The Near Future in Mobile and Location

When I got my first in a series of Palm’s (I still have most of them including the Handspring Flossmaster) people looked at my as if I was a geek. OK maybe I was, but I was only doing what many or most of you are doing now, mobile computing. OK, the dental floss dispenser was a bit of a gimmick, but a very cool one and it was actually done as a promotion, not as a serious concept.

Handspring Flossmaster

So back in the 90’s I was reading eBooks from Fictionwise and other sites which are amazingly still there even though Palm and Handspring are long gone. Fictionwise was already there before Amazon was launched and several years before the Kindle existed. I used to use my PDA during dead moments in-between appointments, while exercising etc. I had apps for Africa, work outs, diaries, games, even mobile email at 9.6kbps on my Ericsson mobile with its expensive Bluetooth dongle.

I helped introduce the first Symbol Palms in New Zealand with bar code readers and whilst they are now running a different OS they are fundamentally being used for the things I suggested such as warehouse inventory management, field sales automation, ticket management at events and so on.

Then my devices got audio and became phones, so I could listen to music, podcasts and started publishing my own podcasts and getting my songs on other people’s shows through to the last few years when my Smartphones got GPS. During that time we went from PDA’s that could also function as phones through to now where our mobiles are powerful computers that are as ubiquitous as I said they would become.

So here are a few thoughts on what is coming next, things that you dear reader are likely to take for granted within the next few years.

As a consequence of your use of check in functionality on your mobile using Facebook, Foursquare, Google+ or whatever software you chose, details about your interests, your friends and family and your activities will be profiled along with most of the people you know. You will get notifications based on where you are and your interests, on your mobile offering you relevant deals as well as a load of spam that will have you wondering whether you should disconnect alltogether, but you won’t.

Your mobile will be your multi-modal navigation device, not just while driving or keeping the cabbie honest, but walking, running, hiking, boating, shopping, providing navigation on the road and even inside buildings such as shopping malls, hospitals and university campuses. You will be able to see where your friends and family are and you will be offered deals based on mutual interests and be able to buy them and pay for them on your mobile.

You won’t have to carry loyalty cards any more. They will be maintained on your mobile which will give you the option of looking for deals, comparing prices and getting directions to the nearest retailer with whom you are a loyalty member. You will also have the option of having your mobile notify you of deals based on its prediction of your needs. For example on a Saturday morning when it sees you are buying garden tools at the DIY, it may offer you a promotion at the nearby garden centre which is uniquely created for you.

You will have a personalized newspaper on your mobile which carries both stories and advertising offers of specific interest to you. You will be surprised at first at how relevant they are. You won’t have to search for stories any more and you won’t be pushed information you are not interested in. You will only buy newspapers on rare occassions and within a few years printed newspapers won’t be available any more.

Music is an interesting one and the way you enjoy it will change dramatically in the near future. Within 24 months music CD’s will be out of production and you will either subscribe to a music service with a monthly subscription or possibly it will be offered as part of a mobile offer from your telecommunications provider. The question at the moment is whether the major music provider will be Apple, Nokia,  Vodafone or a service such as Spotify.

For those who want to really get into their artists, you will be able to download apps. Several years ago I wrote a piece for NetGuide, which they declined to publish. I said that CD’s would die because the record companies were not providing any added value. I suggested that they add music videos, interviews, digital photos, background stories, lyrics etc to the media. It wouldn’t have cost them anything because it was all material that they already had access to. Anyway, long story short, guess what is already available to an iPhone, Android or other device near you? All of those things. Bands and their management are using off the shelf tools to put all of these things onto mobile devices including gig calendars, social media and the ability to purchase event tickets and merchandise from within the applications. They will also allow you to communicate with other fans from within the applications and future functionality will include the ability to remix tracks and record your own cover versions to share with other fans. Competitions and special offers will also be included.

In future when you go to a concert you will be able to hold your mobile up towards the stage using facial recognition to identify the performers using augmented reality and take tagged photos showing the names of the artists and of course the location the photos or videos were taken. Of course the facial recognition will also identify your friends and associates for posting and sharing on your favorite social media pages.

I could write a book on this stuff, but I thought it was time I shared a few things with you before they start happening and you take them for granted. I like being able to say “I told you so”.

In finishing I note that Apple have just filed a patent on mobile facial recognition. They also mentioned biometrics, funny, I still have a HP iPaq with a finger scanner. Want to know more about facial recognition? Here’s a quick 2 minute primer.

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76 Deaths, surgical mistakes in New Zealand Hospitals

As one of the old blues songs goes, ‘I laugh just to keep from crying’.  This morning the headlines are out there nationally and internationally. MSN tells the story that in the YEAR ended July 2008, 76 people died out of a total of 258 incidents, that is those that we now about, in New Zealand hospitals.

The story says that the Ministry of Health’s Quality Improvement Committee went on to say that each of these deaths and incidents were avoidable.

