I like computers (see previous post), but despair of them in the clinical context of keeping medical records. By contrast nobody sane doubts that computers are advantageous in other medical contexts: imaging, radiotherapy, or even using an insulin pump. We don’t have problems with the latter instances, because self-evidently computers work, and they are the result of a culture of improvement. Not so with electronic medical records, where a neutral observer might thing that the purpose is to save money in one budget at the expense of diminishing clinical care in another. The economists might talk about externalities, but essentially many electronic record keeping systems are a form of pollution of the clinical workspace.
The following quote caught my eye because, whilst in Scandinavia recently, a dermatologist from Denmark was expressing frustration with how bad their computer systems are; and how older physicians choose to ignore them by retiring early. I heard a similar tale from the US in the summer, from a dermatologist who takes a financial hit because he has not implemented electronic records. He says he can either manage patients or do IT (and yes, he is planning to get out early).
Electronic medical records (EMRs) have resulted in increased documentation burden, with physicians spending up to 2 hours on EMR-related tasks for every 1 patient-care hour. Although EMRs offer care delivery integration, they have decreased physician job satisfaction and increased physician burnout across multiple fields, including dermatology.
I would add, that I have read that the average ER doc on a shift in the US presses his mouse 4000 times.
A long time ago, Richard Doll wrote an article pointing out that hospital record systems such as hospital activity analysis were perhaps useful to managers, but not much use for doctors or researchers. He was right, and I even published a paper saying similar things. My experience of electronic records in hospitals is that they are designed for the purpose of ‘management’ not clinical care. Contrary to what many say, these two activities have little in common, and share few goals. Our care system is not designed for care or caring, and our software is not designed for clinicians or patients. As for EMR, we are still waiting for our VisiCalc or Photoshop. If somebody can pull it off, it would be worth a Nobel.
Today (Oct. 17) was International Spreadsheet Day, marking the day back in 1979 that VisiCalc first shipped for the Apple II. Creator Dan Bricklin devised the program originally to help him crunch numbers for an assignment at Harvard Business School. [Link]
I dislike spreadsheets, and think the world will end not in fire, but in one giant bloody spreadsheet (or as a result of one). I also think they are a great metaphor for what is often wrong in medicine: an Excel spreadsheet can calculate a PASI (pissing awful psoriasis index, in lay terms) but it cannot tell you when somebody has bad psoriasis. People get confused about the epistemology here.
But these comments are a little sour. I have never really had to use spreadsheets, instead preferring to use something like R for when I have need of matrices, or when I was really young, FORTRAN. And to be fair even then, I would (now) need to go via a spreadsheet / csv file to enter the data. And this ignores the fact that mostly spreadsheets are used as static tools to present multicoloured tables rather than do calculations. But spreadsheets were, and are, revolutionary. I knew of Dan Bricklin, their inventor, but not all of the following story about how he invented then because he needed them to carry out a set assignment at Harvard Business School
Bricklin knew all this, but he also knew that spreadsheets were needed for the exercise; he wanted an easier way to do them. It occurred to him: why not create the spreadsheets on a microcomputer? Why not design a program that would produce on a computer screen a green, glowing ledger, so that the calculations, as well as the final tabulations, would be visible to the person “crunching” the numbers?
Why not make an electronic spreadsheet, a word processor for figures?
Bricklin’s teachers at Harvard thought he was wasting his time: why would a manager want to do a spreadsheet on one of those “toy” computers? What were secretaries and accountants and the people down in DP for? But Bricklin could not be dissuaded. With a computer programmer friend from MIT named Bob Frankston, he set to work developing the first electronic spreadsheet program. It would be contained on a floppy disk and run on the then brand-new Apple personal computer. Bricklin and Frankson released VisiCalc (the name was derived from Visible Calculation) in late 1979.
There are some general points. Advances are often made by tool makers; and the best fillip for great software is a problem you personally need to solve (a point Paul Graham makes repeatedly). And of course, people who know better, will not think your efforts worthwhile. Little of this is true of hospital information systems.
This is from an article discussing the difficulties in recommending people to content they might like. The bigger picture is the dismal state of online journalism / news and polluters not paying. But Netflix’s understanding about how fine scale a taxonomy has to be, struck a chord with me. This is exactly the problem of diagnosis in some areas of medicine.
