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Showing posts with label RFID. Show all posts
Showing posts with label RFID. Show all posts

Friday, August 10, 2018

Korean medical TV dramas III

Life

Korean TV darma - Life

There are now many Korean dramas on Netflix. Dramafever or Viki carries many and we have found they often appear there first then end up on Netflix if they are popular. Just because they are on Netflix doesn't necessarily mean they are great or anything but indeed some are very good. The most recent medical drama is called Life.  This follows several very good Netflix posted Korean dramas that were non-medical, but are equally as enthralling. I am thinking of  Mr. Sunshine, Live, Prison Playbook, and Hyeori's Bread and Breakfast.

TV dramas about hospitals probably started out as soap operas. As a kid the soap opera General Hospital appalled us for it's lack of general intelligence and fake acting. Korean epic medical dramas, to my mind starting with Hur Jun in 1999 are extremely interesting to watch - and now that I think about it - better than reading novels. Or, maybe that is an excuse for how much time I have sunk into watching Korean dramas. In fact, I mostly read these dramas anyway because without the sub-titles I am lost. I do hear and know a lot of Korean spoken language and I understand a lot about Korean culture, but it is not a language I am fluent in. For example, sometimes, I can watch a French movie and for the most part can understand what is going on, even without sub-titles. With just French sub-titles I would have an even better understanding.

Life has a well recognizable cast of excellent actors, as they - "star studded cast". I would say it is a powerful cast which would most surely ensure the success of the drama. In fact, the Wikipedia article on Life says for a cable TV drama, the ratings are very high. Anything over 10% is high, and that is very high for cable TV. The most prominent actor is the lead, Lee, Dong Work, who we saw not too long ago in Doekebi ( 도깨비 or English translation - Guardian: The Lonely and Great God ).  He is as good looking as a model, and as the secretary to the Hospital CEO, who has a crush on him in the drama says; "Looks like a Greek God", which in a sly way is referring back to his role as "The Grim Reaper" in Doekebi (도깨비).  Followers of Korean dramas often see these kinds of comical references of actors back to previous roles in famous dramas. One scene we saw recently watching Yi San again were two palace maid friends who said "I think we have met before in a past life somewhere". "Yes, I get that feeling too", which is an obvious reference for the audience who knew those two as not so friendly adversaries in the superb medical drama Dae Jang Geum. Speaking of 'having crushes", any Korean drama would not be worth it's salt without a romance plot or twist and turn, and now into episode number 5, something appears to be developing. Though I also heard that many people were enjoying this medical drama because it lacked a romantic focus.

There is an eHealth reference in Life which startled me for several reasons. The CEO needs to find a way to generate revenue in the hospital, which is a non-profit teaching hospital so that is kind of hard to do. He decides to create a subsidiary non-profit pharmacy that would sell nutritional supplements and all his physicians under this command would be asked to help sell and promote them - a kind sole sourcing monopoly. He finds a supplement company willing to sign on as partners but only in exchange for them funding a technology that the hospital needs.  We later see a scene where the nurses start using RFID bar code readers to interrogate signals and bar codes on patient wrists, medical bottles, inventories, and charts. It is the perfect way to reduce medical error. In early scenes there was a lot of drama over physicians in cancer wards covering up for medication errors that killed a patient. The CEO asked for a solution for reducing the errors but the physicians did not think of the RFID solution. It was the brilliant young CEO who was parachuted in from a subsidiary company that efficiently ran warehouse and product shipping to discover the idea of using RFID and getting his new pharmacy partner to foot the bill. All seems really good with RFID technology until the staff learn that in exchange for the benefit of the technology they now have to be salespeople for the nutritional supplements like whale oil, shark oil, etc, substances most scientifically trained specialists don't give the light of day to. From my own studies of RFID technology, the CEO is right. They do reduce medical errors and improve efficiency.  The technology, as I understand it, is also a bit expensive to implement, and maintain securely. The other thing that startled me is that RFID technology like this is at least a decade old, but really looks new and revolutionary in this drama.

There is another eHealth component in episode 7 or 8 where the CEO of the University Hospital meets a high powered CEO of an electronics company and they talk about starting a health app. They joke that the more people follow their blood pressure on the app, the more worried they will be about their health conditions and thus more prone to book appointments at the hospital and thus more money in the coffers. Thus are the benefits of private healthcare.

