Twitter is raising the drawbridge and becoming an island. Bad move.

Recently Twitter disconnected Instagram so that users are no longer able to discover their friends on Twitter. Yesterday Tumblr became the next victim as Twitter works down the chain of developers that have connected to it. LinkedIn has already become a victim and the betting is that Flipboard will be next.

This is coupled with recent changes in the developer rules that insist on Twitter content being displayed "as is." See this article from TechCrunch: Twitter Handcuffs Client Apps with New API Changes - by Anthony Ha

I am wondering how long it will be before Wordpress plug-ins that display a twitter stream in the context of a web page are forbidden by Twitter. Those plug-ins would seem to be out of compliance because Wordpress blog pages have comments. As I understand it that is a no-no.

If Twitter follows a strategy to drive consumption of Twitter content on twitter.com then they will devalue the Twitter ecosystem and drive many people away to other services. One of the huge values of Twitter is that we can pull content that is relevant and mash it up with other content. 

Twitter is like electricity. The value isn't in the power station at the center of the grid. The value is in the electricity that flows to millions of devices where it enables all manner of things to happen. 

Posted via email from ekivemark: pre-blogspot

Digital imaging breakthrough for Cholesterol testing #HIT #MHealth

This is really cool news:

http://in.news.yahoo.com/indian-scientists-develop-photographic-test-cholesterol-determination-083100895.html

Indian scientists have been able to use digital images of the back of people's hands to match to cholesterol levels. This is a non-invasive procedure that opens up the possibility of Cholesterol level self testing without the need for a specialized testing kits.

Posted via email from ekivemark: pre-blogspot

Containing costs for Medicare via Competitive Bidding - a pipe dream? a couple of must read articles via @thcbstaff

The Health Care Blog and Mother Jones have two "must read" posts on containing Medicare costs.

The proposal to use Competitive Bidding - will it work. This is what private companies have resorted to for the last 15 years and been rewarded with costs that have risen even faster than Medicare.

Check out these articles:

Paul Ryan and the Problem With Competitive Bidding

Here’s a Question to Ask Romney or Ryan by Aaron Carroll, MD

Posted via email from ekivemark: pre-blogspot

Affordable Care Act, Unleashing the Innovator and Entrepreneur

This is a post I have been thinking about writing for a long while. It is also a very hard post to write because this has been a very personal journey.

Back in the early days of HealthCa.mp, in 2008-09, there was a lot of speculation about whether the Affordable Care Act would be passed in to law. In 2012 the focus has been on the build up to the Supreme Court decision regarding the ACA. During those periods of uncertainty I often reflected on the need for HealthCa.mp if HealthCare was going to be "fixed." All I needed to do though was to listen to the participants who took part in each HealthCa.mp we held. The vibrant discussions, the diversity of views, the range of problems people faced, both in the medical and the patient community. It was abundantly clear that the status quo was not good enough with well over 15% of the US Population going without any health care coverage and for those with health care coverage the costs were rising at a dramatic pace with no sign of easing. 

The concept of people being able to keep the health coverage they were happy with is a quaint idea that has no real basis in reality. In a health care insurance world dominated by employer plans keeping your insurance depends upon keeping your job. In this day and age that is at best a crap shoot for many.  For those with secure jobs the idea of keeping the insurance you are happy with is still a mis-nomer when many employers shop around for the cheapest quote every couple of years and in order to contain costs they adjust the content of the health plan. In this day and age the only real solution is for individuals and families to purchase their own insurance. 

Eighteen months ago I left the safe and certain world of an employer provided health plan. For a period I was able to continue my existing health plan but when that ran out a switch to COBRA was out of the question. Without the employer subsidy a 10-fold increase in cost to maintain the same plan, with no stable income was simply un-realistic. So, probably like many others who lost their jobs in the recession, I found myself flying without a health care parachute. it is a frightening prospect I can tell you. You see, one of my jobs is as a part-time ski-instructor. It doesn't pay much but the rewards of teaching a new generation of skiers is immeasurable. Fortunately, while working as an instructor I was covered by Workman's Compensation if an accident was to happen. But practicing my skills on my own time was out of the question. It was too dangerous. One collision with an out of control skier or snow boarder and you could be facing a trip off the mountain to the emergency room where costs sky-rocket quickly.

Annual Preventative Physical Exams to get an early detection of problems - forget it. 

During this 18 months I have continued to take part in efforts to drive change in Health Care. Putting on HealthCamps, taking part in conferences and doing development work here and there. It has been an incredibly rewarding journey. But it got me thinking.

Innovation and Entrepreneurship is one aspect of the Affordable Care Act that has been given very little attention and it deserves some promotion. 

