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Skeptics and competitors anticipate HIMSS '08 keynote by Google's Eric Schmidt

I'm still looking for a blogpost from someone who attended yesterday morning's keynote at HIMSS '08 by Google CEO Eric Schmidt.

Modern Healthcare is reporting skeptical comments from some medical informaticians about Google's involvement with PHRs:

Physician Daniel Masys, who chairs the department of biomedical informatics at the Vanderbilt University School of Medicine, said Google, the Internet search giant, has “no idea of what it’s getting into” with the company’s plans to launch a personal health record.

And:

...[S]peaker Holly Miller, a physician who is vice president and chief medical information officer at University Hospitals in Cleveland and chairwoman of the HIMSS PHR Steering Committee, took a swipe herself, saying that personal medical information stored by Microsoft or Google has no legal protection to guard the privacy and security of the information.

Google already has competition from such companies as Microsoft's HealthVault, Healthline, WebMD and Revolution Health, founded by AOL founder Steve Case.

As the HIMSS conference was opening Monday, Microsoft announced that it was providing $3 million to help attract health application developers to its HealthVault electronic medical records platform.

In particular, Microsoft is interested in applications related to preventive care, acute care diagnosis and treatment, management of juvenile diseases, women's health, and community and social health applications.

Microsoft is also making a gesture towards the open-source software community in an effort to comply with antitrust legal requirements.

MORE: The Wall Street Journal Business Technology blog is just as skeptical:

While researching our article, we came across a number of people who thought the tech companies are naïve — bordering on arrogant — to think they could come waltzing into the healthcare field and settle decades-old turf wars.

And, to close their blog post:

But we’re pessimistic: Tech alone – or even combined with a brilliant marketing strategy – is enough to overcome institutional resistance. That’s true for projects, companies, and yes, industries.

The announcement on the official Google blog by Marissa Mayer, VP, Search & User Products.

The WSJ's coverage of the announcement yesterday.

Sony releasing new crop of digital voice recorders in April; speech recognition supported

Here's a photo of Sony's new digital voice recorders ICD-UX70 ($100), ICD-UX80 ($150) providing 1GB and 2GB in memory, respectively. Both support stereo MP3 recording, USB mass storage.

Their ICD-SX68 ($150) and ICD-SX68DR9 ($200) both have 512MB and support Dragon NaturallySpeaking speech recognition. The DR9 is bundled with the Dragon software.

Finally, they're releasing  the ICD-P620 ($60) and ICD-B600 ($40), both with 512MB and USB mass storage. The P620 includes Digital Voice Editor software.

Google's PHR to debut at the Cleveland Clinic

The NY Times is reporting that the Cleveland Clinic will start a pilot project linking the health records for some of its patients to Google's personal health records (PHR).

Here's an example the points up the need for such a service:

Cleveland Clinic is at the cutting edge of health information technology, and its more than 100,000 patients each has a personal health record. But a sizable portion of those patients are retirees, notes Dr. C. Martin Harris, the clinic’s chief information officer. Many of them, he said, spend about five months elsewhere, typically in Florida or Arizona, and the clinic’s sophisticated electronic health records don’t follow them there.

For my experience covering the ER as a surgery resident, a significant number of patients had trouble saying what meds they were taking, or giving a brief account of their medical history. Some had a slip of paper with the list of meds in their wallets or purse, a very few had a detailed medical history with them also.

It seemed so haphazard in trying to find out very important information, such as if the patient was taking coumadin, an anticoagulant. I would imagine that with the Google system, it would just be a matter of the patient or relative giving permission to access the PHR, then the information would be available immediately.

However, it becomes the responsibility of the patient or the caretaker to create and keep these records up to date. It might happen that their personal MD could upload significant information into their accounts, such as ECGs or recent lab data, but I haven't heard of any program to do this as of yet.

Data such as recent blood glucose levels, blood pressure could be captured via wireless sensors and then stored in their cell phones or uploading directly to the Google PHR site. Making it easy to maintain these records will be a prime consideration.

