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The Downside of Electronic Medical Records


Part of President Barack Obamaâ''s plan to improve the U.S. health care system is to move every doctorâ''s office and hospital to electronic medical records. Most of the time, I think that will be a very good thing. This week, not so much. Because not even a state-of-the-art specialized highly secure record keeping system works all the time.

I live in Silicon Valley, and get my health care through a very large and modern group medical practice. It seems like weâ''ve had electronic medical records forever, though, thinking back, I have vague memories of the computers coming in, the conversion, and a period of extra-long office visits as the doctors struggled to input their orders correctly. Thereâ''s lots to like about electronic medical records; prescriptions are sent directly to pharmacies, so instead of dropping off a written prescription and coming back later to pick it up I only have to make one trip. I can make appointments online. I can look up test results and check when Iâ''m due for my next mammogram online. And, at least for my youngest child, I can print out a vaccination record myself whenever I need it instead of calling the office and asking for a printout (and sometimes being charged for the service).

Not that there arenâ''t some things about the electronic medical system that bug me. That prescription transmittal? There appears to be no way of telling the system not to send a prescription to the pharmacy whenever the doctor updates it, so when I have an annual checkup I can either choose not to update my allergy prescriptions (which means a phone call to the doctor a few months later when I need the medication), or go for the update and end up buying a new supply of allergy medication, whether I need it or not. And Iâ''m currently shut out of two of my three childrenâ''s medical records; once a kid turns 13, their parent is not allowed to access an electronic medical record. However, the kid himself isnâ''t allowed in until heâ''s 18. A catch-22 that means Iâ''m back to making appointments, asking for vaccination records, and checking test results over the phone or in person.

But, in general, Iâ''ve been happy with electronic medical records. This week, however, the system went down. (A computer virus, a staff member told me.) And it wasnâ''t pretty.

On Tuesday, I went in with one sick kid, and was in for a long wait. When we finally got in to see the doctor, the reason for the wait was clear; the doctors had no charts, so had to at least review a basic medical history with the patients. Ordering a test took foreverâ''first, finding or creating a form, then, finding someone who remembered the code for the test, since there was no place to look it up.

The next day, I took a second sick kid to the lab for a blood test. The doctor had written out a paper order for the test, and I checked it carefully to make sure it was right and legible before handing it over to the folks at the lab. The lab technician read the paperwork and, by hand, copied the information, or so I thought, on labels for the tubes of blood (these labels are normally printed out automatically).

The next day, the electronic medical system was up and running again, so the good news was that the doctor could view the test results. The bad news was that it turned out the lab had run the wrong test and my daughter was in for a second round of blood drawing. She wasnâ''t pleased.

So yes, letâ''s move to electronic medical records, because, for the most part, they do make the process more efficient. But letâ''s not think that we can rely on them completely, throw out the paper, and forget how to do it the old-fashioned way.

Photo by J.Reed

Nano Ethics Goes to Washington

I have already expressed my resistance to the idea of nano ethics and my opinion really hasnâ''t wavered much despite some prior skeptics allowing for at least the consideration of the subject.

I am heartened, however, that others remain unbowed in their skepticism.

Personally, I still just canâ''t get passed the idea that part of government funding for nanotech is going to be spent on Think Tank studies on nanotechnology ethics. I just canâ''t get my head around it.

I have not read the recently released report, Nanotechnology: The Social and Ethical Issues, from the Project on Emerging Nanotechnologies in its entirety, but the bits I have read just leaves me asking, â''Couldnâ''t you just replace the term â''nanotechnologyâ'' with â''semiconductorsâ''?â''

Why is it that nanotechnology always gets burdened with this stuff. Does the word itself somehow appeal to these ethicists?

But the more perplexing question for me is why these people who dedicate themselves to the subject of ethics donâ''t realize that it is somewhat unethical to always come to the same conclusion that their work â''needsâ'' to be funded by the taxpayer dime?

It's sort of like Dick Cheney leading the vice-president search team for Republican nominee, George W. Bush, only to conclude that he would be the best vice-president.

I don't know maybe that's not a question of ethics, but just bad manners. In either case, it doesn't look good.

The Boy who Twittered Wolf

I'm one of those people who is skeptical of Twitter. It seems so narcissistic. Who cares if you just woke up? I do not. I'm sorry.

So David Pogue's Twitter experiment was fun for me. If only for the occasional mean-spirited snicker.

