The Age of the ePatient: Not Quite There Yet

July 25th, 2011 | 2 Comments | Source: Commentary

The Internet has transformed every aspect of health care. Online communities provide new forms of support for people with a thousand different medical conditions. Email has streamlined communication between stakeholders in the system. Electronic medical records and social networking sites hold a wealth of data that can be leveraged to study the effects of various treatments.

The most significant advance by far though, has been the ease with which people can access information about their health. As many as 74% of all people search for information about their symptoms and treatments online. Many of these information-empowered people now see physicians as guides to and interpreters of this information, a far cry from the era in which passive patients simply recounted their symptoms and relied on paternalistic physicians to act in their best interests.

There are problems with the new paradigm, just as there were with the one it replaced. In particular, online health information can be incomplete, biased, lacking for proper context or flat-out inaccurate…and not everyone can sort through these deficiencies in a way that assures they are properly informed.

A recent study by Alexander van Deursen and Jan van Dijk of the University of Twente has quantified these problems. The scientists used performance tests to assess health-related Internet search and other online skills in a representative sample of the people in the Netherlands.

Their tests focused on four types of skills:
Operational-These included basic internet skills like opening a health website, saving a PDF file and adding a website to a list of “favorites.”
Formal-These included navigating health-related menus and websites, and surfing a list of websites.
Finding Information-These included accessing specific information regarding medical conditions and answering specific questions like whether it is appropriate to begin a treatment after being infected with a particular germ.
Strategic-These included extracting information from different sources and making decisions based on the information. For example, “find out whether it is wise to give a 3-year-old boy Vitamin A and D.” (more…)


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Health Care in the Cloud: A ‘Case Study of What Not To Do’

May 2nd, 2011 | No Comments | Source: Commentary

Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.

The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.” 

One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.

Life of our patients is at stake—I am desperately asking you to contact

Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you

Oh this is not good. Man mission critical systems should never be run in the cloud. Just because AWS is HIPPA certified doesn’t mean it won’t go down for 48+ hours in a row.

(+30 minutes since comment thread began) Well, it is supposed to be reliable…
Anyway, I am begging anyone from Amazon team to contact us directly. Thank you

Go to your backups? Or make a big deal out of it on the forums maybe someone will take a look. In any case anecdotal empirical evidence has shown don’t bother with premium support its a freaking joke.

Thanks for the comments, but we are really desparate. Amazon team – please contact us

(+10 hours since comment thread began) Not restored. Not heard from Amazon. People out there – please take a look at our volumes! This not just some social network website issue, but a serious threat to peoples lives!

Your only option at this point is Premium support. However, they’re just going to tell you to wait. Sorry.

(+ 13 hours) There is some progress. 2 servers are operational and one still not working. Unfortunately, the one on which we have the most patients

Aren’t you braking some compliance laws by not having a highly-available environment?

You put a life critical system on virtual hosted servers? What the hell is wrong with you

Not sure whether you’re plain incompetent or irresponsible. Anyway, you should be ashamed and prepare yourself with lots of money to pay for the lawyers. Would it be so difficult to have a contingency plan? another provider? or even another availability zone? Are you so fsklong dumb as to think that nothing could ever happen to a data center. (more…)


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Too Drunk to Drive? There’s a Car for That

February 2nd, 2011 | No Comments | Source: Washington Post

Drunk driving continues to be a serious problem. In 2009 for example, alcohol was a factor in more than 10,000 highway deaths. The same year, a stunning 10% of respondents to a survey of US adults said they had operated an automobile while drunk during the previous year. Nearly 6% said they had done it more than once.

So how would you feel about a car that can instantly detect whether a driver is drunk and prevent that person from starting the car?

You better make up your mind quickly, because scientists are close to perfecting this technology.

“We’re five to seven years away from being able to integrate this into cars,” Robert Strassburger, the VP for safety at the Alliance of Automobile Manufacturers told the Washington Post. The AAM, an automotive trade group, is on the development team for the new technology which is being spearheaded by the Automotive Coalition for Traffic Safety and National Highway Traffic Safety Administration.