The main plot of this drama is how business intelligence pits its wits against medical staff in a top level (big 5) university teaching hospital by applying an all business efficiency and revenue generating model to public healthcare. I don't know all the reality of healthcare in Korea but the trend appears to be towards more privatizations. This drama explores that idea in the extreme. It always makes me think of the journal article written by the McMaster University physician and one of the founders of evidence-based medicine, Dr. Gordon Guyatt, in which he wrote that for profit healthcare is hazardous to your health. That was not just his opinion, but the results of the meta-analysis and evidence-based literature research. In Life, the CEO is played by Cho Seung Woo, who was brilliant in the 2017 drama Stranger (which was written by the same writer as Life - Ms. Lee, Soo-Yeon). Indeed the context for the drama, though not based on reality but is fiction as stated in the intro - has a basis in reality - rural Korean public hospitals being shut down by greedy profit seeking interests.

The focus of interest in the drama is whether or not the CEO of the hospital, who is just following the orders of the Chairman of some huge conglomerate to generate revenue in the hospital after it was bought out ( and don't ask me how a non-profit university teaching hospital can be bought out), is the most unethical, cold hearted greedy capitalist to ever walk the face of the earth, or whether he has inside a human heart capable of compassion and actually being able to listen to the over worked, over stressed and over resourced medical staff, who are just about to go out on strike as a protest to the CEO decision to cut and move out  to the rural areas outside Seoul 3 departments that are losing money. As an audience we start out believing he is a "malicious jerk" to quote the sub-title translation (and I think I even know how that is said in Korean) but through the sympathetic understanding of some of the medical staff and our own inner doubts, we start to believe that the CEO is a human being, who will eventually "pivot" and be able to harmonize solutions for all concerned.

What you have to do with this drama is hinge your mind on every spoken word (or sub-title) because the nuance and intrigue comes fast. You also have to pay attention and learn a lot about business, life insurance, and medical diagnosis, all at the same time. That the drama is packed with dense intelligence is all that I can say, which is why it reminds me more of reading a novel than watching a drama. It is not a "vacuum land" where you can passively watch in an empty state on the hope of being entertained. You actually believe that you can learn about how business and healthcare can operate together. These are also universal and extremely important ideas for society, such as should MDs also have MBAs, or is that some kind of oxymoron?

There have been some other medical dramas that have appeared on Dramafever and Viki but I don't think I will go into them in this Korean Medical TV Drama III post. You can discover those on your own. They are not entirely without merit. This drama called Life, however, I think will be well worth your time watching, and we eagerly look forward to see how this one will evolve past Episode 5.

Tuesday, February 25, 2014

The "sousveillance" world of Steve Mann

When I studied the use of RFID in healthcare I was amazed at the possibilities for this technology and it's essential humanness. An RFID barcode is much safer for an infirm patient because the identification or drug dosage on the RFID signal can be picked up without having to move the patient. A barcode, on the other hand, might be on a wrist under a sleeping patient, so they would have to be turned over in order to scan the bar code in line of sight. RFID technology was also great for keeping track of physical assets like infusion pumps, and inventory replenishment systems. On the other hand, keeping track of people presented some ethical and privacy concerns because people would be under the impression that they would be constantly under surveillance. When the word "surveillance" is used, Big Brother rears its ugly head.

Surveillance needn't be a fearful word even though it has a strong presence in security organizations and anti-terrorism. There are forms of surveillance in public health that can be beneficial for the health and welfare of society, such as syndromic surveillance, even though that too may have had some origins in state security, i.e. finding out where that anthrax threat was.

One thing I like about the wearable computer work of Steve Mann is his bold claim that the eye-tap or video glasses he created and wears present to society a form of what he calls "sousveillance", which is a much more nuanced, benign or human form of it's evil cousin - mentioned above. Sousveillance is an understated way of trying to balance the power of who is watching who. For some totally unknown reason it reminds me of the anti-sus dub poetry of Linton Kwesi Johnson. The anti-sus laws, or suspected person vagrancy laws in 19th century Britain might have nothing to do with sousveillance, but I am sure Steve Mann has had that feeling of being considered a suspicious and unwelcome person. Racial profiling for cyborgs? His McVeillance experience is indicative of that.