Anyway, turns out Twitter is not a completely useless time drain!

Pogue demoed it at a Las Vegas conference by sending into the Twitterverse the following cry for help: "I need a cure for hiccups... RIGHT NOW! Help?"

The replies, of course, poured in. My favorite, by Chiron1: "I take large sips of bourbon. It doesn't stop the hiccups, but I stop caring!" (I'm also a sucker for silly, obvious humor, because I would have been one of the 20 or so who responded with "Boo!!")

What I didn't expect is that when Pogue told them the whole story, the Twitterverse got mad. "I feel used," groused one. "Not sure I appreciate being your guinea pig," grumbled another. The most ominous reply was Twittered by one briand: "might want to add "(demo)" to tweets like that. I was suspicious of the original. Don't play the community; they'll turn on you."

To be fair, not everyone's panties were in a wad. Tweeth thevideodog: "That's like the boy who hiccuped wolf...pretty soon when you really need a cure for something, like diarrhea, no one's gonna answer!"

Who knew anyone could be offended by the non-sanctioned re-purposing of their 140-character-max chatroom thoughts? It's not like they were being wiretapped by the NSA. A Twitterer has no expectation of privacy.

Is Twitter really that much of an intimate experience? As a Twitter-luddite, I am curious and have no perspective on the issue myself. So tell me. Meanwhile, for a roundup of unlikely hiccup cures, you can read Pogue's blog, which also contains every possible variation on "the boy who twittered wolf."

DTV Transition: Date Uncertain

digtv120-thumb.gifThe analog shutdown â''date certainâ'' of 17 February is now date uncertain. Earlier this week the Senate passed a bill to delay the transition to 12 June; meanwhile, the House voted against a similar bill under special rules that required a two-thirds majority to pass. The House bill is likely to come up again next week under different voting rules.

The case for 12 June: more of the coupons that subsidize digital converters have been requested than are available, evidence that analog TV viewers need more time to get ready and the government will possibly need more money to help them. The case for 17 February: any delay will just confuse consumers more, will cost television and other companies and the government a lot of money, and might not make the transition any smoother.

I think Iâ''ve seen this show before. Itâ''s a rerun from 2005, when the House and Senate established the date certain in the Digital Transition and Public Safety Act as part of a budget reconciliation bill. Lobbying for the date certain included an industry coalition representing wireless, computer, telecom, semiconductor, software, and manufacturing companies and industry associations. They argued that only a date-certain would let companies move forward to develop new wireless technologies for the spectrum that was due to be vacated. Also lobbying hard for a date certain were public safety agencies. Since 11 Septemberâ''s attacks and the communications difficulties experienced by rescuers inside the World Trade Center, such groups are eager to get their hands on the big, clean chunk of high-quality bandwidth due to be dedicated to emergency services after analog shutdown. The cable television industry, of course, also supported a hard date.

On the other side, Congressmen expressed concerns about low-income folks, the elderly, and Hispanic viewers, demographic groups that represent the vast majority of people who rely on over-the-air broadcasts for television, and discussed at length they could be converted to digital with little cost or trouble. The solution that got the date certain bill passed was the converter program which, for the most part, handled the cost, but didnâ''t address the trouble part of the equation. And the subsidy program did not include any money for new antennas, because the FCC assured Congress at the time that current antennas would function just fine with digital receivers.

So now weâ''re back to date uncertain. Some corporations are sweatingâ''it costs broadcasting companies big bucks to run two transmitters, for one. Some of the companies that bought the spectrum real estate wonâ''t be affected muchâ''Verizon, for example, wasnâ''t going to start testing its next-generation wireless network on the new bandwidth until the second half of the year. But others have made big investments to be ready to move into their new homes on 18 February, like Qualcomm, who has its MediaFlo video service ready to go, spent the money to build the infrastructure, but now, potentially, will see a delay before it can start selling the service to subscribers.

And my mother, who now has to struggle with multiple confusing remotes to watch 60 Minutes on her little 15-inch TV, is going to be angry that I made her go through conversion when she didnâ''t really have to.

For more of Spectrum's coverage of the digital transition, see Special Report: The Day Analog TV Dies.

Fable Teaches Lessons, But Do Nice Guys Really Finish Last?

Boeing Co. today announced that it will up its layoffs to 10 000 unfortunate employees. The bad news came hard on the heels of downsizing announcements in recent days from all over the tech sector.

