’s worse, who knows where these businesses get their data from, and how often they update their information? Looks to me like most are fly-by-nite operations that only care about having a record about someone, not the record. If they list bad information about me, how do I go about changing it? I can’t possibly contact every single one of these shady operations. Yeah, I call them shady, because I think they have absolutely no right to my private information. Only licensed law enforcement officials (read certified and cleared government employees) ought to have the right to view my aggregated private information. Yet these people profit from MY private information by selling it to whoever wants to get it. This disgusts and angers me.

Anyway, what got me started down this warpath? Those of you who know me know that I like old movies. Remember scenes from those movies where people would get into brawls, or there’d be some misunderstanding, and they’d get booked? They’d spend the night in jail, get out in the morning, and be done with it. Everyone would laugh about it. That’s how it should be for the occasional offense. It should NOT affect one’s career, education and finances. Everyone messes up here and there. These mistakes should not be recorded for posterity, or if they are, they should not be made available to every idiot that wants to look at them. It just isn’t right. And no, I’m not talking about serious or repeat offences.

We may have modernized our data storage and retrieval, but we’ve lost our good, old common sense about how to use it.

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How To

Mechanical locks on the way out?

At least their current iterations, anyway. Turns out a $1 bumpkey – a key whose every notch was cut to its lowest setting can easily open any lock of a given brand. (You need a bumpkey for each brand/kind of lock). Basically, this bumpkey then becomes the master key for all of the locks that use a particular kind of key. Since there are about a dozen kinds of locks on the market, all a thief needs to carry around is a dozen or so bumpkeys, and he can get into your home in less than a minute.

It gets worse: insurance companies don’t reimburse for theft due to bumpkeys, because no damage is done to the door. They can’t determine that someone forced their way into your home, and they’ll simply assume that you left your door open, or are trying to scam them.

Both Make and Engadget are talking about this, and there’s a video as well. You won’t believe your eyes!

Lest you forget, you can open “tough” bicycle U-locks with a BIC pen.

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