Computing Community Consortium Blog

The goal of the Computing Community Consortium (CCC) is to catalyze the computing research community to debate longer range, more audacious research challenges; to build consensus around research visions; to evolve the most promising visions toward clearly defined initiatives; and to work with the funding organizations to move challenges and visions toward funding initiatives. The purpose of this blog is to provide a more immediate, online mechanism for dissemination of visioning concepts and community discussion/debate about them.


Live Webcast: The U.S. Ignite Gigabit Applications Workshop

May 16th, 2011 / in research horizons, workshop reports / by Erwin Gianchandani

Note: NSF and OSTP are providing a live webcast of today’s workshop; click here to view it. And a live blog of the workshop, updated throughout the day, appears below.

White House Office of Science and Technology Policy (OSTP)NSF - Directorate for Computer and Information Science and Engineering (CISE)The White House Office of Science and Technology Policy (OSTP) and the National Science Foundation‘s CISE Directorate today are co-hosting a workshop on U.S. Ignite — an exciting new initiative that will create a high-bandwidth, national testbed and accelerate the development and deployment of high-bandwidth applications and servicesWatch a live webcast here.

NSF/OSTP:  The U.S. Ignite Gigabit Applications WorkshopU.S. Ignite currently comprises several cities and regions throughout the country that have recently made investments in broadband: Chattanooga, TN; Lafayette, LA; Cleveland, OH; Washington, DC; and regions of Utah. These cities/regions have agreed to be open to researcher/entrepreneurial experimentation, and to be interconnected with one another via the GENI testbed to provide high-bandwidth, virtualized network access for a small set of experiments.

The goal of today’s workshop is to bring together researchers and entrepreneurs interested in partnering with the infrastructure providers in these cities/regions (as well as the specific anchor institutions open to experimentation) to surface exciting gigabit applications/services in areas of national priority, including clean energy, smart health, cyberlearning, smart transportation, and general economic development (e.g., advanced manufacturing, robotics, etc.). In the long run, these apps/services are likely to provide interesting results — as well as demonstrations of what might be possible were broadband more widely available in cities/regions across the country.

Through the workshop, NSF and OSTP are hoping to align cities/regions with researchers/entrepreneurs based on common interests in applications/services and national priority areas. The “teams” that emerge from today’s discussions will be charged with developing plans for moving forward, to be presented at a second workshop in Cleveland in mid-June. The most innovative, feasible projects will receive awards to try their ideas over the next several years — with the aim of having successful apps/services up and running as early as this fall.

We’re spending the day at the workshop — and will be live blogging the discussions below, beginning around 9am EDT. Keep checking back throughout the day for updates!

Live blog roll:

10:59 am EDT

And that’s a wrap. For complete details, scroll below or see our post yesterday summarizing the US Ignite Broadband Initiative.

10:58 am EDT

And last but not least, Todd Park, the nation’s Chief Technology Officer, offers closing remarks, describing how the effort to connect islands of broadband stands to leverage the expertise of industry, universities, and communities to catalyze developers and “the growth of an entirely new marketplace.

Quoting Mark Smith: “Amazon isn’t Kramerbooks with a computer in it. Travelocity isn’t a travel service with a computer in it.” Both of these are entirely new paradigms, Park says — “and I can’t wait to see the next generation of applications” enabled by US Ignite.

10:54 am EDT

As to why you cannot do this with the existing Internet, Elliott comments:

“The current Internet is extremely open at the edges. If you know how to write software, you can convince people to install that software, use it, and so on. But you can’t do that in the firewalls, in the routers… So one of the core GENI concepts is to make the entire network, all the way to the cloud, completely programmable. The same kind of innovation that we saw with laptops — what if we were to extend that all through the network? I think that could be a real winner — it’s too early to say, but the potential for new opportunities is fantastic.”

10:52 am EDT

Now on to the Q&A portion of the event:

A questioner in the audience asks, “What’s the business model as this stuff gets more complex?”

Surman notes, “You can’t see the business model until you start building the stuff. The business model for the iPod is incredibly different than what Apple could have envisioned when it first put it out. So I think a leap of faith on the business model is something that you have to take when you innovate.”

10:47 am EDT

Brown on a vision for the future: “Imagine a patient is in an ambulance — I can start to take some image and transfer it to a doctor. And it’s 2 in the morning. And there’s a doctor in his/her home office who can analyze that image and tell the [paramedic in the ambulance or the doctor in the operating room] what to do.”

10:44 am EDT

Estrin: “What’s so exciting is that students can know that the ideas that they generate can actually happen out in the real world… [in local communities and users’ homes]. In part, what’s so exciting about the way Ignite has been posed is that it recognizes that creating this infrastructure will ignite this innovation and the ability to move this innovation quickly.”

10:42 am EDT

Deborah Estrin offers her take on US Ignite:

“In creating US Ignite — in creating this open ecosystem — it’s about creating an open, modular ecosystem where the underlying components get reused so that ‘moments of innovation’ can recur and have multiplicative effects.

“That’s an opportunity — if we want to do it again, that’s what we have to do again.”

10:39 am EDT

Mark Surman on the Mozilla Ignite Challenge:

The goal is to “propose apps in healthcare, education, and other priority areas. The phase that opened today is a brainstorming phase. Anybody here can go [to the website] today and throw in [their ideas] there. [There will be] up to ,000 in prizes for the first round. Then we [will] do a series of hackfests and educational activities, start to work with engineers, and [offer] a little over 0,000 in prizes for the best apps that come out of that. We’ll do some of these hackfests in places that have GENI networks deployed, but also open it up to folks on the Internet…

“I think at the end of the day we’ll begin to see a bit of the future.”

10:36 am EDT

Brown notes a new initiative that Verizon is announcing today under the US ignite umbrella — effectively “upping the connection speeds” for 200 ‘developers’ in the rich research and innovation ecosystem in Philadelphia:

Verizon will … offer a testbed using very high speed FiOS connections in the Philadelphia area. This testbed will leverage Verizon’s network, operating at speeds of up to 300 Mbps, to community institutions, homes and businesses. It will offer a much broader coalition of entrepreneurs, practitioners, and developers a chance to come up with new ideas that can take advantage of very high speeds connecting homes and institutions. Philadelphia has a rich density of healthcare and university research-related organizations that can take advantage of this testbed, and healthcare is one of the major areas Verizon is focused on for the future. High-speed broadband will also support over-the-top video programming on TVs and portable devices and accommodate the rise in Internet-enabled applications like video and audio streaming, home monitoring, and medical services and medical monitoring.

10:33 am EDT

Chip Elliott begins with an overview of the GENI Project — a programmable virtual laboratory, or testbed, for Internet-scale networking experimentation — which provides the technical foundation for US Ignite. Using GENI, US Ignite will be able to stitch together high-speed broadband resources to create a national testbed across university campuses and cities.

10:31 am EDT

Now on to a panel, featuring:

  • Steven Levy, Senior Writer, WIRED;
  • Kathy Brown, Senior Vice President, Verizon;
  • Chip Elliott, GENI Project Director, BBN Technologies;
  • Mark Surman, Executive Director, Mozilla Foundation; and
  • Deborah Estrin, Professor of Computer Science, UCLA.

10:28 am EDT

Selman describes surgical theater, a concept first pioneered by retired Israeli military officers, who developed techniques for high-immersion, high-touch technology to enable fighter pilots to envision the experiences of a plane’s cockpit before physically entering it.

Surgical theater constitutes the ability to leverage hyper-realistic simulations to determine the very best approaches to very complex surgeries. As Selman speaks, Sloan demonstrates the ability to allow physicians to practice surgeries with patient-specific data ahead of time — using a cerebral aneurysm as an example — paving the way for next-generation surgery in which surgeons are able to rehearse the critical parts of an operation before performing them.

Selman says, “We can look behind the aneurysm, something that is not possible during surgery, and say, ‘Well, that [particular] clip fits well’. [Or] I can say that that curved clip is going to work better than the bayonetted clip. So again, the ability to be able to rehearse this decision ahead of time [is key].”

Surgical theater allows us surgeons to communicate across universities and provide mentorship to residents and students “in a way that was never before possible” without the capability afforded by ultra-high-speed, deeply programmable broadband connectivity.

“Purposeful practice is the only thing that separates the rest from the best. So really, what we’re trying to do is to make sure that we’re all the best that we can be — and we believe that collaborative theater afforded by high-speed broadband connectivity will enable us to do just that.”

10:16 am EDT

Next up: a live demonstration by Warren Selman, Director of the Center for Stroke at the University Hospitals of Cleveland, and Andrew Sloan, Chair of Neurosurgical Oncology at Case Western Reserve University.

Here’s a video that presents some of their work leveraging gigabit connectivity in Cleveland, OH:

10:08 am EDT

AT&T Senior Executive Vice President John Donovan and PCIA (Personal Communications Industry Association) Chairman Marc Ganzi describe industry support for US Ignite.

Noting how mobile technologies are improving health outcomes through remote monitoring, allowing us to find our way through strange cities via GPS capabilities, and leading to digital homes, connected cars, and mobile wallets, Donovan says today’s announcement “speaks not only to our imagination but also exemplifies how government and private industry can work together.”

Ganzi, meantime, describes the importance of the Executive Order.

10:02 am EDT

Sue Spradley, the new Executive Director of the US Ignite Partnership, is now on stage, describing the mission of US Ignite — and calling on more universities, companies, non-profits, and communities to join the effort.

10:00 am EDT

Tom Kalil, Deputy Director for Policy at OSTP, walks through a number of additional key steps that the Administration is announcing today. Among them:

  • The Department of Defense is connecting military families on base with new US Ignite services, while creating new research opportunities to students at West Point.
  • The Department of Health and Human Services’s (HHS) Beacon Community Program, starting with the Mayo Clinic, and the FCC’s Rural Healthcare Pilot Program are partnering with US Ignite to provide new healthcare applications, such as remote surgical theatre and patient monitoring.
  • Through Department of Energy’s National Training & Education Resource (NTER), the Department is supporting the NSF/Mozilla US Ignite application competition, helping to create new workforce online training tools and apps. NTER is an open-source platform that is designed to revolutionize online training and education through 3D immersive content, making it easy and inexpensive to build state-of-the-art learning experiences by reducing the cost and complexity of creating engaging 3D content.
  • The Institute of Museum and Library Services (IMLS) [is] helping libraries and museums use high-speed broadband to improve education, workforce, and health outcomes for millions of Americans. Its grants spur innovation in the creation of tools that enhance access, use, and management of digital assets.

A complete list of activities is available here.

Kalil emphasizes the role of students in fostering innovation, noting how graduate students at Stanford University were instrumental in the development of Google. We must “empower students to develop the next generation of applications and services by bringing high-speed broadband to university dorm rooms.”

09:52 am EDT

Strickling describes NTIA’s efforts over the last three years in support of nationwide broadband. Through grants funded by NTIA, over 56,000 miles of new or upgraded networks have been laid out, connecting more than 8,000 community anchor institutions to broadband service.

In addition, he touts 200 million USD in grants to build and expand public computer centers with over 30,000 workstations, and 250 million USD in grants to sustainable broadband adoption.

Some of these funds, Strickling notes, have testbeds enabled — in Northeastern Ohio, Utah, and Washington, DC, to name a few — that are key partners of the US Ignite Broadband Initiative.

09:47 am EDT

Next up: Larry Strickling of the NTIA.

09:44 am EDT

Genachowski segways into a video describing some of the innovations already being enabled by ultra-high-speed, programmable broadband connectivity deployed throughout Chattanooga, TN. Watch it below:

09:43 am EDT

Genachowski: “US Ignite is a complete to GigU, the effort to drive ultra-high-speed testbeds at college campuses around the country.

“These things together — and more — will bring us an incredible world of innovation and drive U.S. leadership in innovation in the twenty-first century, as we have in the twentieth.”

09:40 am EDT

Genachowski references the “dig once” strategy summarized in the National Broadband Plan — and notes how today’s Executive Order removes barriers to building out broadband technologies on Federal properties and roadways.

09:40 am EDT

Genachowski: “We need to open up spectrum… increase our broadband efficiency… and need to drive greater and greater speeds and capacity in and around broadband. We need to have testbeds all around the country driving super-high-speed broadband so that innovators like Oblong can not only envision what the next two or three decades will look like, but actually do it.”

09:36 am EDT

Julius Genachowski, Chairman of the FCC, is now on stage, describing how “this is an exciting time in broadband.” He makes the economic argument, noting that broadband technology has enormous potential to advance our national goals in strategic areas.

“I’m happy to see so many people here today who are working around the clock to drive an exciting future,” Genachowski says.

09:32 am EDT

Remember when Tom Cruise put on his data glove and started whooshing thrugh video clips of future crimes?

That iconic scene in The Minority Report is the subject of John Underkoffler’s short presentation. Underkoffler, Chief Scientist at Oblong Industries, is describing the research that led to the technologies imagined the movie — and how today’s announcement enables new apps for aerospace, bioinformatics, video editing and more that take advantage of radically new human-machine interfaces operating across “high-speed, low-latency, and software-definable traffic lanes [with] intelligence in the underlying network itself.”

We’re talking about “new kinds of applications, new kinds of services, and by corollary, new kinds of jobs,” Underkoffler notes.

“It’s not about the raw technology; it’s about the people who shape that technology for human use and human benefit.”

09:26 am EDT

Suresh: “The creation and deployment of previously impossible apps on next-generation Internets have the potential to transform our lives in ways we cannot image today… A potential revolution in ultra-high-speed networking. We look forward to nurturing this initiative through collaborations with our sister agencies [as well as academic, corporate, and non-profit partners].”

09:24 am EDT

Among the EAGER awards being made today:

  • Mike Zink and his team at the University of Massachusetts Amherst are demonstrating the benefits of connecting radars to ultra-high-speed networks to improve weather prediction–an application to help mitigate the impacts of natural disasters.
  • A team led by Marge Skubic at the University of Missouri Columbia is exploring the potential for early detection of health changes with research on unobtrusive monitoring of individuals with in-home sensors–possibly extending independent living for seniors.
  • Lev Gonick and his team at Case Western Reserve University are developing high-definition, multipoint videoconferencing and realizing its potential to improve healthcare delivery–enabling, for instance, seniors to consult clinicians for diagnosis and treatment, without leaving their homes.
  • Another team led by Henry McDonald at the University of Tennessee, Chattanooga is working on a disaster response system that provides emergency staff with training and planning, as well as real-time guidance on effective strategies to protect first responders and the general public–greatly improving public safety.

09:22 am EDT

Suresh is describing four key activities under the umbrella of the US Ignite Broadband Initiative — as we described yesterday:

  • NSF will announce 10 EAGER (EArly-concept Grants for Exploratory Research) awards totaling approximately million that “exemplify the types of applications and services possible on advanced networks.” These awards will span several strategic areas, including advanced manufacturing, education, smart health, and emergency response.
  • NSF will post Dear Colleague Letter that will encourage the research and education communities to develop novel applications “that take advantage of ultra-fast, programmable, next-generation Internets and [that] have the potential for significant societal impact.”
  • NSF will commit significant funding toward expanding GENI’s footprint by integrating “university campuses that have GENI technology with research backbone networks, and broadband cities across the U.S., enabling a virtual laboratory for experimentation at the national scale.”
  • NSF, together with the Mozilla Foundation, will announce an open innovation competition with 0,000 in prizes available over three rounds. The contest will “invite designers, developers, university students, entrepreneurs and others across America to brainstorm and prototype next-generation, open-source applications and services on future networks.”

