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Posts Tagged ‘telecommunications’

The opportunities and risks of telehealth in the NHS

Thursday, June 18th, 2009

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Originally posted in computing.com

Though their lineage dates back to before World War II, ATMs in their modern form appeared widely on the high street in 1973. Since then they have bred like rabbits and spawned numerous cousins in the form of automated ticket dispensing machines and point-of-sale devices. They have also arguably created the payment services backbone that has enabled the “cardholder not present” transaction capability that is internet payment services.

Along the way ATMs have also fundamentally altered the relationship customers have with their banks. Gone are the days of queuing at inconvenient times in actual banks and dealing with real tellers, bank managers and advisors. All replaced with anytime, anywhere banking, in whatever currency of whichever country you’re standing in. Meanwhile branches have closed, and while almost everyone appreciates the convenience, there are many who rue the dehumanising of the bank/customer relationship.

All of this is worth keeping in mind as the NHS, and its international health care counterparts, dabbles increasingly in technology-enabled remote diagnosis and treatment of patients. The efforts of the NHS’ Aberdeen TeleHealth initiative, based in no small part on Cisco’s telepresence technology, have yielded some impressive results.

The NHS trials used high-definition telepresence communications, enhanced with customised cameras, scanners and a wide variety of other electronic diagnostic tools. The patient, normally assisted by a relatively unskilled helper (who may have no more than rudimentary first-aid skills), can be subject to an array of tests as well as being interviewed by the remotely located GP or specialist.

The healthcare service has field tested such diagnostic services in the remote wilds of Northern Scotland, out to the remote North Sea oil drilling platforms and with the communities on the Orkney and Shetland islands. Such communities are remote, sparsely populated, and suffer from a lack of dedicated and local health professionals. If enough trained personnel were to be supplied, they would be underworked - but horrendously expensive to maintain and manage.

The NHS trials have delivered impressive results, with the service reporting that diagnostic accuracy is on a par with in-person capability. While the telepresence approach requires availability of relatively high network bandwidth between the patient location and the remote healthcare professional, as well as a not-insignificant capital cost in technology, it is cost effective compared to providing comparable healthcare to remote communities via traditional means. Telepresence-based medicine makes it possible to more accurately and more rapidly diagnose a patient compared to the service that could be provided by way of the irregular in-person approach that such remote communities have historically suffered.

Such benefits are substantial, and it is clear that remote diagnostics provide important potential benefits in terms of service and cost. That said, it is also critical to remember that effective healthcare ought to be more than just treating patients as “units” to be pumped through an increasingly automated health service factory. Arguably, telepresence-based health services are another step down the path of dehumanising healthcare and turning it into an assembly line for the dispensing of treatments that address mainly the symptoms, and rarely proactively address the causes. The provision of telemedicine to a remote community that previously had no service is better than nothing, but is it the best we can do as a society?

The old bedside manner has to become the new telepresence-side manner. If some of the more mundane reviews and check-ups can be automated out of the health system - such as repeat prescriptions, blood pressure tests and anything else that can be made self service through web interface or remote monitoring - then more time should be freed up for the medical professional to spend in real consultation with the patient. This can then help with preventative treatment, so minimising reactive treatments, and again freeing up more time.

Therefore, technology used correctly can create a virtuous circle - whereas used wrongly can be counterproductive. Let’s ensure that the healthcare beancounters don’t ruin it - and that healthcare professionals can get back to caring more about their patients, and focusing less on the profitability of the service.

Many people would complain already that they are treated as walking wallets rather than individuals by GPs, as they are herded through community clinics in 10-minute appointment increments. We need to be careful as we take this path that we do not end with unintended consequences whereby there is some added convenience to some, at the expense of degraded and dehumanised services to everyone.

Originally posted at http://quocirca.computing.co.uk/

Telecommunicating a changing energy supply model

Friday, February 6th, 2009

Henry David Thoreau said, “We are double-edged blades, and every time we whet our virtue the return stroke straps our vice”.

And so it is with technology and the energy supply model underlying it. What wonders the profligate use of petroleum based fuels and coal has brought to mankind over the last century. Borrowing profusely from the energy stores of the past has allowed us to break free from the limits otherwise placed on us, had we needed to continue relying solely on plant based energy sources for fuel, and animals (and human slaves) and the occasional use of wind, water and gravity for motion. Supporting as it has the major technology innovation driven macro economic cycles of the 20th century we must recognise that even our current plans (such as they are) to move to widespread use of renewables for electricity supply would not be possible without the construction and technology innovations fuelled by the petro industry.