Now try to imagine a year in the future when everyone is wearing eye-tap video devices of that type Steve Mann and then Google developed. Maybe this is in 2020,( appropriate for seeing perfectly), and maybe it is not, but won't this mean that everyone we see on the street, and their dog, will be the equivalent of a Google Street View with a 24/7 refresh rate? And then ask yourself what does this do for for privacy laws, and you will have to wonder why the privacy commissioner of Canada wrote a letter to the lawyers at Google in 2007 to say that Google Street View would break all of Canada's privacy laws if it was implemented! It is interesting to try and imagine this future and one science fiction book I read by Charles Stross, called Halting State did exactly that. It was a murder mystery inside a video game but the real life police all had video recording visors they were obligated and/or controlled to wear on the job, recording all the visual details of their day to day investigations. Surveillance technology may not have been extended to all citizenry, but now the details are slipping away on me - read it a few years ago.

Notions of privacy will be changing beyond a doubt. Even now in different cultures there are different notions of privacy and proxemics. I think it was Iceland that lists your tax return information in the phone book or something like that. Imagine if we all started using Augmented Reality eye-tap devices, like the ones on the veillance.org website which are tied into redundantly backed-up servers. Imagine people walking through hospitals with such wearable devices scanning people sitting in the STD clinic waiting rooms. Personal space is being violated in terms of personal health information (PHI). The technology is wonderful though. As Personal Health Records are being developed (even with HL7 standards) a problem area is how to capture and store personal information submitted by the patient, not the physician, and how to make that information intelligible. Streams of data from daily blood tests, BP, and now possibly wearable computer video images, needs to managed and made relevant somehow. On the other hand, IT and policy specialists in healthcare have mostly normalized the Bring Your Own Device (BYOD) phenomenon.

Another notion of privacy that might need to change is the idea that PHI is always private. Some people are already posting their PHI on facebook and they don't care if it is public. In rare cases we have even heard that this has saved lives. I have personally heard research participants with rare and chronic health conditions who are posting their personal health records as widely on the internet as possible in order to obtain possible help or insight for future research. It is technologically possible I suppose to put PHI and other forms of identification into Augmented Reality "fields of vision" for other persons with wearable devices to readily pick up. The only thing stopping people from doing that is the notions of privacy and their willingness to consent to have that out there in the public domain.

I like Steve's distinction (on wikipedia - or brilliant IEEE article ) between surveillance and sousveillance:

Personal sousveillance is the art, science, and technology of personal experience capture, processing, storage, retrieval, and transmission, such as lifelong audiovisual recording by way of cybernetic prosthetics, such as seeing-aids, visual memory aids, and the like. Even today's personal sousveillance technologies like camera phones and weblogs tend to build a sense of community, in contrast to surveillance that some have said is corrosive to community.[29]
The legal, ethical, and policy issues surrounding personal sousveillance are largely yet to be explored, but there are close parallels to the social and legal norms surrounding recording of telephone conversations. When one or more parties to the conversation record it, we call that sousveillance, whereas when the conversation is recorded by a person who is not a party to the conversation (such as a prison guard violating a client-lawyer relationship), we call the recording "surveillance".

It is within this realm of "personal sousveillance" that the work of Steve Mann as applied to health informatics, is really to going to shine. Steve  was one of the original group who helped secure funding for the Centre for Global eHealth Innovation at the University of Toronto, which is a world leading health informatics incubator. Steve has also done some research using sousveillance on hand hygiene to reduce hospital infections. There are other more bold applications, of course, like using google glass in surgeries or dentistries for training and/or assisted learning.

In my own small way I am also trying to think through the "legal, ethical and policy issues", as Steve says, here on this blog. Those at the Institute for Ethics of Emerging Technology are also doing that "in spades", and there is a recent article about Steve Mann and sousveillance on it (here). Steve has recently argued for "legal" rights for sousveillance in an editorial for MIT technology review. Veilliance has become a study in itself, in all it's various forms, as Steve leads a Veillance conference and research group, which it would appear I made a blog post about last year< here >.

I could also blend in here a discussion related to the ethics of self-experimentation (and hat tip again to the folks on the CAREB Linkedin group for that article). Mostly we have known about clinical self-experimentation, and in social sciences/humanities there are '"autoethnographies", but now with the development of new technologies people are trying their own DYI experiments.  I saw an TVO Agenda program (Mysteries of the Mind - Tomorrow's Brain ) that discussed the health benefits for improving cognitive function and mental health using Transcranial Magnetic Stimulation (TMS)  where the panel experts played a youtube video they had discovered and discussed the guy in it who hooked his brain up to his own home-made TMS device. In the video we see the guy, when he turns on the electricity, explaining: "Just saw a white flash". So don't do this at home kids!