09:21 am EDT

Suresh describes US Ignite as an opportunity to “advance applications and services for next-generation, high-bandwidth networks — not just local networks but across the country.”

09:19 am EDT

NSF director Subra Suresh notes how the Foundation has supported many paradigm-shifting technologies that today “affect billions of people across the globe in different corners of the Internet.”

“One thing common about all of these life-changing technologies is that they can be traced to basic research supported by NSF,” Suresh says.

“The Internet began as a search tool and grew into an unprecedented game-changing tool of economic development.

“We at NSF continue to facilitate collaboration to jumpstart the next revolution in networking.”

09:16 am EDT

Holdren notes that among the partners of US Ignite are 60 research universities, 25 local communities, and 9 government agencies.

09:16 am EDT

Holdren: “US Ignite is a collaboration between the public and private sectors that will demonstrate the ability of ultra-broadband networks to transform education and workforce development, health, transportation, advanced manufacturing, public safety, clean energy, and more.

“US Ignite is going to help entrepreneurs and researchers create the applications that will drive demand for the Interent of the future.”

09:12 am EDT

And we’re underway — The President’s Science Advisor, John Holdren, is kicking things off this morning.

04:55 pm EDT

And that’s a wrap on today’s live blog. Video of the U.S. Ignite Gigabit Applications Workshop will be available here for the next few weeks. And we’ll have a post summarizing the key themes that emerged from today’s discussions later this week. Needless to say, there will be much more on the U.S. Ignite front.

04:52 pm EDT

Suzi Iacono wraps things up: “This is just the beginning. What you have ahead of you is really, really important — and really, really hard. But I think I just heard [Aneesh Chopra say] that we are the Ignite family. You heard it here — you folks have the responsibility to carry this forward.”

She notes how the city folks are yearning for experiments but don’t know where to find them, while the application folks have applications in their labs but don’t know where to go to deploy them at-scale. And this is just the beginning to find partnerships. “We have the infrastructure — and we need to use it,” she says.

We are going to move on the first spiral, meaning that we are connecting up the six cities with the 14 campuses that are already GENI-enabled. We are holding a series of workshops to identify what kinds of teams we need to form to move things forward. We are holding competitions so that everyone can participate.

“Go forth — be emissaries — you are the Ignite family.”

04:42 pm EDT

Chopra: Another example about liberating learning assessment data. In the spirit of open data, parents are entitled to access to their childrens’ assessment data. For example, there are 166 (or so) indicators for algebra. If you knew how many of these your child was struggling with, you would be able to find personalized apps for your child — and parents could even pay for the development of personalized apps for their children — thus paving the way for an improved learning ecosystem.

04:40 pm EDT

Chopra: A healthcare success story: there’s a community that’s looked at deploying asthma inhalers that record the GPS location and the date/time every time patients use their inhalers. By then crowdsourcing the resultant data, these modified inhalers have cut the number of uncontrolled asthma attacks by 51%. Note that the cost of an uncontrolled asthma attack patient to the system is 3,000 USD — and it is the second leading cause of hospital admissions.

04:35 pm EDT

Chopra: The way we’ve architected the Wireless Innovation Fund is to make sure the “demand-pull” is as great as the supply chain. Of the Wireless Innovation Fund, 1 billion USD is intended for fundamental R&D at NSF; some portion is intended for DARPA to look at the security of these wireless networks; and some portion is intended for application areas like education (ARPA-ED), energy (through ARPA-E), and healthcare, and so on.

04:23 pm EDT

Chopra: “There’s never been a better time to innovate” — from the rise of open data as a philosophy of governance; to the power of “big data” which has really made a difference in many sectors of the economy; to the shift in the culture of innovation to one of collaboration.

Moreover, we’re no longer looking at budget cycles in years, but rather in 90-day rollouts.

“Every one of you today should feel like, regardless of how we formalize this, you can get to work right now. You can go to data.gov and download all the data.”

04:19 pm EDT

Challenge #3: Could be the smart grid, but “today we’re going with advanced manufacturing.” We’ve put 5 million USD into democratizing access to modeling and simulation for small and medium enterprises to increase competitiveness.

04:17 pm EDT

Challenge #2: A learning system that works. “We are moving our education system from one with butts in seats to one that’s focused on mastery.” The President’s FY 12 budget calls for an ARPA for education to take advantage of information technologies that personalize learning.

04:16 pm EDT

Chopra is walking through three challenges:

Challenge #1: Transform our care delivery system, i.e., transitioning from paying for services to paying for value. This transformation opens up a brand new market in data mining/analytics, care integration tools, timely clinical data, decision support tools, and the like. These products do not exist at the commercial scale in the U.S. right now because there is no business model that rewards these capabilities. As we shift toward value-driven healthcare, there will be a business model that rewards these capabilities — and “if you don’t invent some of these capabilities, shame on you.”

04:15 pm EDT

Chopra: Government, healthcare, and education are three sectors in the economy — in aggregate, over a quarter of the nation’s economy — that have not seen an increase in productivity, and the belief is that this is because they have not capitalized on information technology.

04:12 pm EDT

Chopra notes that about 1 billion USD of the President’s 3 billion USD innovation fund for basic R&D, testbeds, and public sector application development is directed to the NSF, and a good chunk of that is further directed toward initiatives of the kind that were discussed here today.

04:11 pm EDT

Chopra: “Digital infrastructure is very much defined by the President as an effective building block for the President’s overall strategy for innovation.”

04:09 pm EDT

Aneesh Chopra, the U.S. Chief Technology Officer, has taken the podium. Definitely catch the live webcast.

04:02 pm EDT

And that brings the report-outs from the breakouts to an end. The workshop is taking a short break, and then we’ll be back for the final discussion to be led by U.S. Chief Technology Officer Aneesh Chopra.

03:56 pm EDT

The group focused on transportation first brainstormed a range of applications and their policy implications, and then chose one that can serve as the basis upon which the others can build.

The initial range of applications included different kinds of sensors, car-sharing (such as the Zipcar model), different types of smartphone applications (to include traffic sensing, prediction, routing, etc.), and media streaming and conferencing. All of these applications need some type of awareness from the environment, and then they must run analyses and make predictions.

It’s therefore important to build an enabling platform for sensor network applications: We can develop a single networking framework that aggregates the data and sends it to the cloud to different data repositories. Then different application builders can come in and do their own analyses. This effort yields a consistent, single framework and requires a public-private partnership.

03:49 pm EDT

A table on energy and the smart grid discussed what it takes to capture value from, and cost savings in, the energy system. The power industry invests hundreds of millions of dollars at the wholesale level, yet tools at the consumer level must be adopted to enact cost savings. These tools — smart sensors, actuators, low-cost devices capable of delivering reliable controls, communications capabilities, etc., all with the appropriate kinds of privacy and security of data and systems — must be integrated into the smart grid on the consumer side.

03:48 pm EDT

On education, “the best table discussion I’ve been at in several years.” We talked about several things:

– Using networks to transport university resources beyond the campus: take students and have them mentor folks in the community, or take courses and making them available to high school classrooms.

– Students are learning more from multi-player educational games than almost anything else — so we need to explore these “learning tools.”

– We need to provide the kinds of immersive environments, game playing, smartphone apps, education application creation tools, etc., that are hugely powerful in education. GENI-enabled, competitively-chosen group of schools nationwide that could go and work together.

– We need to further home schooling apps — including collaborative real-time home schooling.

03:43 pm EDT

A table on “customized virtual clouds available on demand”: if I’m sitting at home, then I should be able to instantiate many machines on different clusters running U.S. Ignite; specify how these machines are interconnected (type of network, topology, bandwidth, etc.); and allow end users at schools, businesses, etc., to opt into my network and use these clusters.

03:42 pm EDT

A plea for education: connecting learners. We talked about high bandwidth, high-quality video, semantic labels on videos, advanced social networking, etc. Those are the building blocks of where learning applications might go. We also talked about taking those building blocks and throwing two things at them: (1) connecting learners to mentors (not just teachers talking at students, but really connecting scientists and artists to students with these high-bandwidth applications); and (2) connecting students to each other.

03:41 pm EDT

On advanced manufacturing: we would like to develop “the iTunes of manufacturing.” We think we need to develop tools to reinvent manufacturing as a service, not a specialized activity. We need people who can help us define the architecture for that service; we need a semantic web for manufacturing to determine the manufacturability, give advice/criticisms, etc.; and so on.

03:40 pm EDT

A few of the themes being presented:

One group focused on applications that need to exist — and creating the competition to do that. Once you start having everything on the network, security becomes an issue. Compressing the cycle of innovation — and getting the cycle of innovation from carriers — was the focus of another group.

03:35 pm EDT

And we’re back from a brainstorming session.  The different subgroups are sharing the key themes that emerged during their discussions. You can view the 90-second summary presentations through the live webcast online.

02:39 pm EDT

And we’re going to take a break from live blogging for a bit — as those in the room take part in a 45-minute brainstorming session to (a) help organizers define and advance the U.S. Ignite mission, and (b) help researchers and communities to identify projects and partners. Jon Peha, formerly of OSTP, is leading the session. We’ll be back shortly.

02:32 pm EDT

Frank — speaking with lots of energy at the podium: “Philly is a big city with lots of moving parts … but we cannot leave our citizens behind.” The city has deployed a five-year technology plan and is making a citywide IT investment with 120 million USD capital. About 25 million USD of this amount is going toward infrastructure, and the rest — 95 million USD — is going toward applications.

“The big play here is our vision around a ‘Digital Philadelphia’ Network,” Frank says, linking the public safety network (including video surveillance, 800MHz radio, wireless network), core fiber in Center City Philadelphia (city government, hybrid wireless, leased access, city-owned fiber), field workforce wireless network (streets, health, infrastructure), and remote sites (water, libraties, streets, recreation centers, and infrastructure).

“We’re a hell of a national sandbox,” Frank says. “The entire city itself — the city infrastructure — is available to play… Our goal is to [make] Philadelphia the national model for urban transformation to the 21st century knowledge economy,” through citizen engagement (via OpenAccesPhilly), digital inclusion (PhillyConnects) and, ultimately, an InfoTech Economy (via Gigabit City).

02:20 pm EDT

One last talk before a breakout session: picking up on this morning’s presentations by the cities/regions involved in U.S. Ignite, Allan Frank is now at the podium describing Philadelphia’s “Digital Vision.” (Frank couldn’t make it this morning, so his talk was delayed.)

02:17 pm EDT

Jon Taplin of the University of Southern California’s Annenberg Innovation Lab is the final speaker of the current session, describing a few of the apps his team has been developing. Among these:

– Participatory Learning and You! (PLAY!) — in consultation with a new school district in Los Angeles comprising six schools in a low-income district that are built around a central media lab. The goal was to build a multimedia participatory learning system, in which kids could combine video, audio, graphics, etc., from many different locations and make projects together.

– “Big data” challenges. Just this weekend, Taplin’s team analyzed three million Twitter feeds in a span of three hours to understand which movies might be the big-ticket items in the coming weeks. “‘Hangover’ is going to be really popular,” he said, drawing laughter from the room.

02:05 pm EDT

Zhang describes current sustainability challenges, e.g., transportation: there are over 45,000 fatalities and 2.4 million injuries per year in the U.S. caused by automobile accidents; and Americans spend greater than 500 million hours in their cars each week. To address these challenges, we need “smart transportation” approaches, to include sensing and control (active safety, autonomous driving) and infotainment (mobile theatre, caravanning). Zhang displays a 3D axis, relating application, link/network, and scope/domain.

He also touches on:

– The Smart Grid — microgrid-based distributed generation and control; and
– Workforce development — developing broadband solutions and providing these to underserved communities in the Greater Detroit Area to improve workforce and business development.

01:56 pm EDT

Finally, a Detroit speaker — after much comparison between Cleveland and Detroit today! Hongwei Zhang of Wayne State University is describing the various broadband initiatives he’s spearheading there.

01:54 pm EDT

Adams: The value of nanoHUB.org is that it provides a real framework around research. Some additional areas of interest include sustainability, healthcare, and most recently, advanced manufacturing.

01:50 pm EDT

Adams: Several dozen hubs are currently running. The first one — nanoHUB.org — was funded by NSF in 2002. In the last 12 months, it has supported oer 175,000 users. Over time, it’s been used by 487 classes at 158 institutions. The content spans 741 content authors of 206 applications. It is the “world’s largest nanotechnology user facility,” Adams says.

01:48 pm EDT

George Adams from Purdue University is up next, and he is describing the HUBzero(R) platform — which can be used to create dynamic websites for scientific research and educational activities. With HUBzero, Adams says users can  easily publish their research software and related educational materials on the web.

01:45 pm EDT

Schwartz is articulating guiding principles, such as:

– Improve the quality of healthcare while reducing the cost of healthcare — fewer trips to doctor’s office, emergency room, and hospital. Consider, for example, that congestive heart failure (CHF) rebounds cost Medicare just billion/year.

– Help people with cognitive disabilities to live independently and stay longer in their own homes.

– Reach into high schools to enable students to participate in STEM classes at home using one-to-many video and receive tutoring using one-to-one video.

– Ultimately: Connecting people to people in their neighborhoods and beyond.

01:43 pm EDT

Schwartz: The Case Connection Zone spans four key application areas: health and wellness; home energy management; public safety; and STEM education at the high school level.

Touching all of these areas is video, i.e., one-to-one (telemedicine, tutoring), one-to-many (classes), many-to-many (support groups and meetings for chronic management or energy conservation). Video requirements include uncompressed video to reduce latency, very high resolution stills, and annotation (“think John Madden football maps”).

01:38 pm EDT

Marv Schwartz is now delving into details about the Case Connection Zone, comprising home-run fiber to 100 residences, each with a Gigabit media converter (fiber to copper) and a Gigabit router with 802.11n wireless. The composition of this “beta block” is 40% permanent residents and 60% students at Case Western and affiliates, Schwartz notes.

01:33 pm EDT

Skubic: A two-camera system extracts silhouettes of individuals (silhouettes to preserve privacy) and generate 3D profiles that provide insight into varying gait characteristics, such as velocity (feet/second), step times (seconds), and step lengths (feet).

One can imagine implementing this approach in a rehab setting, coupling a patient’s gait analysis with an idealized version.

01:31 pm EDT

Skubic: The sensor networks capture changes in lifestyle, showing different activity levels as a function of motion density. Activity profiles are classified computationally as “active,” “sedentary,” or “cognitive” — and changes can trigger alert information.