The latter is my favorite. Four years ago, I realized the size and scope of Netflix’s secret weapon, its suggestion system, when reading this seminal Alex Madrigal piece in The Atlantic. Madrigal was first in revealing the number of genres, sub-genres, micro-genres used by Netflix’s descriptors for its film library: 76,897! This entails the incredible task of manually tagging every movie and generating a vast set of metadata ranging from “forbidden-love dramas” to heroes with a prominent mustache.
This reminds me of the old story about how impressed somebody was, after being shown some small computing device that could ‘think’ using powerful algorithms. The observer did however ask about the aircraft hanger size machine that came with it: that was necessary to implement all the code for the exceptions to this universal reasoning machine, he was told.
Lots of room too, for fake news and fake diagnoses.
Public Domain, Link
I dislike LMS (learning management systems). There are lots of reasons for this, but chief is that the ones I have seen are ugly and don’t entice. Universities are increasingly employee facing, rather than student facing (they claim the opposite). LMS are ‘management’ tools, not tools to help you learn. Fit for widgets, not humans. When you go back and look at Gutenberg’s bible or the great illuminated manuscripts you feel the power and pleasure of what the authors intended transmitted via the scribe. The monks understood this — they shared the passion. The web and nascent industry of informal learning for autodidacts is also full of great design (here is an example from Highbrow), even if it usually designed as part of a ‘pop culture’. But not the dismal corporate LMS.
If you don’t like how careless Equifax was with your data, don’t waste
your breath complaining to Equifax. Complain to your government.
Surveillance capitalism fuels the Internet, and sometimes it seems that everyone is spying on you. You’re secretly tracked on pretty much every commercial website you visit. Facebook is the largest surveillance
organization mankind has created; collecting data on you is its business model. I don’t have a Facebook account, but Facebook still keeps a surprisingly complete dossier on me and my associations — just in case
I ever decide to join. I also don’t have a Gmail account, because I don’t want Google storing my e-mail. But my guess is that it has about half of my e-mail anyway, because so many people I correspond with have accounts. I can’t even avoid it by choosing not to write to gmail.com addresses, because I have no way of knowing if email@example.com is hosted at Gmail.
Just last week, when faced with a report that its advertising numbers promised an American audience that, in certain demographics, well exceeded the number of such humans in existence, judging by U.S. Census Bureau numbers, Facebook told the Wall Street Journal that its numbers “are not designed to match population or census estimates. We are always working to improve our estimates.” Facebook’s intercourse with the public need not adhere to the so-called norms of so-called reality.
It’s almost vanishingly rare that we pick a new device that we always have with us,” the historian of mobile technology Jon Agar says. “Clothes—a Paleolithic thing? Glasses? And a phone. The list is tiny.
In 2014, Wall Street analysts attempted to identify the world’s most profitable product, and the iPhone landed in the top slot—right above Marlboro cigarettes. The iPhone is more profitable than a relentlessly marketed drug that physically addicts its customers.
The One Device, Brian Merchant
(As an aside, I was also playing with a new operating system called Linux, which Linus Torvalds had announced on the
comp.os.minixnewsgroup with one of those throwaway phrases that have gone down in history: “I’m doing a (free) operating system — just a hobby, won’t be big and professional…”.)
One thing about trying to put the Internet and computing in context, is that you are forced to look back at the history of other communication revolutions (pace Tim Wu, John Naughton etc). It is now a well trodden path, but one I still find fascinating. Even down to the details of how the cost of distributing images or 3D moulages had an effect on my own specialty. The following caught my eye — or maybe my nose.
“When paper was embraced in Europe, it became arguably the continent’s earliest heavy industry. Fast-flowing streams (first in Fabriano, Italy, and then across the continent) powered massive drop-hammers that pounded cotton rags, which were being broken down by the ammonia from urine. The paper mills of Europe reeked, as dirty garments were pulped in a bath of human piss.”
Awhile back the University of Edinburgh changed some of their guidance around passwords. In my 1Password app, I counted over 250 passwords. Some of these are old and no longer used, but the large number reflects the nature of academic life, in which information and knowledge flow is more outside the institution than within it. My bugbear is of course the NHS and the practice of making people remember hard passwords and change these passwords every 3-4 weeks. This is just bad practice, and leads to people writing them down close to where they use them, or choosing more guessable passwords. Another example of bad practice is below.