And no company has been spared from the toll of the financial downturn, even among the greatest. Sprint: 8000. Microsoft: 5000. IBM: 4000. Texas Instruments: 3400. And so on, and so on.

The mass layoffs have cast a pall over the engineering community worldwide, no doubt. Still, those who do have jobs must continue to work and be productive, even with the sword of further cuts looming over them.

Into such a worrisome environment comes an instructive fable that the editors at IEEE Spectrum thought deserved attention.

In the online pages of Datamation, contributor Eric Spiegel, a veteran software developer, tells a tale of office politics run amok in an IT department facing layoffs.

The article, Do Nice Engineers Finish Last in Tough Times?, relates the story of three mid-level managers working at a server farm who have to cut staff by 50 percent due to the economy.

Stuart, a systems manager, is the "nice guy" in Spiegel's script. He believes in doing the right thing by others, for his team and his firm. Doug is his counterpart in security. He's the "not so nice guy," who thinks of himself first and others only when it suits his purposes. Then there's the director of IT, Kelly, who must decide who stays on and who goes.

'Kelly gathered her team of managers and asked them to rate their employees and then she would work with them to determine who would be laid off. What she didnâ''t tell them was that she was rating her direct reports because managers would be on the chopping block as well.'

You can guess what happens next. Doug meets secretly with Kelly and tells her: "Really, Stuart is too nice and isnâ''t capable of making the tough decisions that will be necessary for us to survive this downturn. I will be ruthless and make you look really, really good, Kelly." So Kelly fires Stuart.

Ratting out his co-worker gets the ruthless guy what he wants, and the company gets the results it wanted, regardless of morality.

Spiegel concludes by asking, "So what would you have done in Kellyâ''s shoes?"

Good question. Will the firm be better off with aggressive types such as Doug or loyal types such as Stuart?

It makes for a robust discussion thread for Datamation, and there are plenty of comments following Spiegel's article. You should read them for yourself and chime in with your own opinions (which is the whole point).

Back in the real world, though, there is no right or wrong answer to the dilemma Spiegel concocts over the long haul. It's an age-old classic of management studies and plays out everyday in the trenches of the corporate world to various resolutions (see Gordon Gekko and Bud Fox in the movie "Wall Street" for a slightly less fictional take on the paradox).

The kicker in the question, however, lies in the words "in tough times."

While Spiegel's fable may be naïve, I believe his motives for presenting it are sincere (although highly biased to appeal to the Stuart's of the technosphere). So the question he asks in his headline, whether "nice engineers finish last in tough times," deserves a hearing, in my opinion, and I might as well cough up a brief response of my own to it here.

First, under full disclosure, I'm not an engineer or a developer, just a writer who covers the tech beat. Moreover, I've worked for the publisher that put Spiegel's piece on the Web, which would be JupiterOnlineMedia. In fact, I used to work for its predecessor,, and before that worked for EarthWeb (which acquired Datamation a decade ago and positioned the publication as its IT Management vessel). And to complicate things further, EarthWeb itself started out as a software firm. So while I was writing for the company's online presence, I was surrounded by developers who were creating some of the first Internet applications of the Nineties, such as interactive chat and peer-to-peer file sharing. Whew.

So I've actually seen the office politics described in Spiegel's article. And in my experience, I've got to admit that "nice" engineers actually do finish last in tough times.

It's a matter of human nature. When conditions turn bad, managers get nervous. Their fear tends to lead them to favor aggressive, short-term solutions. And aggressive types tend to be attracted to likeminded individuals.

Yet most people who have heard the famous quote "nice guys finish last" think it means that good people are always doomed to lose. It doesn't. The quote refers to the thinking of the old Brooklyn Dodgers' manager, Leo Durocher, who uttered something like it in 1946. In an interview, Durocher commented on his cross-town rivals, the old New York Giants, by saying: "Take a look at them. They're all nice guys, but they'll finish last." They did.

Durocher had put together a Brooklyn lineup of cold-blooded ballplayers back home after the war years, men who reflected his own demeanor, which could be summed up nicely by another of his trenchant quotes, "Ruthless tactics succeed more than kindness."

That team finished first in the National League the next year. They then lost the World Series to the New York Yankees, another bitter rival. But Durocher was not there. He had been suspended by the commissioner of baseball for off-field gambling. The following year, the Dodgers fired him and he joined the Giants as their skipper.