01:31 pm EDT

Marge Skubic of the University of Missouri is focused on “squaring the life curve,” i.e., maximizing the area under the curve time vs. functional ability. Her team’s efforts on lessening the functional decline in life include assessing behavior patterns, assessing gait and activity level, recognizing pattern changes, detecting early signs of health decline, and detecting falls, etc., through an advanced sensor network (to include bed and chair sensors (for activity/restlessness detection) and motion sensors).

01:23 pm EDT

Up next we have David Sailor of Portland State University, who is particularly interested in sustainability issues — and notes there are many subtopics under sustainability that have opportunities within U.S. Ignite.

His areas of emphasis include:

Transportation:

– Public safety & health — better management of road conditions, visibility, and street lighting;
– Transit optimization — increased polling rates for Automatic Vehicle Location system, traffic signal optimization, etc.; and
– Traffic/pollution assessment — vehicle counts and instantaneous fleet composition assessment.

Metrics of urban sustainability:

– Urban energy/water/carbon budgets; and
– Baseline and performance assessment for sustainability endeavors.

And urban air pollution and dispersion:

– Pollution emissions, transport, and exposure; and
– Real-time urban dispersion assessment for chemical/biological releases.

01:18 pm EDT

Nick McKeown from Stanford kicks the session off with an overview of the OpenFlow technology, using a demo to highlight the value of optimizing a network in service of applications. “GENI has been ahead of the game in identifying a restructuring of the network that is taking place,” McKeown says. In a nutshell, such network optimization requires moving the control panel of the network above the data plane.

There are three requirements to make this vision — for a software-defined network (SDN) — a reality:

1. Open interface to packet forwarding;
2. At least one network operating system, probably many (open- and closed-source); and
3. A well-defined open API, with new routing mechanisms, etc.

SDN is in development across many domains (data centers, enterprise/campus, cellular backhaul, etc.) and products (switches, routers, software, etc.).

And most recently, to steer these efforts, a number of companies have come together to create the Open Networking Foundation (ONF) to “publish open interfaces and promote SDN.”

McKeown argues that SDN is the infrastructure the industry is betting on (“future proof infrastructure”; “U.S. Ignite can be at the forefront”); it enables innovation (wired and wireless networks; home, campus, regional, and backbone networks); and it supports the creation of new companies and many new hirings (builds on GENI; on campuses, across Internet2 and regional backbones, etc.).

01:00 pm EDT

The 90-minute presentations have concluded.

We’ll resume live coverage following a five-minute break. Up next are a series of presentations describing sample high-bandwidth applications.

12:45 pm EDT

Derek Meyer of the University of Wisconsin-Madison: “WiRover” is equipping approximately 250 city buses in Madison acting as mobile access points. A next step is to equip ambulances to enable direct interactions between paramedics and doctors through video over wireless.

12:40 pm EDT

Kiran Nagaraja of Rutgers University is describing the “MobilityFirst” Future Internet Architecture project funded by NSF/CISE.

12:38 pm EDT

Ali Ipakchi of Open Access Technology International, Inc.: “the largest cloud infrastructure for managing energy and energy transactions across the U.S. power grid.”

12:29 pm EDT

Peter O’Neil: “A great deal that we can do on the social side” with encouraging adoption of the new tools and approaches that are being developed.

12:23 pm EDT

Peter Whitehouse with the most memorable slide: “Thinking like a mountain.”

12:17 pm EDT

And we’re back for the afternoon session following a short lunch break.

First up is a “Research Blitz,” during which approximately 20 researchers will have up to 90 seconds each to describe their research interests.  It’s all part of “matchmaking between city/infrastructure providers, researchers, and the other U.S. Ignite partners,” a key goal of today’s workshop.

Check out the live webcast to hear these 90-second spiels.

11:37 am EDT

It’s lunchtime at the U.S Ignite Gigabit Applications Workshop. We’ll be back in about a half-hour.

11:35 am EDT

Elliott is responding to questions from the audience.

Again, a reminder to check out the live webcast of today’s workshop here. If you have questions, you may submit them through the webcasting interface.

11:31 am EDT

Elliott: Starting with Philadelphia, a number of cities/regions have expressed strong interest in GENI-enabling cities. “This notion of having research ideas engaging very large numbers of people” is a very interesting idea, and offers a number of benefits to the people in these cities/regions.

He touches on the citizens’ view (future internets = new services; access to novel services as created; and new content, weather, health services, etc.) and the entrepreneurs’ view (this really fosters discovery and innovation, all the while “lowering the barrier of entry to really things going”).

11:28 am EDT

Elliott:  “We’re very much interested in ramping up research experimentation,” as that will help determine what features and capabilities are in demand.

Meanwhile, the GENI Project Office (GPO) is focused on “at-scale” buildout at up to 100-200 U.S. campuses. Currently, there are 14 GENI-enabled campuses — and the aim is to double or triple that number in the next year or so. An important part of this buildout is to do it in a staged manner, so that lessons may be learned as more campuses are brought on.

11:23 am EDT

Elliott: As opposed to building a research testbed “as big as the Internet,” the goal is to “GENI-enable” testbeds, campuses, and backbones. A number of groups are already engaged in building out GENI at-scale.

He is highlighting several of the demos that were presented at the GENI Engineering Conference in Washington, DC, last November.

11:13 am EDT

Elliott is providing a great overview of the goals underlying GENI. A researcher instantiates a slice of GENI, conducts an at-scale experiment, and then watches as his/her experiment takes off. Importantly, GENI doesn’t really resemble anything different to the end user. “The fact that the plumbing may be different deep into the network really means nothing at all to the people who are using these applications and services.” In other words, with GENI, the current Internet stays the same, but there may be additional offerings — some that are intermixed, partly using the Internet and partly not using the Internet.

“The easiest way — and the way we are doing this right now — is through Web portals.” People register, find out what experiments are running near them, and then opt in, indicating that they are willing to participate in specific experiments.

11:05 am EDT

We’re back from a short break.

Chip Elliott is providing a short overview of the GENI project — a virtual laboratory for exploring future internets at scale. Read much more about the GENI project here or here.

10:43 am EDT

Some Q&A right now — and a reminder that you can watch a live webcast of today’s NSF/OSTP workshop here.

We’ll be taking a 10-minute break shortly.

10:41 am EDT

Gonick describes how Case Western Reserve University created a regional aggregation strategy for broadband — and the resultant OneCommunity is now operating in 22 counties in Northeast Ohio, spanning 1,800 sites, and enabling creation of GENI-like slices for experimentation. OneCommunity is particularly interested in facilitating open broadband and wireless — on university campuses, in airports, etc. Over 0 million in investment has resulted in more than million in savings — through improved quality of life propositions.

The Case Connection Zone has been up and running for nearly a year.  It comprises 104 residences connected with fully 1G wired connections, each enabled with HD video conferencing. Much of the work, if it involves residents directly, has an opt-in for the residents — and needs to be reviewed by Case Western’s IRB.

10:39 am EDT

Last but not least, Todd Marriott of UTOPIA speaks about his team’s efforts in the Salt Lake City region. “We provide 1G of symmetric connectivity sub-100 USD to over 3,000 residents in Utah.” He describes open access as the key — and notes that there can be sustainable open approaches. UTOPIA goes door-to-door suggesting buy-in into this infrastructure; the first time through it had a take rate of about 31.5%.

10:31 am EDT

Suzi Iacono says, “[NSF aims] to see new developments and bring people together who normally don’t talk to each other — and we think innovation happens in just that way.” Today’s workshop — and the broader U.S. Ignite effort — is about trying to pair infrastructure providers with researchers who have interesting applications. It’s about aligning the teams — perhaps a city person, an anchor institution person, an app developer, a networking person, etc. — and resources that will be necessary in order to carry out the deployment that’s being envisioned.

Moreover, Iacono describes how, in parallel to doing the traditional NSF call for proposals, the NSF plans to try competitions with cash prizes for the first time.  “We’re hoping to reach the non-traditional NSF PI community — the people in the open source world, people in their garages, students,” etc.

10:25 am EDT

Nick Maynard of OSTP and Suzi Iacono of NSF/CISE deliver opening remarks framing today’s workshop.

Maynard describes that a driver of this activity is answering the renewed investments in other nations.  “We need to take the communities that have already upgraded their capacity and turn that into a seamless network — just like we’re seeing in other countries.” The White House’s role, Maynard says, is to serve as “convener and uniter” of all the varying activities by creating an organizational structure to foster collaboration and innovation.

U.S. Ignite can lead to a “whole new generation of business models and applications” for non-profits, for-profits, universities, and communities across the country. And it’s working steadily toward a launch event this fall. “We want you all working with us” in the months from now and then] to help leverage what has already done, raise the awareness and get people excited about this, and continue to educate partners and end users about why this is important for them, Maynard says.

“I look forward to working with all of you to make U.S. Ignite a success!”

10:25 am EDT

Tegene Beharu is up next, representing Washington, DC. He describes DC-NET, which was established after Sept. 11, 2011, to provide secure, managed data, voice, video, and wireless services for government and education institutions in DC. Today, a 360-mile fiber optic network connects over 350 DC government locations, including 127 public schools connoted at 1G speeds.

DC-NET is seeking to engage with DC universities to foster high-bandwidth application and technology development — including providing a platform for collaboration. Specific areas of interest include:

– Public safety and government operations — dedicated fiber ring for public safety communications (a specific focus includes the next-gen 911 application);
– Healthcare — HIPAA-compliant transmission of electronic health records, access to applications for health providers in the DC region, virtualization of health applications, and capability for telehealth applications; and
– Education — ultra-high-speed video conferencing capabilities, Internet2 for the University of the District of Columbia, and GENI-enabling the network backbone.

09:50 am EDT

Jim Ingraham, the Vice President for Strategic Research at the Electric Power Board (EPB) of Chattanooga, TN.

He begins by noting the recent tornado outbreak, which resulted in the biggest outage in EPB’s 75-year history. “The smart grid that we’re deploying today — and the communications infrastructure that we’ve deployed over the last 10 years — were critical to restoring power for 90% of the customers within five days.”

EPB’s service territory spans 600 square miles in East Tennessee and North Georgia, including 170,000 meter customers. The system peaks in the summer at 1,300MW.

EPB’s wholesale power supply comes from the Tennessee Valley Authority, which is moving to time-of-use rates in 2012. And the average electric bill has risen from 100 USD/month in 2006 to 130 USD/month today, and it is forecasted to reach 185 USD/month by 2015. This is “precisely why we’re interested in smart grid” technology — to enable cost savings.

Ingraham describes how EPB is seeing record data growth — from 2 million (today) to 6 billion to as much as 90 billion data points per year by the time the smart grid will be fully deployed. It is deploying over 2,000 switches to automate the electric system for greater reliability. And a huge opportunity is to define electric use in the market for wholesale electric providers.

09:44 am EDT

Gonick walks through major areas of interest (calling it “smart, safe, healthy, green”), including smart health and wellness, the smart grid, and smart STEM education approaches. There’s a considerable focus on behavioral change in the homes.

09:33 am EDT

Lev Gonick, Chief Information Officer of Case Western Reserve University, kicks off the first session of the day, “Next-gen Networking.”  He’s the first of six representatives describing the people, network resources, and areas of application interest in their respective cities/regions.

09:16 am EDT

Geoff Daily of Lafayette, LA-based FiberCorps begins by noting that fiber has the potential to better connect society — but the challenge is to reengineer our communities to take advantage of all this fiber. FiberCorps is a new non-profit established by a coalition of community stakeholders to energize the Lafayette community to be the hub of fiber-power innovation. It is focused on two things moving forward: how do we find demonstration projects, and how can we build community coalitions around them?

Daily describes six community-inspired projects that FiberCorps is facilitating right now, titled the 3D render farm, health information exchange, business telemedicine, netcast, virtual horse farm, and “Virtual Lafayette.”

Areas of interest for Lafayette include:

– Healthcare — regional heatlhcare hub;
– Education — schools of choice program, focused on creative IT, biomedical sciences, etc.;
– Research — CACS, CVDI, Wireless Sandbox;
– Energy — oil services key industry, and smart grid; and
– Public safety — a business emergency management operations center has been started recently.

09:15 am EDT

Jahanian describes how NSF “has funded a suite of national testbeds — wired and wireless” over the years. Today, “with GENI, we have begun federating these testbeds and bringing new networks on board as new technologies are becoming available — as a resource for researchers to access and deploy to do their experimentation. Today, [researchers] can create [their] own [slices in] the network, with many slices co-existing in parallel…  Experimentation at scale in campuses and cities is becoming the reality.”

He goes on to say: “We have seen significant investment in broadband in a number of highly innovative cities… We have also seen significant investments in wireless and broadband by anchor institutions across the country. These investments collectively are creating exciting opportunities for researchers and entrepreneurs to develop novel gigabit applications and deploy them across these regions.

“If islands of broadband exist across the country and potentially we could use the GENI infrastructure as the glue, can we bring them all together to support applications [for national priority like smart health, smart energy, and so on]. This could benefit the large segments of society.

“NSF cannot do this alone; we need your help.  I think it’s time to innovate.  I am thrilled to see that there are so many partners here from a cross section of city infrastructure providers, industry, non-profit organizations, U.S. government agencies, and of course our friends in academia.

“Let’s keep an open mind.  Let’s see what we can do together.”

09:06 am EDT

Farnam Jahanian, the CISE Assistant Director, is kicking things off.  “It’s my pleasure to welcome all of you to the U.S. Ignite Gigabit Workshop.  Cheer up — we’re going to have a great day today!”

09:05 am EDT

We’re just about set to get started this morning.  Take a look at today’s agenda here.

05:45 pm EDT

…And that’s a wrap.  Thanks to all the participants — and to all who followed this blog the past couple days.  We’ll have a summary blog report in the next few days.  Please feel free to continue the discussion below.

05:41 pm EDT

And from NSF’s Howard Wactlar:  “Maybe something we could go forward with is a set of teleconferences by some of the speakers here, maybe one- or two-hour teleconferences elaborating more on… what they’ve accomplished… [before] a worldwide audience. … These experiences and lessons learned can be shared.  We should share the things that worked and share the things that didn’t work.  We should figure out how to stand on one another’s shoulders instead of one another’s feet.”

05:39 pm EDT

And some concluding remarks from Dimitri Ypsilanti, Head of the OECD’s Division of Information, Communications, and Computer Policy, and Howard Wactlar of NSF/CISE.

Ypsilanti goes first:  Lots of great conversation.  We also need to be sure to consider the economics of health.  ICTs are the tool in order to solve the dilemma of cost vs. care provisioning; they can help adjust the supply/demand curves in economic terms.  There’s a clear need to integrate the provision of health services and care services.  In the longer term, putting the two together can actually decrease costs and lower the demand curve for health services.  The OECD slogan for its 50th anniversary sums it up:  “Better policies for better lives.”

Quoting Ypsilanti:  “It’s been a tremendous workshop  The last two days have strengthened our conviction that innovation in the health sector — creating a smarter health and wellness future is … something we need to spend time on. … There’s been much food for thought… lots of ideas for future research… we need to sift through the data and pull together some messages from this workshop.  We do intend to produce a special edition of the International Journal of Medical Informatics based on this workshop.”