BusinessWeek mobile killer apps: two do speech recognition

This is part of their Wireless World special report.

The particular story I want to talk about, "Killer Mobile Apps," is Handango's list of most downloaded software for smartphones. But I can't link to it because it's a slide show that comes up as a pop-up window.

Here're the ten:

MobiTV - $10 per month to watch MSNBC, ABC, Discovery Channel, etc.

Spb Mobile Shell 1.5 - uncluttering Windows Mobile

Spb Pocket Plus - customizing the Windows Mobile display

VoiceControl - Provided by Nuance Communications for $6 a month, the software enables users of devices based on the Palm OS to voice-dial, dictate e-mail and text messages, and view Web content without pressing a button.

Ringtone Megaplex for BlackBerry - "Designed for Research In Motion's (RIMM) BlackBerry devices, this software offers more than 1,000 distinctive ringtones in genres from classical to pop."

Microsoft Voice Command - From Microsoft for $39.99. This is another speech recognition application that makes it easier to use voice commands, this time to look up contacts, make phone calls, and choose music.

Pocket Mirror Standard Edition - sync MS Outlook features to Palm OS

Ringphonic Lite - $7 per month to let BlackBerry users customize their ringtones

Pocket Informant 2007 - For Pocket PC users, it allows them to create and move appointments and tasks

Spd Diary 2.5 - Launcher for Windows Mobile Pocket Outlook

UPDATE: I signed on for Sprint's Voice Command which will be billing me $5/month. I was able to set up the service through a rep chat service on the Sprint Web site. I then hit asterisk, dial, which started some voice instructions which said something about adding names to an address book on the Sprint Web site. Now, I'm told by another Sprint rep that this isn't necessary.

You basically dial "*" and then are prompted for a name or number. It works for names in my address book, but I'll have to give it a thorough test to come to a final conclusion.

I also downloaded Nuance's VoiceControl which is embedded speech recognition software for navigating through Palm OS allowing you to do a Web search or add an item in your address book.

You hold down the side button on the Treo 700p, you hear a beep, then you dictate a command, then let go of the button.

Here's a sampling of the commands available (the full list):

• Phone Calls - Call [Contact's name] + [phone type (optional)].    
  • Call John Doe.
  • Call John Doe home.
  • Call John Doe office.
  • Call John Doe mobile.
• Phone Dialing - "Dial" [phone number].    
  • Dial 555-1212.
  • Dial 513-555-1234
• Call Voicemail - "Call Voicemail"
• Quick E-mails - "E-mail" [Contact's name] Subject [subject text] Body [body text].    
  • E-mail John Smith subject meeting body John, I'm going to be late to the meeting.  Go ahead and start it without me.
  • E-mail John Smith body Call me as soon as you get this.  We need to talk.
• Calendar - "Add Appointment" [appointment text] Date [date of appointment] Time [time of appointment].    
  • Add appointment dentist date January fifth time ten o'clock.
  • Add appointment Joe's birthday date March second.
• Web sites - "Go to website" [website URL]    
  • Go to website google.com    
• Quick Web    
  • Weather [ZIP code]    
    • Weather 10001

Smart pillbox and cell phone promote compliance with TB meds in India

A person with tuberculosis (TB) is infected with a slow-growing organism Mycobacterium tuberculosis with a waxy coat that needs a long regimen of antibiotics to effectively halt its growth.

The majority of those infected are asymptomatic but the infection may progress causing lung lesions that erupt into the bronchial tree and allow the organisms to be coughed up potentially infecting others, not to mention disseminating the disease throughout the patient's body.

For these reasons, the patients need to take a regimen of antibiotics despite feeling well. for if they should stop their meds, this could help select the organisms with a higher resistance.

Public health officials have devised directly-observed therapy (DOT) programs to help ensure compliance. This means that a person is assigned to witness each time the patient is supposed to take the meds. But these programs have stirred up some controversy among ethicists and patient rights advocates.  Another approach is to use a device that can remind a patient when to take the meds, and then record if the medication was accessed. Discussion of the controversy and the use of medical monitoring devices as a solution  is highlighted in this journal article: "Medication Monitors to Treat Tuberculosis: A Supplement to Directly Observed Therapy."