Our current perilous state is the end result of two human failings.

Firstly, we have treated as an externality the economic and environmental cost of the pollution generated through burning coal and petro fuels. The treatment of pollution as an externality is not just a problem of human behaviour; it is clearly also a systemic failure of market fundamentals, and one that must be addressed even as we seek a way out of the current global economic unravelling.

Secondly, we have failed to plan sufficiently for the eventual and entirely logical decline in the availability of oil supplies. The extent to which we have collectively found it convenient to ignore the clarion calls regarding the peaking of oil supplies is breathtaking.

Yet here we are; facing the environmental unravelling that results from a century of spewing greenhouse gases into the atmosphere, the collapse of the market systems as a result of self deception as their true operational nature, together with the real likelihood that peak oil is a “now” not a “later”. You couldn’t plan that nexus better if you were the scriptwriter for a Hollywood disaster movie.

While the irony of our current problems should not escape us the technology that it has allowed us to develop might however provide the means for us to avoid some of the worst of the potential resulting scenarios. It may be argued that in the long term (meaning: really long term) human society needs to evolve to an entirely different model (and why not - we have seen already in human history the existence of several different models that have been effective in their day, given the needs and limits of the time). However in the short to medium term we must recognise that we cannot simply stop doing every activity that is currently performed and that in this new reality is recognised to have an unacceptably large ecological footprint. To attempt to do so would be far too disruptive of the current social order to be acceptable. Instead, we must use technology in different ways in order to provide low GHG emission alternatives to current heavy GHG emission ways of working and living.

Of all of the changes we must make, the two areas that will require technology-supported alternatives to most desperately are travel and electricity supply, and they are in fact linked.

Lets first look at travel. The four most common forms of polluting travel are (road based) vehicular, sea-borne bulk carriers, air, and rail. Which is worse is a moot point as far as progressing the discussions along in the short term, especially given the debate over the actual impact of jet propelled, high altitude flight. For simplicity’s sake it is worth assuming that they’re all bad, and they will all need to be drastically curtailed and/or re-engineered if they are to remain viable.

Sea-borne bulk carriers are the easiest to deal with, so lets get that topic out of the way first. The easiest way of avoiding pollution resulting from an activity is to not perform the activity in the first place. The vast majority of bulk carriers are either carrying crude or refined petrochemicals or derived products or coal; raw or semi refined minerals; components that are destined to used somewhere else as part of a highly distributed supply chain; or completed manufactured goods. The shipping of petro products and coal in bulk will clearly decline anyway as we remove these products as primary energy supply sources. Highly distributed and long tail supply chains look increasingly unviable when we recognise those costs that are currently treated as economic externalities, and in doing so account for those costs in the price of the resulting product and service. Already companies are beginning to re-examine their supply chains in light of GHG emissions, and work is underway to further refine the Scope 3 calculations of the GHG Protocol by the World Resource Institute in order to provide further clarity regarding the details of supply chain reporting. In a similar fashion, we can expect a reduction in long distance shipping of manufactured products, especially as the embodied footprint of such products is more commonly calculated, reported, and as a result priced in to the product. In such a scenario a locally produced product will become more desirable than an equivalent product manufactured remotely. The accounting for the pollution resulting from the fuelling of the remaining shipping movements will naturally encourage a re-examination of nuclear driven ships, and the use of wind power.

Rail meanwhile needs to be powered by either clean sources of electricity, or through acceptable bio-fuels. These same two energy sources are also required for road based vehicular transport. We must however get much smarter in our use of technology if we are to make rail transport again acceptable as a common form of mass human transport. Currently rail journeys are more often than not an exercise in frustration, uncoordinated as they are with bus services, and with the thicket of overlapping rail service providers that has resulted from privatisation of the rail network in many countries. Successfully getting from A to B via rail services is an unnecessarily complex wrestle with numerous timetables, ticketing systems, and interchanges - none of which have seen much effort to simplify. It needn’t be so. If we made the same effort toward taking the friction out of rail transport as we have to making car travel easier and more enjoyable we would go a long way toward making mass rail services far more attractive as a form of human transport. Coordinated web based services for timetables and ticketing is a start. Telecommunications based services to enable information to be readily available to travellers is also required - why can we buy a GPS mapper for a vehicle for $100 but can’t be similarly helped to navigate from one train to another or from train to bus to address. Location based services must be extended to encourage commuters out of their vehicles and onto public transport. Meanwhile, we must also look to move much of the bulk transport of goods off the roads and back onto the rails. The decline of the use of rail as a viable bulk material transport method is illogical, should be reversed, and will certainly become more attractive as road carriage costs are internalised into the economic model.