05:33 pm EDT

Testbeds are taking the stage now…

The participants are agreeing that we need numerous massive testbeds — we need the 10,000-patient trials with home medical devices and with home monitoring.  (The problem of course is that you have to contend with IRBs, and the question is, do we need everyone’s permission to go in there?  We need to make a huge amount of processing and data available.)

In addition to the homes and hospitals, we’ve also heard lots about health behavior — so let’s also do 10,000- or 100,000-mobile phone testbeds in partnership with social scientists.  Let’s not think if it’s medical, it’s the hospital.

05:29 pm EDT

Lots of states have strict health IT laws — and these states have less data sharing.  At the same time, transparency is hugely important to privacy — because people want transparency.

More and more, we’re looking at privacy that facilitates selective sharing.  So, it raises the challenges that were mentioned earlier around usability; the more nuanced you make things, the more difficult you make the interfaces, and the more difficult it is for the patient to be able to interface with his/her data and manage his/her privacy transparently, understandably, and effectively.

05:17 pm EDT

A participant relays the similarities between health IT and “car IT”:  “I just recently took my car in to have it serviced.  The mechanic said, ‘We’ll let you know; we have to hook it up to the computer.’  The computer gave a printout — and the mechanic said, you don’t have a problem with this or a problem with that.”  In a sense, the role of the mechanic has changed profoundly in recent years.  Mechanics are using technology — technology that’s powerful and saves time — and they are essentially part-computer person and part-car person.  The only difference:  the doctor works on the engine while it’s still running.

05:14 pm EDT

And another point:  One thing that’s changing — the handwriting is on the wall, in fact — is that the patient is going to become much more involved in the decision-making process.  And with that, the patient is going to have to accept some responsibility for this process.  We need to provide much better decision support systems that bring together as much information as possible — very adaptive decision-support systems so that they’re not just empowered but intelligently empowered.

05:14 pm EDT

A point about increased transparency:  we need to know what the costs are so that we can achieve an outcome and pay as little as possible to achieve that outcome.

05:12 pm EDT

A point-counterpoint just now that seemed to “strike a nerve,” in the words of the session chair:

Point:  Do we get rid of half the doctors?  The current healthcare system is unsustainable.  Maybe holographic doctors are the way of the future.

Counterpoint:  Doctors aren’t the problem.  Moreover, part of what you’re looking at in healthcare is not only the outcome, but also how you got to the outcome.  Did I feel like a human-being along the way?  First class is great, but I would not get the same level of comfort from a holographic flight attendant.  Measuring the outcome should also include how you got to the outcome.

Counterpoint to the counterpoint:  When I want to listen to the “Eagles,” I do it on my iPod; I don’t call up the band into my living room.  Maybe we just need to consider alternative pathways.

05:10 pm EDT

Now for some open-ended dialogue:

We need real, long-term collaborations.  This isn’t about taking the problem and going off and innovating on our own.  We need programs that give us grounded ways for pursuing innovation — real data, real people, real systems, technological, socio-technological, etc.  And we also need to understand what the research is providing us.

04:58 pm EDT

Joseph Alhadeff of the OECD emphasizes proportionality and context — there isn’t a “one-size-fits-all-cure” for any of this.

He touches on privacy and security.

And finally, he speaks about regulation and policy.  Most regulations “are out of date the moment the ink is dry,” he says, “which is a term by the way that is out of date” — drawing chuckles from the room.  “Is [the regulation] narrowly tailored to achieve a public policy?  Have you considered its unintended consequences?  Have you tested it with trial runs?”

04:53 pm EDT

Howard Wactlar of NSF/CISE, is providing his summary of the topics that boiled up to the surface over the past two days’ of conversation:

– We’ve talked about the health system, not healthcare, which his fine – but we mustn’t give the world the impression that we’re taking “caring” out of health.

– We heard a lot about social networks.  They’re not the cure.  They’re certainly part of the next therapy.  We need to think about adding to the social networks some telemedicine and remote monitoring, etc.

– The “super-aging societies” represent almost a “perfect storm” event.  The fastest growing segment of our population are those over the age of 80 years.  Within the U.S., almost half of those over the age of 80 years have Alzheimer’s.  And recent evaluations have shown that by the year of 2050, nearly 1 in 2 working adults within the U.S. will be an informal care giver.  This suggests we need significant research in behavioral monitoring and cognitive assistive devices that enable people even with impaired function to be able to conduct large pieces of their own lives – to sustain a kind of quality of life.

04:50 pm EDT

Elettra Ronchi, a Senior Policy Analyst at OECD:

We need to move from a fragmented, organizationally consrained view to a more systematic view.  And we can certainly leverage ICTs to achieve this goal.  The actionable agenda here is working on a whole range of fronts to enable meaningful sharing of data across settings.

Lots of discussion about interoperability — organizational, legal, and technical, etc.

We discussed a range of social networking sites — and in most cases information is given voluntarily to these sites.  Users may still not realize the quantity and durability of the information — and it’s uniquely challenging in healthcare the kinds of data that patients may or may not share.

04:43 pm EDT

Taylor Reynolds, Head of OECD’s Information Economy Unit, starts with a terrific example:

“I love my pedometer.  After attending this meeting, I understand why.  It’s given me information and helped me change my lifestyle.  It changes the way I do things in my life, because I try to get to 10,000 steps a day.  I connect my pedometer to my computer and can tell you – day by day – how many steps I’ve walked over the past two years.  It’s given me instant feedback – I know if I have to exercise more on a given day – and it’s given me a healthier lifestyle.”

These are the types of technologies we’re looking for in health ICTs — technologies that can give feedback to consumers and help them make progress over time.

ICTs fall into two categories – to improve efficiency and to enable empowerment of users.

On the efficiency front:  Gabriel Tick of MeshMD.com gave a great example yesterday about a doctor who had a patient come in with a dislocated elbow — but who couldn’t remember how to correct for the dislocation.  The doctor jumped on Youtube and saw how one relocates an elbow, and then he was able to do it himself.

Similarly, Mark McClellan spoke to us about the power of information in getting people to act.  Consider his example of original drugs vs. generics — and how lots more people went to the generics once they understood the differences.

In terms of empowerment, knowledge is power.

We need to look at experiences across countries and go forward with best practices.  We also need to look at other sectors.  What’s happening in electricity and transportation, finance, etc., and where are they making use of ICTs?  What can we pull out of those areas and into healthcare in order to make the health sector beter?

We need more comparisons.  We learned a lot today from countries outside the U.S.  We need better statistics on health ICTs.  We need better infrastructure.  We need open platforms and access to the data so that we can be more innovative.

04:37 pm EDT

Jeremy Thorp, Director, National Health Services, United Kingdom:

– Outcomes – how do we get to a point of measurable outcomes?
– How do we do data fusion?  What are good examples?
– Issues of financing and benefits?  Consider personal budgets, where individuals can make their own choices.  What’s the impact of quality payments?
– The management of risk – “neat vs. scruffy” – we have to make progress and be pragmatic, but how do we do that in a way that reduces risk and makes us feel comfortable about the quality of care and the quality of decisions being made?
– How do we deal with preventative health at an epidemiological level, being predictive across whole populations?

04:30 pm EDT

One more point from Estrin (roughly quoting), for which she received applause from the room:

“Open” is a powerful way to foster this sort of pre-commercial, joint innovation in a way that’s grounded and quickly innovative.  It can reduce the risk of “death by pilot” because when we fail and learn, we can pick up the side lessons and mash them together without having to go back to square one.  That being said, success for any open effort is to ultimately spawn closed efforts that are interoperable, commercial products.  So, seeding exploration with “open” is not about inhibiting or actively promoting commercialization; the latter will happen — and should happen.

04:28 pm EDT

Deborah Estrin of UCLA:

– Health is a worldwide issue and we need better socio-technical approaches — we heard patient data stores and community-contextualized knowledge are necessary.
– It will take more than just the creation of a new Facebook or iPhone app to realize these sorts of innovations.
– New, better methods for analysis (EHR, environmental data, etc., all brought together) — e.g., a sense-making innovation that’s quite important and a large part of 23andme.com and many of the other web-based innovations that we’ve seen are hugely important — constitutes a key gap with reference to research and methodology.
–  Health and medicine is much different than most other sectors — and really requires a unique kind of sense-making and international collaboration.

04:22 pm EDT

Rigby’s key messages:

– New needs from the silos of technlogy to integrated smart thinking in care and wellness
– From medical models to delivery and support by all professionals and carers holistically
– Empowering people and communities
– From data to processes — maintaining health and wellness is about plans and actions
– Focus on those with the deepest need — the oldest, elderly, less well educated, disadvantaged
– Regulatory role — focus on protection and standards leading to enablement, not “perfection eliminates possibilities”
– Evaluation and evidence — eHealth is a health technology, so it should and must follow the same rules of evidence as any other technology; proof motivates people; good solutions stimulate better solutions

04:17 pm EDT

And we’re back with the final plenary of the workshop, a roundtable discussion looking at key messages for an international research and policy agenda.  Robert Atkinson, President of the Information Technology and Innovation Foundation (ITIF), is moderating.  And our first discussant is Michael Rigby from the U.K., from whom we heard earlier today.

03:55 pm EDT

And it’s time for the afternoon coffee break.  We’ll be back with more coverage in 10-15 minutes.  Stay tuned!

03:55 pm EDT

Still more discussion:

– Health knowledge tools at the point of care are critically important — identifying a patient’s symptoms and ratings within the larger population gives a real demonstration of how he/she can improve his/her health outcomes.  The next step is consumers coming in with iPads and showing clinicians important quality information about their conditions, their communities of patients, etc.

– Conventional wisdom is dangerous — because it’s based on what we know in the past.  Things are changing today on the delivery side as well as on the patient side.  We are no longer going to be dealing with patients who are naive to the value of IT; it’s part of their experience and as physicians start to use it, it’s not going to be off-putting to them.

– Differences in cultures — Access to clinical data by insurance companies is against the law in Germany.  In fact, 50 European countries including Russia have to abide by the following:  any healthcare provider must actively protect one’s data.  It’s not a question of whether a patient wishes to have his/her data out there; every healthcare provider must protect his/her data.  A recent case story is exemplary of why:  a nurse who had HIV couldn’t get a job because a hospital didn’t protect her identity and everyone knew she had the disease.

– On the security and privacy front:  We’re still hearing some of the same issues we’ve discussed for decades at meetings like this one.  Can we transcend some of this discussion up to a level higher so that we can actually make progress?

– A panelist:  “As a provider, when I get a six-inch thick paper record, I’m glad there isn’t a weapon in my office because I’d be a threat to myself.  Because there’s about one piece of paper in that six-page paper record that’s actually useful.”  As we convert the paper records to EHRs, we have to be careful to make sure that this changes.   To do this, we have to take the data and put it into a form that’s usable to a provider who has six minutes with a patient.  It’s critical to apply processing power, rationalize information, and produce a list of care opportunities.  When we do this, usage rates go up dramatically and the gaps in care come down.

03:41 pm EDT

Some highlights from an expanded Q&A period:

– On procurement:  A panelist suggests that the limiting factor is the procurement process, not whether doctors are ready for the system.

– On cost-effectiveness of EHRs:  Cost-impact assessments for Kaiser Permanente’s EHR system are just beginning.  Lots of studies that show improved quality and conjecture about saved costs.  Where we see cost reductions is on the hospital side and on the medication side.  We’re doing all the obvious things — e.g., saving on postage, etc. — and while this stuff is sizable, it is also marginal in terms of the overall treatment costs.  Kaiser’s cost structure and trends are lower, and its Medicare five-star ratings are higher — and so Kaiser is hoping this incents the other providers to do the same.

– On shared principles:  HHS formed a MOU with the European community to discuss shared concepts for EHRs.  But the MOU is focused on the exchange of EHRs, not necessarily health IT broadly.

– On security and privacy policies:  All U.S. states have security and privacy laws, but only 8 or 9 have specific laws on the books relating to breach notification for health privacy.  At the Federal level, HIPAA covers health entities (e.g., a healthcare clearinghouse, a provider, etc.) as well as the business partners of these covered entities.  Meantime, medical licenses and reporting requirements are at the state level.  Similar scenarios reported by an Australian representative.

– On the questions we should be asking from a research standpoint:  We already too much data coming into a given doctor’s inbox.  We’re all marveling at the prospect of a single inbox; well, we have that, and you should see what it looks like.  People should get equally enamored with dashboards that have algorithms and intelligent systems in place. Until you get that, you have too much data — too many alerts, too much “red” coming in — all of which is overwhelming.

– And on certification/reliability issues associated with implantable medical devices:  The key question is, who is selling the device into the stream of commerce and what is the intended use of the device?  They then have to present to the FDA their entire profile of the device and show very specifically how that device is going to accomplish what it seeks to do.

03:16 pm EDT

Taffel is emphasizing that “risk changes the HIT value equation for providers.”  Roughly quoting:

The systems were built to document and support coding, facilitating expeditious reimbursement.  But this is the antithesis of what we need for accountable care.  Accountable providers need new tools to manage risk.  For example, it no longer makes any sense to have stacked paper metaphors in your electronic medical system.  Instead, what you need now is a longitudinal view that allows you to view progress over time — advanced systems that leverage payer-developed analytics, adapted for clinical care, including physician-driven disease and case management; clinical decision support systems; patient risk identification and stratification; and performance measurement, tracking, and reporting.

03:10 pm EDT

Taffel providing an interesting view of the current situation (roughly quoting):

More and more risk is shifting to providers, and an emphasis is increasingly on clinical quality measures (CQM) for performance.  In order to do this stuff, you need processing power and the types of investments that have already been made for creating the clinical decision support algorithms.  All the while, payers are beginning to transition to value-based/risk-based contracting — resulting in the return of a new capitation model via accountable care organizations (ACOs).

03:07 pm EDT

And up last (but certainly not least) is Bruce Taffel, who serves as Chief Medical Officer of Government Business & Emerging Markets for Blue Cross, Blue Shield of Tennessee.

Taffel is describing massive investments by care providers in systems to manage risk and deal with clinical decision support.  From a people perspective, it’s about case management and disease management.  From an analytics/tool-building perspective, it’s about data mining and rules engines; risk assessment and stratification; artificial intelligence; care gap identification; and clinical data acquisition (to augment administrative data) .

03:00 pm EDT

He further touches on the ONC’s SHARP program — which began in April 2010 and continues for four years.  The four projects funded at 15 million USD span:

– Security and privacy (sharps.org) (Gunter’s project)
– Patient-centered cognitive support (sharpc.org)
– Health applications and networking platforms (smartplatforms.org)
– Secondary use of health records (sharpn.org)

03:00 pm EDT

Gunter tries to stitch things together by describing several cross-cutting themes:  service models; regulations and public policy; and open validation.

02:56 pm EDT

Gunter is now talking telemedicine challenges and strategies:

– Understanding security threats and countermeasures for implantable medical devices (IMDs):  what are they?