MIT Prajnopaya uBox Initiative is a project sponsored by The Prajnopaya Foundation as part of its Tuberculosis (TB) Treatment & Prevention Project in India (TBTP Clinic). Their solution is to use a medical monitoring device in the form of a smart pillbox, that alerts the patient when the meds should be taken, then records if the patient takes the meds or not. It's able to lock the mechanism to prevent a double dosages.

They're serving a population in the Bihar province of India.
They hope to be able to support 250 patients with these devices.

The MIT News Office describes a cell phone to be used with this device:

The second part of the group's new system is a cell phone, called the uPhone. By using special software, health care workers can record a patient's temperature, weight, and answers to a list of questions related to symptoms, which adds to the set of detailed patient data analyzed by doctors monitoring the study.

Discussion on SlashDot.

The IEEE 802.15 Task Group 6 for Body Area Networks (BAN)

Within the IEEE 802.15 Working Group for wireless personal area networks (WPAN), whose responsibility includes 802.15.1 (Bluetooth), 802.15.4 (Zigbee), is the task group TG6 working on developing the standards for body area networks (BAN). TG6 was formed in November of last year, and will be meeting
at the March 16-21, 2008 Plenary Session in Orlando, FL.

Negroponte at AAAS: fighting electronic device "obesity"

Nicholas Negroponte of OLPC fame gave the final keynote at the annual AAAS meeting yesterday according to this piece by Wired Science. OLPC is the One Laptop Per Child program that hopes to provide these simple but sturdy XO laptops running an open source operating system to school children in countries just beginning to invest in devices and wireless infrastructure to support education.

He's predicting that the XO laptop will drop in price to $100 by the end of 2009, and then to $50 by 2011. He's basing this on the price of the electronic components dropping as Moore's Law (the number of transistors that can inexpensively be placed in an integrated chip doubles every two years) continues to be in effect for the newer products. It's interesting that there is no mention of economies of scale being the major factor driving down the price as I thought was the original plan. Originally, the XO was touted as a $100 laptop hoping that commitments from countries such as Nigeria or Libya to purchase millions of units would make this price point possible .

From Wired News:

So, as we all know, electronics manufacturers fatten up cell phones with cameras and MP3 players, etc. Negroponte termed this problem, "a general obesity in the electronics industry." He went on to say, "Most laptops are like SUVs. You're using most of the energy to move the car, not the person."

He's saying that the XO needn't be "fattened" with new features to maintain its utility, and it's overall price will drop over time for this reason.

This is analogous to the term "feature creep" used to describe later versions of software with features added to prompt an upgrade even though these might work against the simplicity or stability of the program.

In his keynote he hinted at some deals in the works: " Over the next few weeks… there'll be partnerships and changes with companies that can start rolling this out." After all, the whole idea is for these laptops to be produced and distributed at low cost across the globe, even if the production isn't being managed by OLPC. Competitors are already looking at this market, notably Intel with its Windows-based Eduwise laptop. This device goes against the plan for the children teach themselves how to use an open-source operating system, and would require teachers to formally instruct the students on how to use Windows.

Pogue on "Star Trek-ishly accurate" Dragon NaturallySpeaking 9, now licensed for the Mac

Normally I don't watch the very theatrical videos on technology topics produced by NY Times tech columnist David Pogue, but this is a CNBC segment  entitled "Digital Dictation" where's he interviewed in their studio by their anchorwoman, in addition to his Commedia dell'arte clip.