Slashdot asks if password masking — replacing password characters with asterisks as you type them — is on the way out. I don’t know if that’s true, but I would be happy to see it go. Shoulder surfing, the threat it defends against, is largely nonexistent — especially with personal devices. And it is becoming harder to type in passwords on small screens and annoying interfaces. The IoT will only exacerbate this problem, and when passwords are harder to type in, users choose weaker ones.
“I’ve written extensively on the now famous Georgia Tech example of a tutorbot teaching assistant, where they swapped out one of their teaching assistants with a chatbot and none of the students noticed. In fact they though it was worthy of a teaching award”
I keep reading this as ‘turbot’, and wondered what the fish things was. I guess the tutorbot would have corrected me soon enough.
Via Bruce Schneier:
The trouble began last year when he noticed strange things happening: files went missing from his computer; his Facebook picture was changed; and texts from his daughter didn’t reach him or arrived changed. “Nobody believed me,” says Gary. “My wife and my brother thought I had lost my mind. They scheduled an appointment with a psychiatrist for me.”
But he built up a body of evidence and called in a professional cybersecurity firm. It found that his email addresses had been compromised, his phone records hacked and altered, and an entire virtual internet interface created. “All my communications were going through a man-in-the-middle unauthorised server,” he explains.
This can be read as typical Silicon Valley hype, but I think it is more right than wrong. Just as government thought computer education in schools was about using MS Office, too many in higher education think it is about copies of dismal Powerpoints online, lecture capture, or online surveillance of students and staff. The computer revolution hasn’t happened yet. Medical education is a good place to start.
What can we do to accelerate the revolution? From our observation, the computer revolution is intertwined with the education revolution(and vice versa). The next steps in both are also highly overlapped: the computer revolution needs a revolution in education, and the education revolution needs a revolution in computing.
We think that, for any topic, a good teacher and good books can provide an above threshold education. For computing, one problem is that there aren’t enough teachers who understand the subject deeply enough to teach effectively and to guide children. Perhaps we can utilize the power of the computer itself to make education better? We don’t hope to be able to replace good teachers, but can the computer be a better teacher than a bad teacher?
Interesting graphic from Audrey Watters on the bête noire, that is Pearson (especially if you are an investor). But although I think I am in a minority, I think universities are wrong to not understand how the world of content will impact on their business models. What is your content like, and what do you add to it? Content is key. But it doesn’t cost 9K, at least not if you scale it right.
In the context of her research about the implications of information technology she stated three laws:
Wikipedia. A lot of interesting links to her work. I never knew the origin.
“If we are really going to turn over our homes, our cars, our health and more to private tech companies, on a scale never imagined,” he wrote, “we need much, much stronger standards for security and privacy than now exist. Especially in the US, it’s time to stop dancing around the privacy and security issues and pass real, binding laws.
“And, if ambient technology is to become as integrated into our lives as previous technological revolutions like wood joists, steel beams and engine blocks, we need to subject it to the digital equivalent of enforceable building codes and auto safety standards. Nothing less will do. And health? The current medical device standards will have to be even tougher, while still allowing for innovation.”
Nice piece on Walt Mossberg from John Naughton.
Technology magnifies power in general, but the rates of adoption are different. Criminals, dissidents, the unorganized—all outliers—are more agile. They can make use of new technologies faster, and can magnify their collective power because of it. But when the already-powerful big institutions finally figured out how to use the Internet, they had more raw power to magnify.
This is true for both governments and corporations. We now know that governments all over the world are militarizing the Internet, using it for surveillance, censorship, and propaganda. Large corporations are using it to control what we can do and see, and the rise of winner-take-all distribution systems only exacerbates this.
This is the fundamental tension at the heart of the Internet, and information-based technology in general. The unempowered are more efficient at leveraging new technology, while the powerful have more raw power to leverage. These two trends lead to a battle between the quick and the strong: the quick who can make use of new power faster, and the strong who can make use of that same power more effectively.