The anticipated sensing device will look nothing like the breathalyzer machines currently used by police in the field. Instead, it will be comprised of tiny, passive, touch-sensitive sensors that are permanently affixed to a key fob or a starter button. The sensors can determine blood alcohol levels in seconds.

From a technical standpoint, the biggest challenge is to craft a sensor that analyses and responds to tactile information within about a third of a second. Current versions of the sensor take 20-30 seconds to do this. Team members are confident however, that advancements in solid-state electronics and infrared technology will help them achieve their goal.

After that lies the most nettlesome problem of all. Will car buyers purchase vehicles with these devices? Obviously, cost will be a concern, but more important will be the fears people have that the newly empowered vehicles will prevent them from driving home after enjoying a drink or two. (more…)



China’s Hacked Computers

March 10th, 2010 | No Comments | Source: Washington Post

China, not the US, holds the dubious distinction of having the highest number of private computers that have been commandeered by hackers with malicious intent, according to a report by McAfee, an Internet security firm.

urwishisourcommandMaCafee monitors Internet-based threats targeting computers in 120 countries. It found that in the fourth quarter of last year, about 1,095,000 computers in China and 1,057,000 in the US had been infected.

Those numbers don’t count the roughly 10 million computers in each country that had previously been infected.

Infected, or “zombie” computers are typically linked together as botnets and then used to send spam e-mail or launch Denial of Service attacks on Web sites.

McAfee suggested that Chinese computers are particularly vulnerable to hackers since software piracy is common there, and computer users frequently do not download patches for their machines.

In a recent speech about Internet freedom, Secretary of State Hillary Rodham Clinton suggested that the Internet is a “global networked commons” for which “norms of behavior” ought to be developed by nations.

“An attack on one nation’s networks can be an attack on all,” she said. “Countries or individuals that engage in cyberattacks should face consequences and international condemnation.”

The US will have trouble heeding Clinton’s call for accountability and norms because it has so many infected computers. “The government could crack down on botnets, but doing so would raise the cost of software or Internet access and would be controversial,” Harvard Law professor Jack Goldsmith  wrote in the Washington Post.

“So it has not acted, and the number of dangerous botnet attacks from America grows.”


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Cybersecurity Manpower Shortage

February 8th, 2010 | No Comments | Source: Washington Post

When a US embassy employee in East Asia clicked on an e-mail attachment in May, 2006, she inadvertently unleashed the largest cyberattack ever launched against the State Department. The breach permitted China-based attackers to insert malicious computer code into the department’s networks throughout the region.

hackedintheactA cyber-threat response team leapt into action and toiled 24/7 for 2 weeks to isolate the code and develop a patch that officials claim prevented a gargantuan breach.

Unfortunately, State is better equipped to handle cyberattacks than other parts of the federal government. And 2 months later, the Bureau of Industry and Security, a part of the Commerce Department that oversees exports of technology that has both commercial and military uses, was attacked in similar fashion.

The attack was not recognized for days and Commerce was never able to determine when the initial intrusion took place (Commerce claims there is no evidence data was compromised as a result).

Commerce and other parts of government are trying to improve their performance in this regard, but their efforts are often stymied by a marked shortage of skilled computer-security workers, from front-line technicians to so called Security Generals. 

Meanwhile, according to the Government Accountability Office, the number of probes, scans and attacks reported to the Homeland Security Department’s Computer Emergency Readiness Team more than tripled between 2006 and 2008, from 5,500 to 16,840.

The manpower shortage is impacting Pentagon efforts to staff-up a new Cyber Command and Homeland Security’s plans to increase it’s cyber-staff by 1,000 people over in the next 3 years.

The intense demand has sparked bidding wars among agencies and contractors for a small pool of special talent: skilled technicians with security clearances. Some young people with 3 years’ experience and a clearance are commanding salaries over $100,000. 