He then led the "nice guys" to a pair of historic first-place finishes. Durocher had come to discover that his famous line had limited relevance over time.

So "tough times" may bring out the worst in us, as anxiety leads to panic. In that regard, the IT boss in Spiegel's story, Kelly, is probably no different than the rest of us, flawed to some degree. But she certainly was not acting in the best interests of her company in the long run.


A colleague here at Spectrum Online has sent me a note pointing out a certain measure of implicit sexism in Spiegel's article: Stuart is a nice guy. Doug is a bad boy. Kelly must choose between them. She picks the bad boy. Therefore, as one commenter wrote in the discussion thread, "Kelly=Clueless Bimbo." My colleague, who happens to be a woman, wrote for attribution off the record that this particular comment was a "distillation of the story to its essence." She's got a point there.

27 January 1967: Apollo 1 Blaze Kills Three Astronauts

On this date in 1967, an accidental fire on board the command module of the Apollo 1 spacecraft sitting atop its booster rockets killed three U.S. astronauts on a launch pad at Cape Kennedy, Fla.

Though the exact cause of the accident was never determined by NASA, speculation has long centered on a spark from an electrical circuit being the ignition source that set off a blaze in the oxygen-filled, sealed crew capsule.

The fire killed the mission commander, Virgil "Gus" Grissom (USAF Lt. Col.), and astronauts Roger B. Chaffee (USN Lt. Comm.) and Edward H. White II (USAF Lt. Col.).

NASA had intended Apollo 1 to be the first manned mission of Project Apollo, which eventually sent the first humans to the moon. The first Apollo launch, scheduled for early 1967, was to have tested the capabilities of the giant Saturn 1 rocket to safely carry humans into space.

Grissom was one of the first U.S. astronauts, dubbed the Original Seven. He became the second American to fly into space aboard Mercury 4 in 1961. He followed that up in 1965 aboard Gemini 3. Chaffee was chosen in the third group of astronauts in 1963. Apollo 1 was to have been his first spaceflight. White was chosen with the second group of astronauts in 1962. He served as the pilot of Gemini 4 and earned the distinction during that mission as the first American to make a spacewalk.

In their memory, NASA designated the site of the accident, Launch Complex 34, as a national memorial and marked it with the following remembrance: "They gave their lives in service to their country in the ongoing exploration of humankind's final frontier. Remember them not for how they died but for those ideals for which they lived."

Time to Start Mourning the Living in Nanotech

I was alerted to the recent news that Unidym was closing its Houston offices and consolidating their operations in California.

Some see the news of the Houston plant closing regretfully as the end of Richard Smalleyâ''s Carbon Nanotech Inc. (CNI). They really shouldnâ''t.

They should have counted the sale of CNI over a year ago to Unidym for $5.4 million worth of Arrowhead Research shares, which considering the capital that had already been pumped into CNI was like getting the company for free, as the final denouement of the company.

This sorry tale was told some time ago on this blog.

But what should really get people concerned is that Unidym seems to be getting sold off in bits and pieces at bargain basement prices to Tokyo Electron.

Meanwhile as Rome is burning, Technology Review plays the fiddle describing how Unidymâ''s conducting nanotube films are about to hit the market. I think this is what you call cruel irony.

"Objective" Information from EU Project on Nanotech Provides Much Needed Laughs

These are serious times and as a result much of what you read is quite serious assessments of our problems and serious solutions.

But European Union projects on nanotech always seem to provide some light-hearted amusement even in the most serious of times, albeit unintentionally.

The latest is a project called observatoryNANO (I have never quite figured out why these European projects insist on odd capitalization), which is supposed to provide â''European decision-makers in government, industry, and finance lack objective information for their decisions when considering a rapidly changing field of technology such as N&Nâ'' [thatâ''s â''nanoscience and nanotechnologyâ'' to us uninitiated].

TNTLog had some great fun at the expense of this project by turning up some of the gibberish that it was publishing as â''economic dataâ''. The project must have become aware of some of the silliness that they had on their website and now the page is â''under constructionâ''.

But it was a bit too late. Some of the fun stuff can still be found on the TNTLog:

Scientists have invented a plastic solar cell that can turn the sunâ''s power into electrical energy, even on a cloudy day. The plastic material uses nanotechnology and contains the first solar cells able to harness the sunâ''s invisible, infrared rays. The breakthrough has led theorists to predict that plastic solar cells could one day become five times more efficient than current solar cell technology.