Steve Mann is not a guinea pig. He isn't a research subject. He is the subject of his own research. Developing and wearing computers is something he has done since he was a kid, so he is just using evolutionary momentum for whatever agile developments that improve his cybernetic state of well being. An oversight committee at his place of employment might recommend a technology ethics review, but we have to think that Steve is largely "self-employed" with this system, "dug in like a tick", and there ain't no separating him from this life experiment with digitally enhanced awareness. Anyway, Steve would fight back against anything "oversight". The dangers of any research involving humans is that researchers to a certain extent "have blinders on" and are biased towards their own methodologies and perceptions of risk, and thus lose objectivity.

I don't know who said "the pull of the future is greater than the push from the past", but I do remember the person who I heard it from. Whoever it was must have imagined some strange and distant world waiting to be born. That is the sousveillance world of Steve Mann.






Monday, January 28, 2013

Epidermal Electronic Systems

rfid microchip rice grain

I heard about this identification system on the Institute for Ethics and Emerging Technology mailing list. Instead of being subcutaneous like RFID implants, this electronic identification source is skin-like, kind of like the newer water proof bandaids that are transparent and really stick. The author of the article relates this to the potential for healthcare, but not without some caveats:
"There are some emergent ethical issues stemming from these technologies. I can already guess the EES system being potentially used to tag artificial organs and corporate patients in hospitals. Even now few of us would refuse if a hospital insisted on using an epidermal electronic tatoo patch on us for their patient inventory system. Informed consent has just taken on a whole new different set of meaning. However, the advantages far outweigh the fears of social discrimination and eugenic nightmares. Systems such as Epidermal Electronic devices could eventually help in timely drug delivery especially during medical emergencies. "
Yes, it does look like more patients might be happier to consent to wearing a device like this, as opposed to the more invasive RFID chip implant. Who could refuse?

Friday, January 25, 2013

Gesture interfaces in the surgery


I guess I am still fascinated with new technologies in the surgery. This is not an ehealth activity per se - more along the lines of health technology assessment - but I think it began when we were studying an RFID surgery supply inventory replenishment system.  Using Walmart style supply-chain management to handle healthcare inventory (let alone whereabouts of patients) seemed like an interesting idea - and indeed it is.  As for hand gestures to control MRI images, it would appear that gesture interfaces for computer technology is a big attraction at the Las Vegas computer show, where on also on display are eye tracking technology interfaces as well - Could eye-tracking replace your computer mouse.

I wonder where using gestures to control virtual environments really comes from? I am thinking about art installations where gestures and musical forms interact - things of that nature, or theatre.

Sunday, September 30, 2012

The Rapid Approach of the Health Internet of Things

I subscribe to LaBlogga's "Broader Perspectives" blog and this is one of the first posts that directly talks about "ehealth".  Broader Perspectives is interesting to read because most of the time it is kind of a post-modernist advance search party looking for the intersection between technology and society. I also wonder about the subject of the post, referring to "Internet of Things".  Now, if I am not mistaken,  the "Internet of Things" was coined by a guy who ran an IBM sponsored lab at MIT, who envisioned a world networked together through RFID tags - literally every manufactured thing could have an RFID tag and thus be on the internet.  I know RFID is being used in Healthcare, but I am not sure if it will ever be ubiquitous.

Sunday, August 05, 2012

The Rapid Approach of the Health Internet of Things

The efforts of the eHealth movement have been quietly gathering steam for the last five years and are finally fulminating into what could be a significant transformation in the management of health and health care. The most encouraging sign of change is that it consists of not just the usual shiny new technology solutions, but more importantly, structural changes in the public health system:

The 80% slim-down of the doctor’s office visit…


  • Majority of diagnosis is straightforward: It is estimated that in 18/20 cases (per Singularity University FutureMed), diagnosis is straightforward, and could be accomplished via telemedicine.
  • Trend to higher deductible plans: many programs are underway to transfer employees to higher-deductible plans which both reduces costs and puts more of an emphasis on preventive medicine.
Significant progress could be made with these structural changes acting in concert with the new generation of healthtech tools in areas such as:
  • Quantified self-tracking devices, examples: Fitbit, Zeo sleep tracking, Body Media, Pebble Watch, Nike Fuel Band, Basis Watch
  • mHealth (mobile health) apps, examples: The Eatery, MoodPanda, Map My Run, Cardio Trainer