Bruce Schneier, on Crooked Timber, talking around Cory Doctorow’s new novel ‘Walkaway’. BS—well worth reading in full, as usual.
Nice dissection of some of the issues by Ross Anderson, here.
And in today’s FT, we read
Microsoft held back from distributing a free repair for old versions of its software that could have slowed last week’s devastating ransomware attack, instead charging some customers $1,000 a year per device for protection against such threats.
Gee, a secure version of Windows? That’s extra.
If you want to explore the meme about tech destroying jobs (and value) there are some great quotes in a piece by Steven Levy about John Markoff, of the New York Times, stepping down. Some samples:
I used to tell people that the Times’ loyal readership was both its great strength and weakness. The good news was that they would read the paper until they died. The bad news was that they were dying.
Then when I went back to school one fall, the men were all gone. It was the fall of 1969 and the Union Bulletin had gone to offset type. The men in the aprons had vanished. They had been shipped off with the press to a small paper in Oregon. In their place were women in skirts working at Selectric keyboards.
The next transition happened 15 years later when I got my first job at a daily paper, the San Francisco Examiner. I was part of a new generation of reporters who went to the gym after work instead of the bar.
That’s another irony — that I was one of the first to write about the digital world, but when it really arrived it was pretty clear that I wasn’t going to be a digital native. When blogging began, John Dvorak told me that there was no point in doing it unless you posted at least seven times a day. “Why would I want to do that?” I thought. I had already worked for an afternoon daily and I never wanted to work for a wire service.
Some things won’t change. I’m certain that when the next corrupt president is impeached it will be because of the hard work and persistence of some new Woodward and Bernstein.
I have often quipped that high quality journalism could contribute more to health care in the UK than the Department of Health in London. This was once a daring proposition.
From Audrey Watters excellent round up of the year that was:
I think it’s safe to say, for example, that venture capital investment has fallen off rather precipitously this year. True, 2015 was a record-breaking year for ed-tech funding – over $4 billion by my calculations. But it appears that the massive growth that the sector has experienced since 2010 stopped this year. Funding has shrunk. A lot. The total dollars invested in 2016 are off by about $2 billion from this time last year; the number of deals are down by a third; and the number of acquisitions are off by about 20%.
To the entrepreneur who wrote the Techcrunch op-ed in August that ed-tech is “2017’s big, untapped and safe investor opportunity.” You are a fool. A dangerous, exploitative one at that.
Lots of good reasons for this, but surely the main one is that the products are so awful. It is a big domain of human activity, although whether it is a market I will leave for the moment. But people may prefer to spend their money on something that works. And that is before we mention LMS. Of course we can just sell our students user data….
Lots more good stuff from her here, although a stiff drink may be seasonally appropriate.
“This may upset some of my students at MIT, but one of my concerns is that it’s been a predominantly male gang of kids, mostly white, who are building the core computer science around AI, and they’re more comfortable talking to computers than to human beings. A lot of them feel that if they could just make that science-fiction, generalized AI, we wouldn’t have to worry about all the messy stuff like politics and society. They think machines will just figure it all out for us.”
Joi Ito, Director of the MIT Media Lab
(Via John Naughton)
Or as I quoted Steven Weinberg in a paper with the title, “The Problem with Academic Medicine: Engineering Our Way into and out of the Mess”
“My advice is to go for the messes—that’s where the action is.”
I first became ware of the importance of intellectual property law and custom after reading James Boyle’s ‘Shamans, Software and Spleens’. I had been completely unaware of how important the institution of private intellectual property was, and how destructive it frequently was of human advance. Of course, it was not meant to be this way. Boyle’s book is dense but funny, and he lambasts the contradictions in copyright law, the tortured logic in the bizarre attempts to explain why blackmail and insider trading are illegal, and the craziness that surrounded patenting DNA and what you can do with my spleen once you once removed it. As Cory Doctorow commented, about another of Boyle’s books, ‘Bound by Law’, “Copyright, a system that is meant to promote creativity, has been hijacked by a few industrial players and perverted. Today copyright is as likely to suppress new creativity as it is to protect it.” It was reading Boyle that led me to write an essay in the Lancet on how the ease or difficulty of assigning IPR distorted medical advance.