Long story short:

• He's been using Dragon NaturallySpeaking (DNS) for 15 years now as a result of tensynovitis that developed from his writing/piano playing gigs
• He's excited about the capabilities of DNS 9, he has described as being “Star Trek-ishly accurate" [98.9%] even without training the software by reading passages, compared to when he had to dictate word-by-word with older versions
• He's a Mac person who writes the highly regarded "Missing Manual" books
• He's almost in heaven now that the next version of MacSpeech Dictate (MSD) will be based on the DNS speech recognition engine
• He'll have to spend some time in Purgatory, though. This new version of MSD does not allow correction by voice command (you have to fix transcription errors the old mouse and keyboard way, plus these corrections won't serve to train the software and increase accuracy), but will appear in the second version

See, the message was delivered without extras, costumes and special effects. Plus, I didn't get called out by the anchorwoman for calling her "Dude!"

Talking to your PC: KnowBrainer Command Set

I'm continuing my exploration of the Dragon NaturallySpeaking (DNS) 9 Medical speech recognition software by going back to the KnowBrainer forum where I remember picking up a lot of useful information in the past.

I was asking some questions I had about working through some things I needed to work out, and in the process I received some great tips from the folks there about how to use this software to its best advantage.

Based upon a strong recommendation for the KnowBrainer 2007 Command Set from a person on the forum, I decided to install it and see how it could improve my workflow.

It basically adds 10,000 commands to DNS, tweaks some of the settings, provides their own Command Browser for creating advanced-scripting commands, and a scripting language called VerbalBasic to create commands verbally.

When I first tried out Dragon's speech recognition software, the Pro version 9, the first thing that really amazed me was reading an article from the New York Times Sunday Magazine, and seeing how accurately it could transcribe a variety of words with very little training. Words like "kibbutz" for example, or even some proper names or acronyms.

I think when most people try out this software at a computer convention or any other demo, they judge it by what they try to dictate ex temporaneously, which doesn't work as well. When you read something, it produces a flow and cadence that works better with the software.

This makes you realize that you need to improve your dictation skills, both by pronouncing clearly and thinking far enough ahead so that you can speak a full sentence in a continuous flow, also including the punctuation where needed. So, while you're still getting the hang of dictation, you find yourself trying to remember commands to select, edit or correct your mistakes by moving the cursor and making it do what you want it to do. Now things slow up. This is where the Command Set begins to show its usefulness.

While DNS obviously comes with its own set of commands, some of which are available in the printed manual, all of which are searchable within the program, the list in the Command Set PDF manual gives you the full roster of the commands you can use. What I did was to print out the pages with the commands list, and just scan it for the commands that I've been needing, then trying them out. So far it's increased my speed in the using DNS.

The second amazing thing is realizing that you can navigate through various Windows programs with spoken commands.  It really improves on the tedious task of using the mouse and keyboard to pick through screen menus. And what's really impressive is opening documents without searching through the file folders. If you want to check something in the manual, you simply say "How do I," and the PDF opens. Supposedly it's also possible to search for any file on your PC using desktop search software which I'll be trying out next.

I think anything that saves you from peering at the screen to navigate is a wonder. I'm not particular in love with typing either.

Video demo of Google's Android mobile phone platform

This video by PhoneMag shows a cell phone produced by China-based E28 using the Android mobile phone platform. (Their Web site claims that they are "The Leader of Linux Mobile Converges Devices") The touch screen is similar to the iTouch interface that the iPhone uses, although in this case the screen is much smaller so I wouldn't expect any navigation that requires two fingers.

The company's rep shows off some 3D graphics as a way of demonstrating how efficiently this platform can work with even a "low-tier processor."

From the PhoneMag blog:

What makes this particularly interesting is the specs of the E2831: it uses a relatively old OMAP TI 730 chipset, running at just 200MHz, and has a mere 64MB RAM and 64MB ROM.  Android runs with no modifications, and the E28 team were even able to download applications coded for the platform from the internet and install them directly to the handset.  This, then, is some of that unlocked, open-source simplicity we were promised when the platform was first announced.

The Treo 755p has 128 MB of memory powered by Intel XScale 312MHz processor, just for comparison.

I wonder if this could represent the tipping point for some high-end mobile medical applications such as embedded speech recognition.

UPDATE: LinuxDevices presents this exclusive interview with Roger Kung, Chairman and CEO of E28, a Linux smartphone startup in Shanghai, China.