The NZ Herald had the story on the front page of the printed edition, but semi buried on the net. They quoted the Health and Disability Commissioner Ron Paterson as saying that it was not a surprise and the story continued to say that ‘Reporting is voluntary and District Health Boards do not know how many incidents are unreported.

Incidents included people’s teeth being accidentally removed, 2 patients being given 10 times the needed dose of medicines, in at least one case, morphine, another patient was booked in, anaesthetised and sent to the operating theatre for an eye surgery they had already had 2 weeks prior. Mistaken identity is another common thread.

Does this come as a surprise to you? It doesn’t to me.

I wrote about these sorts of issues in this blog in February last year. I also presented one of the solutions that has been used in hospitals in the US for many years, at least 15 years ago when Welch Allyn (a well respected technology provider to the health industry) first brought out 2D bar code scanners with the ability to read complex bar codes on patient wrist bands and patient record folders, containing a huge amount of patient information, without requiring access to the hospital’s computer systems. All they would have needed was a number of scanners and a handheld computer such as a Windows CE device (which could also contain a database of things like drug interaction data, i.e. don’t use this drug in combination with that one.

Back in the late 80’s we were already able to come up with a solution that would keep track of patient records folders (which always seem to go missing when you visit the hospital) and are able to identify not only exactly what they are in hospital for, but also things like allergies (especially to drugs such as penicyllin) and any other relevant information such as blood type, currently prescribed drugs (both by their GP and in the hospital and much more.

I presented these concepts and more to Auckland Hospital and the Waitemata DHB. The solution was simple and low cost, but they chose the lower cost option of doing nothing.

So they saved some money and chose to ignore solutions which 20 years ago were strting to be installed in some hospitals in the US. How many lives could have been saved in those years?  I shudder to think. Of course there are also many living victims, who have had to have surgery repeated to remove items accidentally left in their bodies, or many of the other incidents. What about the family of those who died?

So I have a couple of questions:

• When everyone in the industry new these things have always happened in the industry, why was nothing done about it?
• Why is it voluntary to report incidents? Why isn’t it mandatory?
• How many more incidents actually occured that weren’t reported?
• What are they going to do about it?

You can read the damning report for yourself by downloading this pdf.

If you don’t want to, check out a few of these incidents from the report:

• Several mental health patients who committed suicide when they should have been under close supervision, or who were discharged and then killed themselves.
• A patient who died because of confusion over resuscitation status
• A patient who’s tests suggested cancer which was overlooked
• Accidental removal of a breathing tube from a ventilated patient
• Accidental bowel perforation during gallbladder surgery resulting in fatal multi organ failure
• Death of a mother from post partum hemorrhage due to a number of  ‘errors’

The list goes on for 84 pages and these are only those which were voluntarily reported!

So is the hospital the best place to be when you are sick? You decide.

Are there solutions? Yes there are and there have been for many years. I introduced some of them over 15 years ago and my ideas weren’t new, they were already being introduced into US hospitals at the time.

Are they going to do something about it? I hope so. My concepts don’t solve all the problems, but they could have saved several of these poor people and their families. Who is going to take responsiblity for this? I put it to you that the cost of the solutions is far less than the consequences of not using them at least 76 times over.

If you ask me, the government needs to step in now and do something about it. In many cases there are very simple technologies that will if implemented save many lives, but will also introduce sgnificant cost savings through eliminating some of the inefficiencies that waste time and money.

While this blog is starting to get a good following, I would love to get more readers and encouraging me to keep writing. If you feel that my blog is interesting I would be very grateful if you would vote for me in the category of best blog at the NetGuide Web Awards. Note that the form starts each site with www whereas my blog doesn’t and is of course https://luigicappel.wordpress.com.

Thanks so much for your support:)

The hospital is the best place to be when you are sick, or is it?

Lately there have been a spate of stories about medical misadventure in the news, focussed on hospitals in New Zealand. Tales of drugs being given to the wrong patient, the wrong limb being operated on, things left behind inside the body after the wound has been stitched and lots more. Stories like Mistakes Kill 40 and Death Tally have been around for years.

In my own personal experience I was once prescribed an antibiotic and an antihystamine where the medical documentation stated that they should not be used in combination. The consequence was a major long term allergic reaction. My father in law who has a lanryngectomy has suffered from pneumonia several times as a consequence, not a reason, of being admitted to hospital for other problems.

For years we have had stories of people waiting in corridors in hospital Accident & Emergency areas because there were insufficient beds in the wards for them, even though they had been admitted. Each time one of these stories come out, the hospital spokespeople make out that it is an isolated incident due to a suddent spate of health problems caused by weather or other factors outside their control. Funny then that each time I have visited A&E with various family members over the last couple of years, I’ve had the same experience, summer and winter. For example last year my daughter suffered what eventually was diagnosed as a relapse of glandular fever. She was instantly admitted to the hospital by agreement between an A & E clinic and the hospital. I got her to the hospital around 5 p.m. on a Saturday afternoon and she got to see a doctor at 1:30 the following morning. I assure you I can quote many more cases with the same results from personal, not anecdotal experience.