– We need to develop home and mobile monitoring capabilities with secure personal sensors.  For example, we may want cameras for fall detection, but the common place where people fall down is the bathroom.  So how do we couple the need to gather information in the right setting with not being offensive?

02:54 pm EDT

Gunter provides some EHR challenges and strategies:

– We currently protect data in flight through encryption services.  But in practice, the vast majorities of problems are attacks on repositories, not communications.

– This is a space full of regulatory implications, and when you’re in business in this space, your ability to be effective depends on your ability to negotiate regulatory hurdles quickly and effectively.  In particular, lots of issues with security and privacy arise very quickly and frequently.  The ability to characterize policies and translate them into the systems in time-sensitive fashion is critical.

– The ability to build systems with flexibility and verifiable assurances — in essence, a shout-out to formal methods.

– Ways to take security policies and get them implemented in compositions of systems are important.

– Developing a lifecycle model for learning from experience with audit logs and improving enforced control.

– In the U.S., we have a challenge that HIPAA-covered entities are taking in data and exporting them to non-HIPAA-covered entities.  So we need to find ways to address gaps in policies.

02:49 pm EDT

Carl Gunter from the University of Illinois is up next.  Gunter has one of the four Strategic Health IT Advanced Research Projects funded last spring by the Office of the National Coordinator for Health IT.

Gunter is describing various healthcare environments, including EHRs, health information exchanges (HIEs) — for sharing records between enterprises or between an enterprise and a patient in the form of a personal health record — and telemedicine.  “These areas look pretty different right now, but in the future they will be much more similar.  So there will be some form of convergence over time.”

02:44 pm EDT

Bunker is elaborating on the technological challenges:  healthcare identifiers and directories; authentication and access security; terminology; and eHealth solutions.

And on the policy challenges:  critical to ensure that policymakers consider the impact of their decisions.  Why should a provider or consumer participate (business and personal driver) and how can they be protected (legal and medical liability, privacy)?

02:41 pm EDT

Bunker is describing NEHTA’s purpose:  establishing the foundations for eHealth.  NEHTA’s product stack includes:  personally controlled electronic health record (PCEHR); eHealth services and solutions; and national infrastructure components.

Bunker talks about an initial focus on access — collection of information, access to that information, use/disclosure of information — and then balancing the privacy and security of that information after the fact.  “We’re not operating in a completely green-fields environment, and there’s implicit trust in the network,” he says.  “We have to understand what the minimum bar is to get over the hump.”

Indeed, Bunker says, heterogeneous data sources are islands of information collected, accessed, used, and disclosed with a purposeful orientation toward the business operation.  And eHealth integration presents challenges both technological (semantic and syntactic interoperability) and political (necessary but business drivers and protections are present).

02:30 pm EDT

David Bunker — Head, Strategy and E-Health Architecture, National E-Health Transition Authority (NEHTA), in Australia — is now talking about heterogeneous data sources and the corresponding technology or policy challenges.  But he notes at the beginning that “it’s half-past five o’clock in the morning from where I am,” drawing chuckles among members of the audience.

02:27 pm EDT

Jarrin notes that CMMS’s total budget in 2010 equaled 784.3 billion USD — of which about 2 million USD was for telehealth.

02:22 pm EDT

Jarrin is describing the U.S. economic, policy, and regulatory framework — touching on Congress, CMMS, FDA, FCC, NIH, and the Office of the National Coordinator for Health IT (ONC), as well as various key pieces of legislation like ARRA and PPACA.

02:18 pm EDT

Jarrin:  Wearable wireless sensor market is predicted to grow by leaps and bounds — 400 million devices annually by 2014.  Wireless body sensor chipsets and revenues are also very high.  Even more stats:

– 15 million wireless health devices by 2012
– 73% of consumers would use remote monitoring services to rack conditions and vital signs
– U.S. market for healthcare wireless technologies in 2007 was 2.7 billion USD; expected to grow to 9.6 billion in 2012

The technology is allowing for healthcare to happen, whether governments want it to happen in a certain way.

02:15 pm EDT

Robert Jarrin is QUALCOMM’s Director of Government Affairs, and he’s planning to focus on economic and regulatory frameworks for mHealth.

Jarrin kicks off by emphasizing that QUALCOMM does not manufacture cell phones or infrastructure any longer, but rather the microprocessors that go into cell phones.  The company has produced over 7 billion microprocessors, and has over 70,000 patents around the world.

There are over 5 billion subscribers of mobile phones — and just for some context, Jarrin says, there are only 4.4 billion people who have access to toilets.

Some more impressive numbers:  over 1 billion 3G subscribers — expected to be ~2.8 billion by 2014.  And over 655 commercial 3G operators in over 170 countries throughout the world.

02:07 pm EDT

Up next is Helga Rippen, Chief Health Information Officer and Vice President, Center for Health Information Technology, who raises questions that we should be asking:

– Does the healthcare business environment match with a mHealth learning health network?
– Who really drives the priorities?  What is the business model?
– Who owns what?
– Who is responsible for success?  For failures?
– What is the primary purpose?
– What is being shared by the network?
– How is it being shared?
– For what purposes?
– Chicken (network) or the egg (data)?

01:59 pm EDT

Silvestre is concluding with a video relating the experience of one KP HealthConnect user.

01:56 pm EDT

Silvestre is walking folks through Kaiser’s EHR, which is called “KP HealthConnect.”  It is universal; no physician may opt out, which is one of the reasons Kaiser has been able to achieve such a high adoption rate.  HealthConnect is in every single exam room, in the emergency rooms, etc.  And HealthConnect comes with “My Health Manager,” which grabs information from the back-end medical record to provide high-value, on-demand data to patients.  Family members can sign on as proxies.  Moving forward, Kaiser will provide mobile options as well as ways for non-members to serve as proxies for their loved ones.

About 3.4 million members have registered with My Health Manager — and over 85 million visits to the website per year.  Some more stats:

– 10 million secure e-mails sent to physicians
– 25 million lab test results viewed online

For the member:  convenient, free, better health.  And for the physician:  efficient, shared data, better care.

01:51 pm EDT

Silvestre:  Kaiser has access to systems end-to-end — from when you first join all the way through to your EHR.  Kaiser is currently working on integrating all of these systems to serve up data that are otherwise often hidden in these systems.

Kaiser’s mission:  “To provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.”  The latter part requires user-centered design — focusing on an understanding of the needs of the users of the system.

01:48 pm EDT

Our first speaker begins by asking, “How many have e-mailed their doctor in the past year?”  About half the hands in the room go up.

“How many are enrolled in a system that facilitates secure, electronic communication with healthcare professionals?”  About a quarter of the hands.

Silvestre describes Kaiser Permanente’s role in providing health information and communication services directly to patients.  “Our progress mirror’s my son’s age — about a freshman in high school.  So we, too, are in the teenage phase.”

She is showing a Kaiser commercial, which focuses not on health insurance capabilities but rather on “the benefits for you as a person on having connectivity and being able to access your information.”

01:46 pm EDT

Ondra introduces this afternoon’s distinguished panel:

  1. Helga Rippen, Chief Health Information Officer and Vice President, Center for Health Information Technology, United States
  2. Robert Jarrin, Director Government Affairs, QUALCOMM
  3. David Bunker, Head, Strategy and E-Health Architecture, NEHTA, Australia
  4. Carl Gunter, Director, Strategic Health IT Advanced Research Project on Security, University of Illinois, United States
  5. Anna Lisa Silvestre, Vice President, Online services, Kaiser Permanente, United States
  6. Bruce H. Taffel, Chief Medical Officer of Government Business & Emerging Markets, Blue Cross, Blue Shield of Tennessee, United States

01:42 pm EDT

Ondra is saying, “Our healthcare system shares some tremendous successes and triumphs.  We also share some problems:  How do we optimize care?  How do we make it a better system for patients and providers?  How do we manage information?”

Technology offers tremendous potential to improve quality and safety, while reducing costs.  But technology can’t realize it’s true potential unless it’s shared.  Sharing information is a much more critical issue than adopting it.  So in this session, Ondra calls for discussing not just the 50,000-foot level issues but also the 5,000-foot level stuff – and how do we address some of the 5,000-foot level implementation issues that we’ve been discussing.

Ondra points out that it’s important to consider practical examples of information generation and sharing.  The Veterans Affairs Department provides one such example — a 3.2 billion USD return on investment for adopting health information technology, all the while dramatically improving safety and quality.  About 85% of the 3.2 billion USD ROI came from things that matter to patients — quality, safety, and so on.

So what are the obstacles, Ondra asks?  Certainly they’re technical, he says — issues of syntax and semantics, correlation of individuals, privacy and security, etc.  Frankly, incentive alignment is the major obstacle; if there were strong incentives to share information, this problem would be solved — because innovators exhibit a great habit of moving into a wide-open market and taking advantage of it.  A key question thus is, How do we align incentives with the outcomes that we want?

Policies are also obstacles, Ondra adds.  We need policies that accomplish the needs of people, with respect to privacy and other matters.

Ultimately, Ondra emphasizes, we need solutions specific to each nation — national interests are the right way to begin — while ensuring that the solutions will work across nations.

01:34 pm EDT

And we’re back for the afternoon session.  Our first speaker is Dr. Steve Ondra, who currently focuses on health affairs in the White House Office of Science and Technology Policy.

12:54 pm EDT

Lunchtime!  The workshop is breaking for lunch for about 40 minutes.  We’ll be back with live coverage of the afternoon session, beginning at approximately 1:30pm ET.  First up, a session on turning ideas into practice:  towards an international research and policy agenda.

In the meantime, comment below on the breakout reports and other discussion from this morning.

12:50 pm EDT

Some interesting commentary following the breakout reports (roughly quoting various participants):

– We first have to define for what purposes we want the data — and then we can decide on semantic interoperability.  There’s a big difference between the U.S. and E.U. on this subject.  In the E.U., we are used to 22 official languages and many unofficial languages — and if we want to provide cross-border care, we cannot simply use Google (or other like tools) for translation services.

– We need to figure out how to make certain technological elements work, and we need to understand where they work best.  For example, “I’m not going to determine whether I need an appendectomy on the basis of a Twitter stream.”

– Often users don’t realize what they actually want is structured, semantically operable information — in order to find what is most useful to them.  It’s important to make sure the information that’s available is useful, trusted, and linked to other information that may be helpful.

– Going back to the neat vs. scruffy debate:  Considering these as two different approaches takes out the time domain.  Often data start streaming in in a very scruffy way, because of the way they are collected (e.g., different types of collection machines).  It is through use and experience with these data that we can move it into a useful format — but that takes time.  So, in a sense, over time, a lot of the “scruffies” are tidied up and become “neats” — and that’s what’s most useful.

12:39 pm EDT

Group 3 — with over 30 participants — focused on achieving change in a system with limited resources.  There were many different perspectives entering the discussion:  effective and efficient management of care; socio-cultural implications of ehealth; impact of innovation on the healthcare system; shareable aspects of global eHealth experiences; redefining sectoral relationships; and others.  Key questions the group considered:  Evolutionary or revolutionary?  Who pays?  Who benefits?  How to make it all work?

Some barricades:

– The structured vs. unstructured (neat vs. scruffy) debate that we heard frequently during yesterday’s plenary — forget the standards and let the data flow; Internet apps leverage the relationship between unstructured data sets to create new value.

– Semantic interoperability is overrated — for many purposes, semantic framework is implied by context (consider, e.g., faxes, which offer enough of a semantic framework for useful interoperability on a day-to-day basis).

– Tension between industrial production approach vs. mass customization approach — data warehouse or “find-ability.”

And a few other key takeaways:

– “Sick” care is only a subset of healthcare, so we need to manage these trans-sectoral issues.

– To determine if things are working, we need to shift from node analysis to (social) network analysis.  We also need more focus on health ICT impact via the supply/demand curve and less via traditional ROI studies.  And we need to better understand how eHealth relates to the broader concept of eGovernment and the whole notion of citizen engagement.

12:29 pm EDT

Rosemary Huxtable is reporting on the second breakout group, which focused on empowering and protecting patients and consumers.

Huxtable says the discussion initially focused on emPOWERing.  Patient support and connections are not new.  The difference is in the power of numbers and the richness of data.  Research that comes from mining and codifying data results in a capacity for consumers to take control and manage their own care, share experience of how to live in the continuum of disease, etc.  On a related note, it’s important to broadcast information about new treatments very quickly; the quickness with which feedback can be provided is key.

The group’s discussion, Huxtable says, also focused on the “economy of donation,” or the empowerment of “helpers” — those who are willing to share their experiences freely.  This economy is largely untapped, and presents a resource that technology can help to unlock to generate new services.

Some quantum leaps — truly innovative opportunities for the future:

– Capacity to codify narratives/patient stories linked to the EHR;
– Enabling globalization of healthcare;
– Unlocked potential of Internet-based health information for research and to drive innovation (e.g., post-market surveillance, opening up clinical trials, empowerment through research, such as patients getting together and establishing their own tissue banks, etc.)

Some technical challenges:

– Open authentication for interoperability;
– Codifying patient content for th EHR; and
– A process for generating trusted information.

Some other issues noted by Huxtable:

– Lots of challenges around health financing systems — competitive, market-driven health economies.  There are opportunities for greater efficiency and effectiveness (such as unlocking community-based care/home-based solutions, social marketing and health promotion opportunities, etc.)

– Privacy and governance — managing privacy effectively and robust governance are keys.

– Cultural and societal differences — some members of the group noted that their members of society were very interested in social networking but not in enabling eHealth, perhaps because the health system was fairly robust in enabling good outcomes.  There is room for international collaboration and engagement, including clinical engagement/partnership, health literacy (games for health), and standards.

– And don’t forget the non-adopters!  There’s a large digital divide globally and in certain subpopulations in individual countries — and we need multiple solutions to enable and advocate for the un-enabled.

12:18 pm EDT

Sheehan, in response to questions:  The breakout group would likely agree that research into how to present information is also critically important, though it wasn’t discussed by the group in much detail.

Some more back-and-forth about standards and interoperability as well.

12:14 pm EDT

Sheehan:  Achieving data coherence and consistency requires getting the data OUT of clinical information systems; getting non-healthcare data INTO the integrated record; and enabling tools for data cohesion (e.g., avatars for locating, collecting data that are storied in distributed systems, personalized health records, etc.).

Challenges for extracting knowledge and meaning include data fusion (need research on how to turn sensor data into actionable data, e.g., ICU monitoring paradigm; digest, combine multiple signals to identify key events, minimize false alarms; and determine which data provide robust and predictive results); and data aggregation (population data vs. personal data).  There was some concern that this research will be iterative, which has trouble getting through grant process at some institutions, but it could lay the groundwork for fairly fundamental changes.

On achieving semantic coherence, the discussion focused on:  interoperability as the goal — linking clinical care data with environmental/sensor data; consumer/patient orientation may influence approaches to coherence and interoperability; interdisciplinary research that combines science and application; open exchange formats for physiological data; and federation of local data sets.  There’s clear opportunity for international collaboration (e.g., data sets available in different countries/regions can be used to examine approaches for data fusion).