Philip Reitinger, deputy undersecretary of Homeland Security’s National Protection and Programs Directorate, conceded he couldn’t match private sector pay scales. “But in government,” he told the Washington Post, “one can have a bigger ability to effect change at an earlier place in your career than anywhere else.” he said.

Besides, Reitinger added, “your country needs you.”



Google-China Update

January 20th, 2010 | No Comments | Source: Washington Post

It’s been a week since Google announced its Gmail systems had been breached by cyber criminals based in China, but the scope of the attack is just now being appreciated.

Anti-VirusIt looks as though the attack was part of a large corporate and political phishing ploy that leveraged security flaws in e-mail attachments to break into the networks of at least 34 companies including  Yahoo, Symantec, Rackspace, Adobe and Northrop Grumman.

According to Google, the hackers accessed the Gmail accounts of Chinese human rights advocates around the world, as well as other human rights groups that shape the national debate on human rights in China.
Google has threatened to retaliate by pulling out of China altogether.

The attacks were more sophisticated than their predecessors, according to security experts, in that they simultaneously exploited flaws in many software programs.

“Usually it’s a group using one type of malicious code per target,” Eli Jellenc told the Washington Post. Jellenc, the head of international cyber-intelligence for VeriSign’s iDefense Labs, added that “in this case, they’re using multiple types against multiple targets. That’s a marked leap in coordination.”

The standoff between Google and China creates a headache for federal officials, since it cuts to the heart of many current issues in U.S.-China relations: from human rights and censorship to intellectual property protection and access to military technology.

Since it entered the Chinese market in 2005, Google has clashed with the Chinese government about which search topics should be censored. The company’s service has been blocked when it defied government wishes.

News about Google’s public rebuke was censored in China, other than an op-ed piece in People’s Daily which called the search giant a “spoiled child” and predicted it would eventually back-off its threats.


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China Wages Cyber War against US

December 4th, 2009 | No Comments | Source: Washington Post

One day during last year’s presidential campaign, FBI agents notified Barack Obama’s campaign that its computers had been hacked. Later, they told McCain’s campaign the same thing. 

ChinesewormattackBoth attacks almost certainly originated in China.

These were not isolated incidents. China, or free-agent hackers on their payrolls, has penetrated computer systems of the State Department, US nuclear weapons labs and defense contractors.

It has stolen files on political dissidents from members of Congress, disrupted e-mail servers used by the Secretary of Defense and launched a spyware attack on electronic devices used by the Commerce Secretary during a visit to Beijing.

Last April, then-National Counterintelligence Executive Joel Brenner famously reported that the Chinese had penetrated “certain of our electricity grids” with malicious code that could be activated at a later date, perhaps bringing it down altogether. 

Officials can’t know exactly what has been stolen or how badly US systems have been exposed, but they do know why China has become an aggressive cyber threat.

“This is the way they plan to thwart US (military) supremacy in a potential conflict,” Robert Knake, a Council on Foreign Relations fellow told the Washington Post. “They believe they can deter us through cyber warfare.”

Chinese officials scoff at the accusations. “Allegations that China is behind cyber attacks against the US are irresponsible,” said Wang Baodong, a Chinese Embassy spokesperson.

“Since the US serves as the hub of the international information highway, attacking the US in cyberspace equals attacking one’s own cyberspace assets. . . . What’s the logic?” Wang added.

Amid the furor, US cyber policy expert James Lewis said it best, “I’m not going to get upset about China spying on us, because we spy on them. The only thing I’m going to get upset about is if we don’t do better.”


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FCC to Move on Net Neutrality

October 15th, 2009 | No Comments | Source: NY Times

Four years ago, the Federal Communications Commission adopted “network neutrality” principles that protected consumers’ rights to use Internet-based applications, services, content and devices of their choosing, and to foster competition among Internet providers.

FCCLast week, FCC chairman Julius Genachowski proposed formalizing these rules and adding an additional one designed to prevent Internet providers from discriminating against certain applications or content by using bans or service degradations against offerings that compete with their own.

Genachowski also proposed that the rules should apply to wireless networks, which had not heretofore been subject to the network neutrality principles.