And this

The primary driving force behind flexible displays is to solve the need of humans to interface with electronics that are undergoing continuous miniaturization.

The secondary push for flexible displays is the desire to place computers in objects that they previously did not belong. This could be shirts, golf clubs, or watches.

No matter how much money the EC poured into this project, it was all worth it when you can generate copy like that that really can put a smile on your otherwise dreary day.

Attack of the Wireless Worms

As reported last year on this Website, a group of academic researchers has recently shown that a new and disturbing form of computer infection is readily spread: the epidemic copying of malicious code from wireless router to wireless router, without the participation of intervening computers. Such an epidemic could easily strike cities, where the ranges of wireless routers often overlap. All thatâ''s needed is that enough people fail to configure their routers with good passwords and strong encryption. And as anyone who has ever (purposefully or inadvertently) hooked up a neighborâ''s wireless network knows, unencrypted wireless networks are all too common.

The study will soon appear in the Proceedings of the National Academy of Sciences of the U.S.A. So keep an eye on the PNAS Website if you want to see the details.

Like most good guys who discover a computer-security vulnerability, the authors of this study are quick to suggest remediesâ''specifically: â''force users to change default passwordsâ'' and â''the adoption of WPAâ'' (the cryptographic system meant to replace the easily-broken WEP scheme). In other words, if you donâ''t want to get caught up in such an epidemic, stay home, close the windows, and lock the door securely.

I suspect that many people learning of these frightening results will have the same reaction. Choosing a sensible administration password for your router only makes sense. Itâ''s your router after all; you donâ''t need to make it an attractive target for drive-by hackers. But before picking out your new WPA key, take a moment to consider whether it wouldnâ''t be better to leave your wireless network open.

â''But I donâ''t want freeloaders piggybacking on my wireless connection to the Internet,â'' you say. That sentiment makes senseâ''until you examine it closely. If a neighbor uses his or her own network connection instead of yours, will your available bandwidth be any different? I suspect it would be exceedingly hard for you to notice any slow down. Consider also why the Internet has value to you: because many people are connected to it. So logic demands that you should want to do all you can to foster connectivity. Here now is a perfect opportunity to think globally and act locallyâ''so long as it doesnâ''t violate your terms of service with your ISP! For more than just my glib remarks on this very interesting subject, I recommend reading Whacking, Joyriding and War-Driving: Roaming Use of Wi-Fi and the Law.

The authors of the PNAS paper point out how difficult it will be to get people to choose good passwords: â''Unfortunately, the dangers of poorly chosen passwords have been widely publicized for two decades now, and there has been little evidence of a change in the publicâ''s behavior.â'' They seem to think that getting more folks to adopt WPA is a more workable strategy. So let me offer my thoughts on what might be a better solution.

Suppose router manufacturers modified the software that runs these devices so that users could not log in as administrators wirelessly. That way, youâ''d have to be physically plugged in to change the routerâ''s firmware. Such a change would make a wireless router that is straight out of the box immune to this kind of infection. And if manufacturers could also be coaxed to make the default password vary from unit to unit, youâ''d even be protected from malicious software on your computer that tries to take control of your router through a network cable.

Perhaps Iâ''m missing something, but such changes donâ''t seem all that hard to implement. If not, router makers of the world, please help us all rest peacefully, knowing that we arenâ''t having our routers hijacked or contributing to a city-wide plague of wireless worms.

AMD Launches New Line of "Shanghai" Processors

Advanced Micro Devices today announced the "widespread availability" of its new 45-nanometer Quad-Core Opteron processor, offering five low-power versions for servers and two 105-watt versions for high-performance computing architectures.

Formerly code-named Shanghai, the chips are aimed at IT customers "looking to do more with less," according to an informational page on the AMD website. The Sunnyvale, Calif., firm said the new Opteron processors deliver "up to 35 percent more performance with up to a 35 percent decrease in power consumption at idle."

It added that original equipment manufacturers will be able to offer more than 27 systems based on the 45-nm Opteron line this year.

The low-end Opteron HE chips will be priced from US $316 to $1514, and will work with two-, four- and eight-socket systems with speeds ranging from 2.1 GHz to 2.3 GHz, AMD said. The chipmaker has priced the high-end 8386 SE at $2649 and the Opteron 2386 SE at $1165.


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