Ultimately:

– Enterprise-centric data vs. individual-centric data (enterprise responsbility for healthcare vs. individual self interest)
– Clinical data vs. environmental, behavioral data
– Privacy vs. accessibility
– Individual prognosis vs. epidemiological use
– Need an iterative approach
– Need to apply existing and new techniques to data sets

12:06 pm EDT

The first report-back:  Predicting Anticipating our Data Future (note the name change by the group’s members), with Jerry Sheehan, Assistant Director for Policy Development at the NLM, reporting.  About 35 people participated in this group.

Sheehan begins by describing new forms of health and wellness data:

– Many forms of clinical data — lab tests, diagnoses, imaging, medications
– Genomic data (personal genomes)
– Sensor data —  e.g., smart homes, in-home diagnostics, personal data, monitoring, cell phones
– Environmental data

The group was particularly interested — focused — on the last two of these, which gave rise to a distinction between healthcare data (as we know it today) and broader health data (data that are important for understanding health but may not yet be captured by EHRs).

12:01 pm EDT

Suzi Iacono wraps the morning session — “International Smart Health 101.”  She introduces Kelly Joyce, a Program Director at NSF and recent author of Technogenarians:  Studying health and aging through a science and technology lens, who will be leading the report-backs from yesterday afternoon’s breakout sessions.

11:58 am EDT

Sakellarides’s team is developing a pilot to connect community-based, people-centered health records with the medical record system that’s being developed nationally.  A key goal is to provide citizens with the opportunity to choose the level of complexity that’s right for them.

Some important points:

– Health literacy and empowerment is a critical element of a new social contract for health.

– We must promote health literacy through personal health information systems.

11:46 am EDT

And the last speaker for the current plenary is Constantino Sakellarides, Director of the Portuguese School of Public Health, who is describing the Portugese experience with personal health information systems.  A 2009 survey of the Portugese found the following:

1.  We can do it!  …Useful way to organize personal health information.
2.  …can inputting be simplified?
3.  …how to fit in our daily living?
4.  …currently outside mainstream thinking in health services.

11:40 am EDT

Rigby implores we need to pursue a citizen first — care secondary — ICT discrete enabler approach.  There are coordination challenges, identification challenges, informatics challenges, and governance and societal challenges.

11:39 am EDT

Rigby is giving a really detailed and striking example.  Consider “Mary”:

– She’s 79 years old;
– Lives alone;
– Has arthritis;
– Has a long-standing digestive problem;
– Has mitral valve leakage;
– Has small mental lapses;
– Is a technophobe;
– Is independent but sociable.

She needs help with nutrition, mobility, shopping, bathing, and socialization.  WIthout all of these, her health with suffer.  But those are not the tasks of the health service — which has kept her alive, but doesn’t care beyond that.

Mary’s informal social support:  she has no children; her stepson and niece live 90 minutes away and work; her two sisters are equally dependent and do not drive; and her elderly neighbors cannot be expected to be her full-time caregivers either (as they need to care for themselves, too!).

Mary’s health support:  general practitioners are uninterested (there’s nothing curable!); the cardiologist provides medication; the orthopedist is undecided; the neurologist is unsure; the geriatrician is the peace maker among the other physicians and the family; the home nurse comes once a month; and the respite care comes once every year.  There’s also no corodination — the family has to broker among the factions of the healthcare system.

So social care is essential:  difficult negotations between family, healthcare, and social care providers.  The one daily hot meal is delivered five days a week, but it comes at the time of day that doesn’t suit Mary’s digestive problem, it doesn’t really appeal to her, and no one checks whether she actually eats it.  Plus, there’s just one hour of home support.

Eventually the family arranges 7-day home visits including a midday meal each day cooked to her choice.

So, who manages Mary’s health?  Mary’s health is seriously compromised if it isn’t helped holistically.  But healthcare and social care haven’t a harmonizing mechanism.  Family and careers’ own needs are factors.  Mary has potential major risks.

The test of the modern society is, “Are we getting it together?”

11:27 am EDT

Next up:  Michael Rigby, Emeritus Professor, Keele University, United Kingdom.  Rigby is describing the need to integrate social care — ensuring services including provision of meals, personal hygiene, household chores, mobility, shopping, and social contacts, etc. — with healthcare.  Increased longevity, chronic conditions, post-treatment care, etc., are challenging traditional social care practices.

11:24 am EDT

In responding to a participant’s question, Huxtable says the PCEHR is a system that both (a) affords access to documentation in different locations and (b) provides integrated data sharing.

An interesting exchange just now about the differences in the opinions on privacy and security between Australians and Americans.

11:18 am EDT

Huxtable, in closing:  The PCEHR strategy focuses on adoption, infrastructure, governance, standards, and engagement.

Showing a picture of a normally busy airport runway covered by the recent floodwaters, she says, “We are a country that is very large and diverse, where people do face very difficult circumstances at times, where the capacity to be able to access records can be very important.  I think the disasters that we’ve dealt with over the last few months have borne witness to that.”

11:16 am EDT

Huxtable is showing a video describing the concept design for the PCEHR.  The full video and transcript is available through Huxtable’s office.  The video “begins the conversation around the health record” and what it means for individual users.

11:14 am EDT

Huxtable:  The single most significant thing to happen in healthcare in Australia was the investment last year of 467 million USD into the development and deployment of a PCEHR in Australia over a two-year period.  Again, the goal is to have everyone register with the PCEHR by July 2012.

A planned release schedule is being pursued for the various tools to be included in the PCEHR, including the ability to access information (e.g., electronic discharge summaries, e-prescriptions, medical records, pathology reports, immunizations and allergies, etc.) through an indexed summary view.  Ultimately, the PCEHR will enable seamless exchange of information anywhere, anytime.

Huxtable notes that a key challenge is the geographic context and variance, so rather than opting for a centralized database, an indexed approach is being pursued — or essentially an incremental approach taking advantage of existing tools and manpower.

11:09 am EDT

As she mentioned yesterday, Huxtable points out that the national PCEHR — first announced in 2010 — must be in place by 2012.  Currently, 98% of health care providers are computerized; 96% of pharmacies have broadband.  But ultimately, responsibilities for health are split between the Federal (focused on primary care) and state (focused on running the hospitals) governments.

11:05 am EDT

Rosemary Huxtable — the Deputy Secretary of the Australian Department of Health and Aging — is our next speaker this morning.  She’s focusing on the development of the personally controlled electronic health record (PCEHR) within Australia.

10:59 am EDT

Turolla:  Three key ICT research directions in disease prevention:  creating a supportive environment for healthy behaviors; creating a sustainable health outreach ecosystem of stakeholders; and utilizing ICT to conceptualize, design, and build HealthGuides (health navigators) and a Personal Guidance System (PGS).

Ultimately, this is a global market with local and national peculiarities, requiring global strategies, global alliances involving all the stakeholders, and global multidisciplinary research.

10:55 am EDT

Turolla:  Sensors and actuators (environment and body) populate our life — and these are the basis for mHealth.  Two focus areas for Telecom Italia:  tele-healthcare + lifestyle.

And Turolla emphasizes once again the importance of green healthcare and greener hospitals.  “We cannot sustain healthcare without considering energy savings.  Healthcare is such a wide activity — hospitals are consuming so much healthcare.”

10:51 am EDT

Turolla:  We need to align with innovative services (food industry, supermarket with office, school; physical exercise, home with hospital, pharmacy, pharma industry) — providing personalized eServices for life and health to educate, motivate, and assign in making informed choices in daily life.  Ultimately, we’re talking about implementing a health navigation system that will help us to navigate through the choices of life, much as our GPS systems help us navigate the roads while we’re in our cars.

And mHealth is perfect for this, because it can provide access to the individual in all of the various necessary settings — all the while providing layers of services that ensure trusted content relationships.

10:47 am EDT

And we’re back from the break, with a talk by Maura Turolla on “mHealth Solutions for Healthier Lifestyles in Italy.”  Turolla says, “Yesterday, there was a question, ‘Where are the hospitals?’.  Well, I am one of them — and we are not threatened at all by the new business models.”

And for the first time during the plenaries, we hear of a connection between health and the environment:  “personalized life and health services — for healthier and (greener) lifestyles.”  Turolla points out that we need to change behaviors of individuals in society for their own good (health) — but we should use the same platform to incentivize change toward greener behaviors.

10:21 am EDT

And a quick 10-minute coffee break at the workshop.  We’ll be back with more coverage at 10:30am ET.

10:19 am EDT

Nitta is showing a slide highlighting the four projects that RISTEX funded in 2010 under its “redesigning communities for aged society” program area.  The titles of these projects are:

– “Development of an area diagnosis tool for promoting home medical care”
– “Development of a new ‘index of competence’ reflecting improved health status of the elderly”
– “Aging in in place with ICT”
– “Senior citizens’ new career model in the community”

10:13 am EDT

Nitta:  A recent RISTEX focus area is on “redesigning communities for aged society,” funded at 20 million USD over six years.

10:11 am EDT

And our final speaker of the first AM session:  Yoko Nitta, Associate Fellow at RISTEX — a part of the Japan Science and Technology Agency (JST) that primarily functions as a funding agency with a think tank-like capacity.

RISTEX’s mission is “creating social and public values through funding R&D which aims at finding the solution of social problems.”  RISTEX doesn’t fund basic research, but rather problem-oriented R&D projects.  Key features include multidisciplinary; application areas (technological and social innovation); social experimentation; collaboration (between practitioners and researchers); and mutual communication between management and research project teams.

10:08 am EDT

And finally from Chung:  There are other mechanisms for, essentially, incentivizing living longer, healthier lives.  An example is “SilvernetNews,” an Internet-based publication for and by seniors.  The authors are 55 years or older, and the majority are 65-70 or 70-75 years old.  The reporters are prideful about their work and about themselves, and “they say they have something to live for — they can’t die yet.”  Only two reporters have passed away in the past several years.

10:07 am EDT

More from Chung:  The elderly — “Silvers” — lack IT knowledge, making it difficult for them to get a job.  Internet-based activities such as e-seminar and e-voting are increasing but unfamiliar to silvers.  And as social networking gets popular, silvers have less opportunity to build personal relationships.

Several basic approaches for improving the digital welfare of the silvers in Korean society:

– Offer various education programs and facilities;
– Support organizations and environments for the silver community; and
– Attract voluntary and active participation from silvers.

Last year, 20 groups of mainly senior volunteers trained 1,600 of their peers, while IT training centers provided information literacy to 12,000 others.

This training has yielded demonstrative impact:  seniors have indicated increased confidence and shown increased participation/improved interpersonal relationships through social networking services.

09:56 am EDT

Chung:  Life expectancy in Korea is 83.7 for female and 77 for male.  “I’m surprised the Japanese people live a little longer than the Koreans.  The men live longer than women, because the men care for the women.”  (Lots of laughter among the participants.)  The proportion of elderly in Korea was 11% in 2010.  Future projections:

– 2020:  15.6%
– 2030:  24.3%
– 2040:  32.5%
– 2050:  38.2%

Korea spends more than a half-billion USD for hypertension, and over 1 billion USD for care of the elderly.  At the same time, 32.8% of the elderly make < 500 USD per month, yet the vast majority percent spend far more.

09:51 am EDT

Our next speaker this morning is from Korea.  Tai Myoung Chung is Professor at Sungkyunkwan University, where he points out “it’s midnight…  So I’m trying to find myself; bear with me.”

09:49 am EDT

Obi shows a great slide summarizing critical technology and research areas, followed by a series of slides highlighting some of these areas in more detail:

– Gaming is an increasingly popular and important area — particularly with Nintendo based in Japan.
– Social networks/portals are emerging (“Community for Aging”).
– Modified radio and TV receivers are providing functions to assist hearing.
– Simple phones with one-touch switches are enabling use by the elderly who may not be technology savvy.
– “Robot suits” are aiding in rehabilitation exercises and general fitness routines.
– “Reminder robot” prototypes recognize users’ voice and speaks to them to tell them when they need to attend appointments or do other tasks.
– eGovernment for aging service (e.g., call centers specifically for the elderly).
– Telemedicine (electronic/mobile/tele/digital).
– eMobility for aging people (e.g., motorbikes; “smart” railway stations equipped with lifts/elevators; digital map services; safe auto driving systems; small cars enabling easier driving for the elderly; etc.).
– eEducation and eEmployment (e.g., enabling ICT vocational training for the elderly).

09:41 am EDT

Obi:  Some more numbers:

– Daily walking distance of the aging population is limited to about 500 meters around the house;
– 30% of Japanese population already elderly or handicapped;
– Peopled aged >65 years old spend half of the national healthcare cost;
– 80% of aging Japanese would like to die at home, not int he hosptial;
– Ratio of digital divide among senior citizens expected to reduce from 33% to 60% in 2010;

Three key paradigms in Japan:  globalization; aging; and information.

And the estimated market size of the health and wellness ICT sector in Japan is 106.96 billion USD in 2010.  Key ICT factors supporting the aging society:  usability/accessibility; safety/security; global standard/low cost; and environmentally friendly.

09:37 am EDT

Toshio Obi is Director of Waseda University’s Institute for E-Government in Japan.  He starts with some striking data — life expectancy over time:

– 1700:  27
– 1800:  27
– 1900:  30
– 2000:  65
– 2050:  74 (projected)
– 2100:  81 (projected)

Japan is a “super-aging society,” which has economic impact in the form of declining growth potential as well as a social impact in the form of increasingly heavy pressure on the social security system.

09:34 am EDT

A quick question of Thonnet:  Any barriers to making this global, rather than just European?  “It was not so easy to manage to work at the European level; I don’t think it’s more difficult to work over the Atlantic.  The first thing is to understand each other and to say that we are good in some things and less good in others.  [Listening] to others and [identifying] the common problem [is a] part of the solution.”

09:29 am EDT

Thonnet:  In describing CALLIOPE and epSOS, she highlights the “need to have an infrastructure” that someone must maintain.  A key requirement for such an infrastructure is E.U. high-level governance.  In draft documents, this high-level governance has three layers:  policy (define common priorities); strategic (agree on concrete strategies); and operational.

09:24 am EDT

Learn more about CALLIOPE here.

Thonnet is now describing the epSOS eHealth Project — aiming at building and evaluating a service infrastructure demonstrating cross-border interoperability between EHRs through the E.U.

09:21 am EDT

Showing a map of Europe, Thonnet says, “Just to help you understand that we are very different.”  (Draws some laughter from the room.)

Thonnet argues interoperability needs to be front and center — not only to understand one another technically, but also semantically, organizationally, legally, and politically.

She begins describing CALLIOPE, a fully operable, open, trusted, cooperative multi-stakeholder environment that seeks to provide value for decision-makers.

09:15 am EDT

Thonnet says she’s not going to be focused on France, but rather what we’re seeing in this space throughout the E.U.  As we discussed yesterday, it’s not only about reforming healthcare, but also about reforming the health system.  “One of the most important levers we have right now is IT,” and we require a multidisciplinary approach, from research to citizen.