The FCC invoked network neutrality last year when it called-out Comcast for attempting to degrade the Internet connections of users who were attempting to use a particular kind of file-sharing software. Comcast appealed the ruling on grounds that the neutrality principles had not been formally adopted.

Formal adoption of the rules promises to be a time consuming process since it requires an extended period for public comment. During this phase, the communications industry is sure to raise several objections.

In particular, some providers want to offer faster connections to companies that pay a premium for the service, such as those who provide high-definition movies online.

Public advocates fear that such services can transform the Internet into a tiered service in which premium offerings are available only to well-endowed users.

GenachowskiGenachowski will likely compromise in this area, allowing experimentation with premium services while assuring that sites which do not pay extra continue receiving service levels to which they have become  accustomed.

The formalization process should begin later this month. A final plan could be voted on by next spring.



Fuzz Alert

July 22nd, 2009 | No Comments | Source: Washington Post

Steven Forage, a metro-DC-based software salesman spends 5 hours per day behind the wheel. Like so many others, he’s closing deals on his cell, drinking coffee and checking email, in addition to driving.

Ihadyougoing87One thing he worries about no more, however, is getting nailed by a speed camera.

That’s because Forage tricked-out his Caddy with PhantomAlert, a system that links all known locations of the cameras with his GPS and warns him when he’s approaching one.

“Fuzz alert!” shouts an electronic voice from his dashboard. “Ding, ding. Ding, ding. Fuzz alert!”

PhantomAlert has subscribers all over the country, including more than 2,000 in metro-DC alone according to it’s owner, Joseph Scott.

Scott’s employees access the locations of speed cameras from government and police Web sites, and receive tips from subscribers as well.

Scott believes cops should dig his device, since after all the cameras are there to slow-down drivers and not generate cash from tickets. “Not only should they support us,” Scott told the Washington Post, “but when they mail out citations, on the back they should say, ‘Get PhantomAlert.’ “

endoftheroadSome officials disagree. “If drivers think they only get a ticket when their little device goes off, that could lead them into a false sense of security, which could cause them to speed,” Lisa Sutter, a District employee who runs camera enforcement operations in DC told the Post.

But in fact others see merit in Scott’s device. Corinne Geller, a spokeswoman for the Virginia State Police, thinks PhantomAlert could create a perception that there is more surveillance going on at any time than is actually the case. “If it’s a deterrent, that’s a good thing,” Geller said.



China’s Thought Police at it Again

June 26th, 2009 | No Comments | Source: Wall Street Journal, Washington Post

Chinese officials have announced that beginning on July 1, all computers sold there must include government-designed software that blocks pornography.

theworldaccordingtochinaOK fine, but a few Internet savants smelled a rat and set out to test the so-called Green Dam-Youth Escort software.

Their conclusion: Green Dam also censors religious and anti-government Web sites, disables programs after people input certain words, monitors personal communications, and tracks the Internet explorations of Chinese citizens, according to the Wall Street Journal’s Gordon Krovitz.

China is in effect asking computer makers to help block access to information and punish citizens if they visit unsavory sites or express themselves freely online.

Green Dam, dubbed derisively by its own citizens as the “Great Firewall of China,” has also been found to close computer applications without warning and create serious security problems.

So far Dell, HP, Apple and Lenovo—whose biggest shareholder is China’s government—have tread lightly around the subject, allowing their trade associations to gently press the matter with Beijing.

But now, US Trade Representative Ron Kirk and Commerce Secretary Gary Locke have begun quietly pressuring China to shelve the program altogether. They claim the program may violate commitments that China made to the World Trade Organization.

In letters to 2 Chinese ministries yesterday, the US officials said, “China is putting companies at an untenable position by requiring them, with virtually no public notice, to pre-install software that appears to have broad-based censorship implications and network security issues.”

The letters encouraged China to seek ways to promote parental control without restricting freedom to roam the Internet, freedom of expression and the free flow of information, according to the Washington Post.


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