My younger daughter was a blue baby and had regular visits to hospital for that and as she got older for various injuries from her sport of gymnastics. As a child a common occurence was that they could not find her file, even for appointments scheduled a week or more in advance.

So what’s my problem with that, other than as a taxpayer and concerned citizen? It’s that they have had solutions available for many years that cost dramatically less than the consequences of not having them. I know because I presented many of those tools and solutions to them.

First there is a simple concept of bar coding or using RFID tags to identify and locate files and other plant. This is everything from patient files (even though a lot of information is digitised, it generally isn’t available to registrars and other staff on demand in the wards or at the bedside) to critical equipment. I’ve heard of operations being cancelled or postponed because equipment had been borrowed from operating theatres and not returned.

So what was my solution? Very simple. Every patient folder has a bar code on it, which identifies the patient, their national health code etc. Each staff member has a bar code on their ID card. A bar code reader can be placed at the entrance to all key areas and as critical documents or plant leaves an area, it is scanned and the person removing it scans their identity and when it arrives at the next location, it is again scanned. Now a central data register knows where each file is, where each heart monitor or other item of plant is. Imagine the amount of time and pain that could be saved and avoided!

Then there is the very common problem of people being given drugs they are allergic to. I introduced 2D and 3D barcode readers into New Zealand many years ago, through an agency I managed with a well respected medical technology brand, Welch Allyn. The conept of these bar codes which are now (12 years later) starting to appear on patients bracelets, is that the bar codes can contain large volumes of digital data including crucial information such as allergies, their condition, their blood type and much more, without having to resort to a central database. Anyone that uses a computer, especially attached to a network, knows that its integrity and availability can’t be relied on.

So, at the bedside, I recommended a protocol each time drugs were administered, that the bar code be read with a small handheld scanner with a display, or built into a small handheld computer, and critical information could be confirmed before blood or drugs were administered. It would also ensure that it was clear that it was the right leg or appendage that was causing problems. By using a drug database, which can reside in a Palm sized computer, an alert would be delivered instantly if drugs that are dangerous when taken at the same time might be administered.

This is not a small problem and it is not a local problem, but it seems that only a few hospitals spend the money on using this technology which is readily available. It is usually hospitals that are attached to universities or med schools that invest in the technology. But it isn’t expensive and the cost of not using it is much greater. In Australia for example according to the Sydney Morning Herald, between 85,000 and 115,000 people over the age of 65 are admitted to hospital EACH YEAR due to adverse effects of their medication. And that’s the tip of the iceburg. What about those under 65, but of coursewith the older ones these problems are often fatal. Google in your country and you will find countless stories. This can so easily be avoided.

I’ve often wondered what has to happen before the government steps in. How many New Zealanders and people around the world have to die because of ‘accidents’ that could have been avoided. What is the cost of each one, or even the prolonged treatment of people who’s recovery from illness is hindered due to these problems. The solution is far cheaper than not doing something about it. I thought that perhaps if the family of an MP got caught i situations like this, that then maybe the Minister or others would do something about it, but I suspect that these people would not find themselves in public hospitals where cost restraints are more important than patient’s health and care.

I’m lucky that I can make a choice and I do have a couple of minor procedures I need to undergo soon. I can assure you, I will be using my medical insurance and going private.

But tell me please, what does it take. What are you going to do nect time you take one of your friends or family to hospital and they say take a number and we will see you as soon as possible. When you ask how soon, they tell you “Maybe 2 or 3 hours, because one of our registrars is off sick” and in ‘2 or 3 hours’ they tell you “another 2 or 3 hours because there has been a major car accident that was unexpected”. Are accidents ever expected? How come tow trucks and ambulance organisations know that there are certain spots at certain times of day or night where they should be waiting because an accident is going to happen, but hospitals don’t expect it. Goodness me, it’s 11 p.m. on Friday night and it’s raining. I guess there is no reason for the hospital to expect one out of a million people to cause an accident due to drunk driving is there?

I’m pissed off. This is the 21st century. I don’t live in the 3rd world, we have a modestly affluent society, but we can’t cater to a growing population? I shudder to consider what it’s going to be like in the next 30 years as the baby boomers get older and need more medical assistance because those that don’t succumb to medical misadventure or die in the waiting rooms. The hospitals might still be saying that they were caught by surprise with the extra people who succumbed to the flu this winter.

People are so forgiving. They say the staff did their best under the conditions they have to work in. I don’t disagree, I have utmost respect for the doctors, nurses, orderlies, domestics and everyone else who make the hospitals run, despite their masters. But why should they have to, shouldn’t health be one of our highest priorities?

Now throughout all this I have been talking about public hospitals funded by the state, by our taxes. I have a couple of minor surgeries coming up and guess what, I won’t be sitting in a waiting list for 2 years and then find myself being bumped after having starved myself overnight because they needed their resources for an unexpected accident. I’ll be going private. No I’m not wealthy, but I pay my medical insurance as I have since I was 18 or so and I’m going to take advantage of it.

Anyway, is hospital the best place to go when you are sick? I don’t think so.