09:11 am EDT

Zilgvaldis:  Much of the funded work is “open.”  E.U. member states and developing countries can get full funding; other countries can also receive full funding if they can demonstrate useful contributions.

Open access?  Yes, publishing everything in open-access scientific journals.  Open source?  Still a mixed bag, because there is industry involvement.  Open source is encouraged, however.

Up next:  Michèlle Thonnet, a health and information specialist with the France’s Ministry of Health.

09:07 am EDT

Zilgvaldis:  E.U.-U.S. Memorandum of Understanding on eHealth signed last September focuses on collaborating on key areas where progress benefits patients, healthcare systems, and the economy.

Meantime, a new E.U. “eHealth Action Plan” is in the works.  The goals include increasing awareness of the benefits and opportunities of eHealth, and empowering citizens, patients, and healthcare professionals.

09:04 am EDT

Zilgvaldis:  The Europe 2020 aim is to add two years to the average healthy lifespan in the E.U. by 2020 by developing innovative products and services for longer healthier lives; helping social and healthcare systems to be sustainable; and encouraging competitive markets.  The focus is on prevention and health promotion; integrated health and social care; and innovative products, devices, and services.

09:03 am EDT

Our second speaker this morning is Peteris Zilgvaldis, Head of Unit, ICT for Health, Directorate General Information Society and Media, European Commission.  He’s talk stems from “Europe 2020,” which is focused on promoting smart growth (an economy based on knowledge and information), sustainable growth, and inclusive growth.  Ultimately, it’s all about “sustainable economic and social benefits for all from a flourishing digital economy.”

Zilgvaldis describes the digital agenda for Europe and eHealth as including:

– Secure access to online access to health data;
– Widespread deployment of telemedicine;
– Minimum set of patient data for interoperability of patient records;
– Standards, interoperability testing and certification.

A related flagship initiative is “Innovation Union,” making Europe a world-class science performer by removing obstacles to innovation and facilitating public-private partnerships.

08:58 am EDT

Colombo:  We need to overcome a lack of evidence on successful productivity enhancement/technology measures, as well as a weak evidence base on cost-effectiveness and stakeholders’ incentives for adoption.

Requirements for technology thus include:  allocating efficiency (optimizing care settings); behavioral efficiency (incentives for providers and users); and technical efficiency (improving work processes, numbers of job errors, overall satisfaction and performance).  In this way, technological support will facilitate improved quality of life; be seen as a solution by providers; and be accompanied by scientific evidence of cost-effectiveness.

08:52 am EDT

Colombo:  Long-term care workers will account for a larger share of the workforce — yet we are faced with difficulties in recruiting people to the job, partly because the prevalent model is very labor-intensive.

At the same time, there is a fear of not having human hands — “to take care of me if I am the care recipient.”  Colombo is showing an article in BBC titled, “No, robot:  Japan’s elderly fail to welcome their robot overloads.”  The article describes technology as a backup as opposed to as a primary form of care in Japan — a country with a particularly rapidly aging population.

08:45 am EDT

Francesca Colombo, Principal Administrator of OECD’s Health Division, is this morning’s first speaker.  She describes herself as a “health policy expert” and says her talk will focus initially on health challenges, followed by discussion of the role of technology.

Colombo says we are seeing growing and diversifying “care needs.”  There’s been a steep rise in the share of the population that is over 80 years old; there are seven times as many users of long-term care in the >80-year-old group as opposed to <80 group.  Longer living implies demand for more formal care, and demand for better, diversified care.  Indeed, the elderly live not just with chronic conditions, but with multiple chronic conditions.

08:37 am EDT

Suzi Iacono, NSF/CISE Senior Science Advisor, kicks off the second day of the workshop by welcoming participants back and introducing this morning’s session chair, Yuko Harayama.  Harayama is Deputy Director of the OECD’s Directorate for Science, Technology, and Industry.  She says, “We’re looking for common challenges” today.

08:34 am EDT

While we wait for things to get underway this morning, we’re ruminating on some interesting points that were raised during the “Predicting our Data Future” breakout session yesterday afternoon:

– For the past 40 years, we’ve collected all the data we would possibly like to collect, yet the monitoring paradigm in the ICU remains significantly unchanged from what it was like in the 1970s.  The physician still has to aggregate a whole bunch of different data streams in his/her head and come up with a diagnosis on the fly.  We desperately need a paradigm shift here.

– There was lots of chatter during yesterday’s plenaries about patient-centric approaches.  But members of the breakout highlighted the need to look at the ecosystem within which healthy living takes place.  Genetics/genomic research and behaviors each contribute some amount.  But we also need to consider environmental factors.  And while there may not be nearly as great an appetite for that in the current political climate, it’s still critical.

– And emanating from the above point, there’s the “valley of death”:  What we need are research investments that address the desire to do radical, iterative (not incremental, iterative!) ecological research.  However, traditional National Science Foundation and National Institutes of Health research/funding programs do not address this space.  Yet everyone agrees that unless we take that kind of research on, you cannot address all the issues in this space.  As one participant said, “We are addressing lots of foundational research, but it will fall on deaf ears if we don’t look at the ecological research that needs to be had as well.”  And later, “Your genes are the bullet.  But your environment (and your behavior) pulls the trigger.”

– There exist multiple data streams in the disease surveillance community — but we’re still missing the chronic disease data piece, which includes the patient engagement component.  Coupled with this point, it’s important to ask what kinds of data will be integrated within an EHR.  For example, will data from non-clinical sources be included?  Currently, we don’t seem to be on that trajectory.  How about GPS data, which are very important for understanding health issues?  What other kinds of data?

03:32 pm EDT

And that’s a wrap on the plenary discussion — and our live blogging for today.  After a short break, attendees will shuffle into breakout sessions to discuss “predicting our data future,” “empowering and protecting patients/consumers,” and “achieving change in a system with limited resources.”

We’ll resume coverage tomorrow at 8:30am ET.  And we’ll try to have a blog post touching on the key themes that appear to be crystallizing by the end of the week.

In the meantime, please let us know your thoughts about this live blog below.

03:22 pm EDT

A comment on semantic interoperability from the audience (roughly quoting):  Do you agree on formatting and then get the data flowing?  Or do you get the data flowing and then agree on formatting?  It’s clear the former is a show-stopper.  The data are already a mess; people currently send it back and forth via fax.  Let’s get the data out there, and then organically you’ll see a convergence.

03:18 pm EDT

Back to the Model T:  “Innovation is all about redefining the problem.  The Model T didn’t deliver with the problem of horse manure; it simply made it irrelevant.  We’ve been talking about finding solutions to existing problems; we need to fundamentally change health and healthcare…  Obviously, things like PatientsLikeMe represent a completely different model… and that may be why there’s a fair amount of antagonism toward that type of model.”

03:13 pm EDT

An impassioned discussion about data liquidity as “the elephant in the room” just now:

“Medical data are actively imprisoned today.”  It’s not just that they are unintentionally imprisoned by the EHR systems; they are imprisoned by the institutions that generate that data.  We must ask, what is the interface at the level of the institution?  What are the obligations of the institution to deliver the data — to the outside of the institutional boundary — where it can be routed under patient control or government regulations?  What are the legal obligations of the institutions to get that data out?  (Just putting the technology — electronic mechanisms — for facilitating transcending the institutional boundary is insufficient; we need real policy means for facilitating data liquidity.)

03:10 pm EDT

From the Australia representative:

The goal in Australia is to deploy a nationwide electronic health record system by 2012 (with this effort having been first announced in May 2010).  Opt-in, personally-controlled health record.  [“Opt-in” meaning, if you register for a health record, you can, but you don’t have to do so.  However, it is mandatory to have a universal health identifier (UHI).]

To have such a system, it has to embrace the diversity of people’s needs.  An earlier discussion touched on people coming to the system with many different perspectives — from chronic disease patients to someone who is acutely interested in retaining their health and fitness.  The reality is that we have to embrace all of these perspectives — and also bring in social networking and related modalities.  Ultimately, we must empower people and make health information accessible and engaging.

On another point, what does the sense of “personal control” mean?  There are two rather competing issues here:  being able to access quality healthcare information from the provider so that we can avoid re-testing; and the consumer’s right to be able to use the record for what the consumer wants to use it.

02:58 pm EDT

Mark Braunstein of Georgia Tech (roughly quoting):  I think the seeds are already being planted.  Those of us who remember the early days of the Internet will recall that no one plotted the strategy for the Internet; they just planted some seeds.  I think it’s important to focus on those seeds — certain degrees of standardization — which in turn created connectivity.  If we look back on this era many years from now, the degree of standardization of clinical data through the CCDs and the connectivity through HIEs is going to turn out to be far more important than anything else.  We’re all going to deploy bad EHRs and so on.  But that will weed itself out over time.  We are creating the platforms that will allow consumers to drive this system — because they have to be the ones who drive this system.

…And two-thirds of the way through the day, we get our first reference to IBM’s “Watson” system which debuted on JEOPARDY! last night — as Braunstein notes that things do eventually get sorted out (as they are in other fields).

02:50 pm EDT

Rob Kolodner reminds us that it often takes time for technology to make a difference.  Are we at the Model T phase of health IT?  Right now, we’re looking in; the innovations that are moving us forward slowly.  And there’s reason to believe there might be rapid change when the right piece comes aong.

02:46 pm EDT

The interesting, lively debate about platforms like PatientsLikeMe and Facebook vs. open architectures continues…  Be sure to check out the comment by my colleague Beth Mynatt below.

Meantime, a rep from Germany points out how the right to data privacy constitutes a fundamental, enforceable right by law in that country.  This law serves to protect the patients’ right to keep things private.  “We can imagine someone willing to share lots of data, but in today’s economic climate, knowledge of a past illness might not get them very many interviews as an example.”

02:37 pm EDT

Kohane takes a crack at responding to some of the questions below:

– On health IT:  Let’s be clear that the health IT investment came about because our healthcare system needed it.  Having said that, broadly we have not done the cost-benefit analyses, except in a few areas.  And that’s because we’ve presumed rightly or wrongly that each healthcare system is different, and medicine is a very regional/parochial practice.  And that may or may not be right.  But it is very difficult to run these studies — though we do need them to be run.

– Going from scruffy to neat:  It is a challenge, and it’s hard to take a scruffy model and make it neat.  But we also have to appreciate the reality of our healthcare system:  the way we measure insulin levels is different than it was five years ago.  The tricks that we do to standardize medicine — whether or not we standardize it in the healthcare system — is also a scruffy process.  We’ll never be quite good enough; but if we’re looking for the perfect data model that’s looking to withstand the travails of time, then we’re going to be standing here.

02:32 pm EDT

Some interesting questions:

– How do you move from scruffy to neat in a way that you don’t lose people?  And how can you do that without losing the structure and aim of what you’re trying to get to, which for our purposes is improved quality and improved care?

– There’s the endowed Harvard professor who works on solutions and then there’s the Harvard undergraduate dropout who creates Facebook and blows everything else away — and we don’t know if we can capture these in our more formal approaches.  The smart app idea is one means to try to break through, but is there a way to capture the dropout undergraduate student dynamic that’s really revolutionizing?

– While we’re enamored by the technologies, we really need to evaluate efficacy on the good side and harm on the bad side.  In health IT, we made an extraordinary investment.  We’ve seen lots of efficacy in some-scale trials, but not any kind of large-scale validation.  We got around the clinical trials that drug companies often require in health IT somehow.  What about the dose-response curve notion for social networking, i.e., what about the value of social effects?

02:22 pm EDT

Starting to get lively…

Kohane says, in his view, open computable data formats aren’t the solution.  But this is a lot like “the debate between the neats and scruffies”; the neats want to make things standardized up front; the scruffies want the data to be let out, and to figure out how to square things away later.  Ultimately, you have to create a business case.

Olauson:  “My dream is that eHealth, telemedicine, used in the electronic way will hover above all these silos — and then I can go down and connect the worlds within the silos.  And thereby we can create a 360-degree change.”

02:13 pm EDT

Olauson:  Something from within caused me to stop smoking.  You make a change from within so that you can make use of the knowledge.  One of the risks we have to face here is — and perhaps this is a research question — how could we think about/how could we develop/how could we make the patient want to use eHealth more and to see it as a friend and as an extension of treatment — all the while keeping in mind that we battle articles in the daily press about stuff like data leaks through Facebook?

02:07 pm EDT

An interesting back-and-forth just now:

Kohane:  If you look around Facebook, for example, they actually have very substantial patient communities around diabetes, around multiple chronic diseases.  You can dial up and down for a variety of perspectives, levels of competence, literacy, etc.  And furthermore, you have additional apps on Facebook that plugs into glucometers.  Why is that not good enough?

Estrin:  Let’s consider an example:  if I want to do something new with the accelerometer in the iPhone, I can’t because it’s a closed platform.  Similarly, practices around usage – elements of the data – on Facebook are owned by Facebook.  And in particular, when it comes to privacy, there’s one form of it.  So it’s not healthy to have only one vendor.

02:03 pm EDT

Lohr asks about Olauson’s European Patients Forum; why was it formed?

The E.C. wanted to involve the patient view in all activities.  It serves as one patient organization, dedicated to high quality, patient-centered equitable healthcare throughout the E.U.  Its mission is to present a strong and united patients’ voice (> 150 million patients).

02:00 pm EDT

Lohr introduces this afternoon’s other discussant, Anders Olauson, President of the European Patients Forum.  Olauson is focuses on the patient perspective:  “It’s not enough to talk about healthcare if you want to involve the patients’ life and wellbeing; you have to [consider a 360-degree] perspective.  You have to be holistic.”

02:00 pm EDT

In his remarks, Kohane also points out how a primary use for EHRs is to communicate between members of the medical care team, but that kind of use is very different than the ‘data-storage’ use many folks think of when they think EHR.

He asks, “Why can’t the EHR be more like the iPhone?”

01:53 pm EDT

Kohane is harking back to the founding days of the Internet:  There is a rich ecosystem in healthcare, just as with the Internet where we started with a very bottom-up set of definitions for HTML.  You’ll recall that HTML initially didn’t have or exhibit a standard — it didn’t render the same in all browsers or on all machines.  But there was enough there that people put up with this lack of heterogeneity and gradually, over time, things converged toward an interoperable standard.  So if the James Heywoods of today can actually deliver value, then there will be a similar driver for convergence.  We just need to enforce continued liquidity of the data, i.e., data can flow.

01:42 pm EDT

Lohr is asking Isaac Kohane, Chair of Informatics & the Lawrence Henderson Professor of Pediatrics & Health Sciences and Technology at Harvard Medical School:

We’re all better served by technology, yet what we’re seeing in health IT is “the biggest forced adoption of technology this country has ever had.”  There are lots of advantages to EHRs, as evidenced by the various islands of excellence.  But we also live in a country where 75% of physicians practice in practices of 10 or less.  What’s your biggest worry — about a bill whose original purpose was to make things fair?

01:39 pm EDT

Back after the lunch break — with a roundtable discussion moderated by New York Times’ reporter Steve Lohr.

Lohr begins by saying, “The challenge is how to make things work.  The overall objective is systems design that does stimulate innovation.  There’s some virtue to top-down design… but the innovation comes from the bottom up.”