This is a funny story with a surprise inside. The funny part is the artwork: an artist created glass blocks exactly the dimensions of a FedEx box and then shipped them in those boxes, producing unique art out of the cracks and breakage that resulted. The surprise is that it turns out that Fed Ex has corporate ownership over that space. “There’s a copyright designating the design of each FedEx box, but there’s also the corporate ownership over that very shape. It’s a proprietary volume of space, distinct from the design of the box.” Now I’m afraid I might accidentally violate FedEx’s ownership over that specific shape should I decide to, I don’t know, create my own mailing box.
Not so much enclosing the commons, but space itself.
Tim Wu: ‘The internet is like the classic story of the party that went sour’
At the risk of raising the ire of many researchers, I should note that I am not basing my assessment on the rapid growth in educational neuroscience. You know, the kind of study where a subject is slid into an fMRI machine and asked to solve math puzzles. Those studies are valuable, but at the present stage, at best they provide at most tentative clues about how people learn, and little specific in terms of how to help people learn. (A good analogy would be trying to diagnose an engine fault in a car by moving a thermometer over the hood.) One day, educational neuroscience may provide a solid basis for education the way, say, the modern theory of genetics advanced medical practice. But not yet.
Keith Devlin, talking sense — again. I want to believe the the rest of the article but, worry it may not be so. But it contains some gems:
Classroom studies invariably end up as studies of the teacher as much as of the students, and often measure the effect of the students’ home environment rather than what goes on in the classroom.
This just adds to the problem that Geoff Norman (DOI 10.1007/s10459-016-9705-6) and others have talked about in course evaluations, namely that many studies — even accepting of the limitations outlines above — are riddled with pseudoreplication.
What is missing is any insight into what is actually going on in the student’s mind—something that can be very different from what the evidence shows, as was dramatically illustrated for mathematics learning several decades ago
But, like many outwith medicine, I think he puts too much store by the robustness of the RCT approach — even with digital tools to allow large scale measurement. RCT: ‘randomised, confounded and trivial’, as has been said before (Norman).
“Trouble is, the intrusions cannot be ignored or wished away. Nor can the coercion. Take the case of Aaron Abrams. He’s a math professor at Washington and Lee University in Virginia. He is covered by Anthem Insurance, which administers a wellness program. To comply with the program, he must accrue 3,250 “HealthPoints.” He gets one point for each “daily log-in” and 1,000 points each for an annual doctor’s visit and an on-campus health screening. He also gets points for filling out a “Health Survey” in which he assigns himself monthly goals, getting more points if he achieves them. If he chooses not to participate in the program, Abrams must pay an extra $50 per month toward his premium.
Abrams was hired to teach math. And now, like millions of other Americans, part of his job is to follow a host of health dictates and to share that data not only with his employer but also with the third-party company that administers the program. He resents it, and he foresees the day when the college will be able to extend its surveillance.”
Cathy O’Neil, ‘Weapons of Math Destruction’, excerpt on Backchannel.
This sort of thing is going to be all over education and our private lives. Big data masquerading as big ideas, or just ‘big money’. Its just because ‘we care’.
Video is cool. Text isn’t.
Houston, we have a problem.
Great post by Bryan Alexander, titled ‘ A Devil’s Dictionary of Educational Technology’. If you work in it, you will recognise it. I will start off with my favourites
Powerpoint, n. 1. A popular and low cost narcotic, mysteriously decriminalized.
YouTube, n. The ideal educational technology: everyone likes and uses it, it’s reliable and free, and neither you nor anyone you know has to support it.
Here are a few more:
Active learning , n. 1.The opposite of obedience lessons.
Asynchronous, adj. The delightful state of being able to engage with someone online without their seeing you, while allowing you to make a sandwich.
Best practice, n. “An educational approach that someone heard worked well somewhere. See also ‘transformative,’ ‘game changer,’ and ‘disruptive.’” (by Jim Julius)
LMS, n. 1) A document management system, whereby a faculty member can transfer a single document to his or her students. Curiously overpowered for this purpose, nevertheless universally deployed.
2) A good way to avoid legal notices about copyright.
3) The graveyard of pedagogical intentions. A sump for IT budgets.
Nice procrastination piece,
or reality check, depending on whether you teach or you deliver teaching.