Road travel in its current form will only continue if fuelled by either acceptable bio-fuels or clean electricity. It is likely however, and perhaps desirable in the greater scheme of things if we also achieve a drastic reduction in the overall use of cars as a form of transport. It is important to recognise that we have managed to engineer into society an unnecessary reliance on vehicular travel. Urban design must be rebalanced such that the use of a car is not required for much of everyday living. It is illogical that we have decimated the economy of the local shops through the adoption of huge shopping centres for which we have no alternative but to drive to in order to use. There is much talk today by the USA’s Obama administration regarding the links between Wall Street and Main Street. The reality is that the death of Main Street (or the High Street if you’re in the UK) has more to do with this engineering out of local economic resilience as it has to do with the failures and corruption of the banking and finance markets.

Removing cars from the road will however also require us to provide technology-based alternatives to many activities. For a start, telecommuting must be made more common and far easier. This will require many changes and the provision of enabling services, not least of which will be the provision of secure broadband services to everyone. In fact, high speed communication links are perhaps the most important enabler of change if we are to at all engineer our way out of both the problems of climate change and those presented by peak oil.

And what of “clean electricity” supplies? Aside from altering the fuel stocks used for generation, away from coal and natural gas and toward renewables, the most important change we must make will be a fundamental change in the energy generation and distribution model. In order to engineer the required resilience into a smart grid system we must move from the highly centralised and concentrated generation model that we have today, and move to a highly fragmented and widely distributed micro-generation model. Such a network will have a dynamic and rich mix of renewable generation sources as well as tapping into the stored energy sources that are parked (electric) vehicles and the like. Successfully achieving a resilient and balanced power supply that supports both baseload as well as peak demands will require co-ordination of the supply and demand “nodes” as well as the grid that connects them. This co-ordination is what is meant by the term “smart grid”. Telecommunications infrastructure is again the enabler, providing the means to monitor and manage the various consumptive or contributory nodes.

That just leaves us with the little problem of air travel. Simply put, even if we develop an acceptable source of biofuels the days of mass air travel are rapidly drawing to a close. All the highly publicised experiments by various airlines in the use of biofuels are nothing more than a distraction and a con. Airline travel will be severely curtailed. Humanity may eventually get used to that - keeping in mind the fact that for all the protestations to the contrary by holiday makers and airline executives the reality is that international and domestic long distance travel is something that we have only recently managed to fall so deeply in love with. Those same airline executives as well as the forty-something holidaymaker would do well to be reminded that as recently as their own childhood humanity managed to do quite OK without racking up half a million air-miles each per annum. Again however we must face the reality of the short term, and again telecommunications must step up to meet the demands now built into our personal and business structures of behaviour. Telepresence enabled communications provides a useful alternative for the business executive, and with the right investment may even provide some acceptable alternatives to flying around the world in order to have Christmas dinner with that distant relative whom you didn’t really like all that much anyway.

Telecommunications therefore is perhaps a great saviour in many ways as we re-engineer our current personal, working and industrial models. However there is also one more role it needs to play - that of helping us to accurately account for the embodied ecological footprint of the goods and services we consume. As the embodied footprint of a product is linked to the distance that we transport it and the mode by which we transport it, location based services will increasingly be relied upon in order to accurately account for that travel. We must become far more aware than we are today of the complex shifting back and forth of products that takes place before they reach their final consumption point.

All that remains is for us to find the will to move forward. A reasonable question might also be to ask whether our various telecommunications providers have the vision and the strategy to play a role in delivering the infrastructure and services we will need from them. Lets continue to shout the demand down the phone line to them, and hope for more than confused static in return.