Lohr is pointing to another survey out today that says that 35% of people think their health information will end up on the Internet.  “It tells you where some of the challenges are,” Lohr says.

12:59 pm EDT

It’s lunchtime at the NSF/OECD Workshop on Building a Smarter Healthcare and Wellness Future.  Stay tuned for more coverage beginning at 1:30pm ET.  And please comment below — your thoughts on the discussion from this morning, the issues that were raised, and even the live blogging are all welcome!

12:57 pm EDT

A panelist notes, the purpose of EHRs to date in the U.S. is to (1) reduce liability from lawsuits and (2) facilitate billing.  If you ask a EHR provider about depression statistics, for example, they have none.  The data architecture that we use today has no information on wellness and healthy living. EHRs only contain scalar measurement of health at the time the patient sees the doctor (one data point at the time the question was asked, with no denominator).

There are lots of good problems we can solve, but we need measures in the EHRs that have proxy relationships to the disease(s).  If you really think about health, you have to have a measure of the vector of the condition from the detection of the very first symptom.  You need a record of the person’s health throughout life.  If you don’t have this vector, or an understanding of what’s missing, you can’t do this.

The first step is to define data standards, on the basis of asking patients what is meaningful in their lives.

12:53 pm EDT

Another question:  We know much more about how to heal the body rather than how to engage the people.  What are the panel’s experiences so far in how we should form a research agenda around engagement?  What should this community be doing in terms of smart health and active engagement?

Heywood:  Good interface design is really key.  We need to be sure to hire really good interface designers, put them in contexts where success can be measured, and allow them to iterate.

Tick:  Take new tools and blend them into tools with which doctors/patients/etc. are already engaged.  Studies show this actually manages to get individuals more deeply engaged in both tools.

Estrin:  We need to provide some kind of feedback that’s actually interesting and engaging so that you can get some sustained involvement.  Tailoring — what kinds of tailoring?  Iteration around and in this space, with real people and real pilots — big, open pilots — and real consumer markets.

12:43 pm EDT

Second question — about barriers, guiding principles, etc.:

van Mulligen:  We need to think about the context in which you make information available.  We need to be able to distill from all the information that which is most relevant.

Estrin:  Two things:  tiering (you can have a professional in the loop that isn’t a doctor — if we don’t do more of that tiering, we can’t address the existing population, let alone growth); and evidence-based informing (recognizing that the person in the loop may be peers or social media, etc.).

Heywood:  Let’s go back to customers.  There are a ton of engineers attempting to enter healthcare attempting to make it better, because there are obviously a ton of things we can do to make healthcare better.  Almost all of them fail.  And they fail because they believe, if they make people better, someone will pay them.  And it turns out that’s not true in healthcare.  So, what do we do?  Who cares (in an economic sesnse) if anything works in healthcare?  Take a look at the pharmaceutical industry, which spends 60-70 billion USD on measuring actual outcomes in individuals against the things they do.  This exceeds the total structured expenditure of all other enterprises by a factor of 10. … It’s about measuring outcomes in the patient.

12:31 pm EDT

On to a 10-minute Q&A session to conclude the first half of the day.

The first question asks for a dialogue on the privacy issues, given that we’ve seen various types of websites, from open form to full closed, professional interaction.

“It would certainly be a lot easier of legislations were harmonized across geography.”  (Lots of laughter in the room.)

Heywood points to a recent multi-nation survey, which demonstrates that the word “privacy” doesn’t mean the same thing in one country as it does in another.  He goes on (roughly paraphrasing):  This debate is pretty dysfunctional at the moment.  There are security issues, which all of us work really hard to solve.  But the question we’re really talking about is, what are the social contracts that we are writing in a modern information age?  Social contracts are a lot different than privacy — explicit understandings between institutional bodies and individuals about what is expected from someone else from a behavior standpoint.  The value of an open network of data — because of the ability for everyone in it to mine all of the elements of the data to the point that patients produce really remarkable research — makes it worth asking people to participate in that.  And that’s an explicit social contract; they also expect us to use their information to achieve good ends for them.  … We have to be careful about confounding privacy as a right vs. privacy as a goal.

Estrin:  Can we create tools and opportunities for people to share selectively as opposed to having to share everything?  It’s not about changing what you are able to do with that percentage of the population that’s being completely open, but rather, can we broaden this population to many more individuals simply by letting them be flexible in what they allow others to see?

12:22 pm EDT

van Mulligen is pulling together health information for 30 million patients in several E.U. nations, and then attempting data extraction, signal detection, signal substantiation, and retrospective and prospective signal validation.

12:13 pm EDT

Eric van Mulligan, Chief Scientific Officer of the Netherlands Bioinformatics Centre, is describing his team’s efforts to engineer semantic web and intelligent systems in healthcare:  creating a semantic web on top of existing information sources, linking information from different sites and databases and with different modalities (text, video, etc.); and making it available in such a way that health information consumers can extract the most relevant, reliable information from the wealth of available data.

11:54 am EDT

Tick:  Four different kinds of medical social media:  patient-to-patient; doctor-to-patient; doctor-to-public; and doctor-to-doctor.  MeshMD.com focuses on the last one — doctor-to-doctor.  (By the way, be sure to check out PatientsLikeMe — a patient-to-patient platform.  Heywood concluded his presentation with a live demo.)

Tick goes on to describe computerized physician order entry systems (CPOEs), which, in the right circumstances, have yielded as much as 80% reduction in medication errors; 55% reduction in harm or death; 57,000 lives saved; and 12 billion USD saved.

11:50 am EDT

Some striking social media numbers by Gabriel Tick, President, MeshMD.com:

– Facebook by itself (with 500 million users) would be the 3rd largest country in the world;
– 1 in 8 people married met via social media;
– 100+ million Twitter pushes per day;
– 60 million status updates on Facebook per day;
– 1500+ hours of video uploaded to Youtube every hour;
– LinkedIn adds one new user per second — or 2.5 million new users per month; and
– 1,700 articles added to Wikipedia per month.

11:48 am EDT

Heywood:  Genetics and medicine is a lot like giving a mechanic the blueprint to a car — but we don’t have the time to generate the blueprint!  We have to compute this stuff in real time.

11:42 am EDT

Heywood:  The key question is, given my status, what is the best outcome I can hope to achieve, and how do I get there?  The challenge for us is to provide the best possible information platform/solutions to enable the patient to answer this question quickly, easily, and cheaply.

11:40 am EDT

Heywood:  Let’s assume patients/consumers pay ~2.5 trillion USD for healthcare.  How do we break this down and look at key market segments?

Healthcare is made up of three kinds of consumers — strategic, rational (don’t think strategically about health, but follow the incentives provided to them), and at-risk consumers (people who are unable to take care of themselves, e.g., the homeless population).  And healthcare is also made up of three kinds of care types — acute care, chronic care, and health itself.  Each point of intersection in this (3 x 3) grid is completely different — in cost, care profiles, etc.

But we can’t figure out how much money is in any of these buckets!

11:39 am EDT

James Heywood of PatientsLikeMe begins with empowering patients — and focuses on the consumer.  Three key questions we should ask:

– Who is your customer?  We believe it’s the patient but when we’re talking about public health it’s society as a whole.

– What does your customer consider value?  We often don’t ask this question.

– What are the results of your system for your customer?  We certainly don’t ask this question.

11:30 am EDT

And more from Estrin:  Multi-disciplinary research is important — it’s even more important to do our research in context.  Don’t take the problem statement and run; this is not just a “meet in a room, come up with a problem statement, and go do our computer science research.”  We really have our research system learn.  It’s time for active data and pilots to drive the kind of research that we need to yield the kind of learning health system we desire 10 to 15 years from now.

11:27 am EDT

Estrin:  We need to focus on open architecture — creating open reference implementations for this important area — and then encourage the commercialization to happen at the edges.

Open architectures enable privacy to be architected as well.  For example, a personal data vault combined with filters yields granular, assisted control over what/when you send to whom, what data says about you, whether you reveal who you are or share anonymously, etc.

11:25 am EDT

Estrin:  mHealth touches everyone:  the woman who is pre-diabetic; the young man who is truggling to find a treatment plan for depression; the middle-aged woman who does not respond well to medical for psoriasis — monitor diet, stress, environmental factors, initiate data campaign via social networking site for psoriasis suffers; and the group of high schoolers with asthma — map their inhaler use and make a case for shifting Track practice to an alternate location from the freeway.

11:19 am EDT

Deborah Estrin of UCLA is delivering a talk on participatory mHealth, i.e., getting mobile into the hands of the individual:  “We have an opportunity to get systematic data from and to individuals outside a clinical setting.  Its all about chronic disease prevention and management, and looking at how we can leverage the mobile capacity in that context.”

Fifty percent of Americans — not 50% of patients, but 50% of all Americans — have one or more chronic diseases.  Mobile devices offer proximity, pervasiveness, programmability, personalization.  mHealth apps allow care support/data collection 24×7.  Together, mobile devices and mHealth apps make chronic disease prevention/management/research a part of daily life.  This vision is centered on supporting individuals, in the context of communities, clinicians, to continuously improve patient-centered, personalized health and healthcare.

11:11 am EDT

Back from a 15-minute break, and Tom Peterson, Assistant Director for Engineering at NSF, is delivering brief remarks:  “It’s hard for me to identify an area that’s in more desperate need for an interdisciplinary [and international] approach than healthcare… Those of you in academia, please encourage your engineers, scientists, social scientists to look very deeply into this problem.”

10:54 am EDT

Eklund:  Privacy and security issues very different in healthcare than in other areas.  For example, bank errors can be costly but remediated (money can often be recovered, cards reissued).  But that’s not the case in healthcare, if a person loses his/her personal health information.

10:53 am EDT

Mikael Eklund of the University of Ontario Institute of Technology describes “Artemis,” an advanced system that provides automation — real-time analytics provide computer-aided diagnostics to the physician — and evidence — data warehouse can be mined by physicians and researchers; tools being developed to allow users to build algorithms and test hypotheses before they are deployed.

Eklund also touches on sensor networks for home care — smart monitors and sensors to autonomously detect and alert the user and/or care providers of accidents, acute illness, deterioration of condition.  His team is deploying the system into multiple hospital rooms in neonatal facilities for testing — but the same system could be deployed in homes.

Eklund, quoting the inventor of the recent portable, wearable ECG:  “the future of biomedical electronics likely holds even more potential than we can imagine.”

10:41 am EDT

Peter Tonellato of Harvard opens with an interesting analogy:  “Round holes” arise in the clinical setting; “square pegs” in the research lab.

Tonellato uses applied mathematics, modeling and simulation, etc., to look at whole populations.  His research team “produces” populations that have certain characteristics — enabling characterization of different parts of the U.S., different hospitals, different international populations, etc. — and then runs simulations to test the effects of different interventions.  This approach provides an optimization system to predict within certain segments of the population which algorithms, treatments, etc., are better overall.

Tonellato emphasizes that these kinds of systems/integrative simulations — adapted by country, population, platforms available, etc. — are going to depend on cloud computing and other advances well into the future.

10:24 am EDT

By the way, follow related coverage of this workshop on Twitter:  #NSFSmartHealth.

10:20 am EDT

As we’ve covered in this space before, a recent President’s Council of Advisors in Science and Technology (PCAST) review of U.S. Federal investment in networking and information technology research — Designing a Digital Future — found that the Federal government, under the leadership of NSF, HHS, etc., should invest in a national, long-term, multi-agency research initiative on networking and information technology in healthcare that goes well beyond the current national program to adopt EHRs.

10:14 am EDT

Friedman:  A learning system is part of the national agenda — and a recent IOM workshop report summarizes key mechanisms for supporting such a system:  promoting technical advances and innovation, generating and using information, engaging patients and the public, and fostering stewardship and governance.

10:04 am EDT

Friedman describes two scenarios for a learning health system:

– Post-market surveillance of a new drug reveals unexpected side effects in some patients.  A decision support rule is created to alert care providers and is implemented in EHR systems.  This is already implemented by Kaiser Permanente in its EHR system.

– During an epidemic, new cases are reported directly from EHRs.  As the disease spreads into new areas, clinicians are alerted in real time.

The system can’t be built on centralized databases.  It needs strong public support and buy-in, strong policy, and strong governance.

09:55 am EDT

A learning health system, as defined by the Institute of Medicine:  “one in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural project of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and health care” (the 17 years to 17 days paradigm shift).  This requires:  “systemness”; aggregation; analysis — data to knowledge; and knowledge dissemination to effect behavior change.  Statutory “meaningful use” by itself cannot yield this kind of learning health system, as it doesn’t afford any of these four things.  In other words, a learning health system > meaningful use system; meaningful use is necessary but not sufficient.

09:51 am EDT

Nearly 2 billion USD has been obligated through the HITECH Act to health information technology — adoption, meaningful use, quality reporting, and trusted exchange of health information.  Included in this portfolio is the set of research projects funded through the SHARP program last spring.  One key outcome:  improved ability to study and improve care delivery.

09:47 am EDT

More from McClellan:  We need to move away from a focus on provider payment reforms.  They cannot succeed without considering interventions centered around consumers — before they become patients.

Up next:  Chuck Friedman, Chief Scientific Officer of the Office of the National Coordinator for Health IT, with a high-level vision of a learning health system.  Historically, there’s been a time gap of 17 years between the discovery of new biomedical knowledge and its widespread use in practice.  Chuck’s tagline for this talk:  “17 years to 17 months to 17 weeks to maybe even 17 days.”

09:20 am EDT

Mark McClellan of the Brookings Institution:  Unless we do a lot more in our healthcare system to support what we want – better quality care, better population health, lower cost – we aren’t going to be on a sustainable course and we’re going to continue to miss out through billions of dollars in extra healthcare costs and far worse healthcare quality.  And this isn’t a problem for just the U.S.; it affects all nations.  A key step to get there is accountability for what we want our health system to accomplish.  There are four key elements (as proposed by McClellan and colleagues at Brookings):  measurement; payment; benefits; evidence.

09:07 am EDT

Our focus should be on wellness, not just illness.  People are living longer; how can we increase their quality of life?  What might a new socio-technical infrastructure might look like 10 years from now?  The challenge for us is, how we can build an interoperable health IT ecosystem?  Is it even possible?  What are the global challenges that we need to overcome?

08:59 am EDT

Wyckoff describes a “radical change in our environment — all sorts of convergence, particularly in the mobile area, which present all sorts of new and untapped opportunities to present health information beyond the traditional bounds.”

08:53 am EDT

And we’re off and running!

Suzi Iacono, NSF/CISE Senior Science Advisor, welcomes over 130 participants from 16 countries and governments to today’s “extraordinary event.”

Andy Wyckoff, Director of OECD’s Directorate for Science, Technology, and Industry, describes the workshop as an opportunity to “get lessons from around the world on the table and learn together through active experimentation.”  The goal is to address the health and wellness challenges of the 21st century; there’s a lot of work to be done.

 

(Contributed by Erwin Gianchandani, CCC Director)


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