The ACA and the work of the dedicated teams at HHS, CMS and ONC are making big behind the scenes changes in Health Care. New payment methods are emerging that have enormous potential to change quality of outcomes in Health Care and bring costs under control.

The liberation of health data is improving transparency. This is an essential part of creating a more even playing field in the market place.

The establishment of Health Insurance Exchanges will also enable individuals and small companies to find affordable health plans. Plans that include preventative care.

I believe that the employer-based health plan model is a drag on the economic growth. Why do I say this?

The USA is an innovator economy. One built on entrepreneurship. However, as the cost of health care continues to spiral upwards the employer-based health plan acts as a discouragement to innovators and entrepreneurs to step out on their own and build their own companies for fear of losing health coverage for their families. 

I believe that in the next few years we will see more individuals taking control of their health insurance coverage. They, and not their employers, will control the relationship with both their insurer and their care team. Employers may still contribute to the care of their employees, but it is increasingly likely to be via Health Savings Accounts rather than by directly negotiating insurance deals. We will see this initially in the small business space but it may well spread in to the mid-size employer market and Employer-lnas may become the domain of only the largest employers.

One of the effects of this evolution may be to unleash a new wave of entrepreneurs to try their hand at building their own companies. Not only will they find providing health care for their employees to be a simpler process but they won't feel shackled to an employer-controlled health plan.

So this past 18 months has been a fascinating journey. HealthCa.mp is still relevant because there is so much to do in order to improve health care but we are only in the first early phases of a transformation.

It is an essential transformation. Health Care costs can't continue to grow as a percentage of the overall economy. It kills our competitiveness. Ultimately each of us has to become active in managing our health and vitality. Taking personal responsibility for our health and our health insurance will ultimately allow us to once again grow the economy, by eliminating one very significant barrier to entrepreneurship. 

I would love to get other's views on this topic. Why not join me at a HealthCa.mp.

Posted via email from ekivemark: pre-blogspot

HealthCamp Autumn Season approaching fast with #HCBOS #HCKC #HCSFBay check out http://healthca.mp/calendar

We are less than four weeks away from a busy HealthCamp Autumn season. We have 3 events coming  up:

• HealthCa.mp/Boston on Friday September 14th at the Microsoft NERD Campus in Cambridge, MA
• HealthCa.mp/KansasCity on Sunday September 23rd as part of the Partnership With Patients Summit in Kansas City, MO
• HealthCa.mp/SFBay on Friday October 5th as Part of San Francisco Health Innovation Week at the Kaiser Permanente Innovation Center in San Leandro, CA.

There are still sponsorship opportunities available at each of these events. Participant tickets are also available. So hurry and sign up for the most exciting Health Care Un-Conference series.

It is exciting to be hitting the East Coast, Mid-West and West Coast in quick succession. HealthCamp provides an opportunity for Patients, Patient Advocates, Health Care Professionals and any passionate about transforming our Health Care system to come together to share ideas and create a community of like-minded do-ers.

I hope you will join us. Don't delay - sign up today!

Posted via email from ekivemark: pre-blogspot

If you can understand the instruction at the top of the page do you need that interpreter?

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

Posted via email from ekivemark: pre-blogspot

Projects in the Cloud in a cloudless auditorium of a communications company.

I am in the Annapolis Junction area of Maryland, near the NSA, and in a classic situation that is reminiscent of attending many health care conferences. I am in the auditorium of a communications company. There is no Wi-Fi available and cell and 4G coverage inside the building is bad.  

This is a lunch meeting of the Baltimore Chapter of the Project Management Institute: PMIBaltimore.org.

The topic is Project Management on Cloud-based projects. It will be interesting to see how projects are seen to differ when dealing with the cloud. My guess is that the major change aspect is probably the reduction in the amount of physical equipment needing to be provisioned and an increase in vendor management since services are more likely to be virtual.

There is a lot happening in the cloud arena. everything is getting virtualized. 

"Cloud Computing - What a Project Manager Needs to Know" - Dr. Patrick Allen - Johns Hopkins University

Cloud - A different mental paradigm.

Two types of Cloud: 

and we don't mean:

- Public 

- Private

1. Computing as a service (Utility Cloud and Virtual Machines - VMs)

Infrastructure as a Service (IaaS)

Platforms as a Service (PaaS)

Software as a Service (SaaS)

2. Data-focused cloud (runs on Virtual Machines)

Data Storage Cloud - eg. Hadoop cloud (Amazon S3)

Be clear about what type of cloud you are talking about. Essential to avoid conclusion.

Amazon is the best example of a Compute Service. AWS - EC2. Rackspace OpenStack.

Pay for use. but you can pre-pay for a better price.

Compute clouds are great for surge-type activities. spin up machines to compute then power down.

Side Channel attacks - When the hardware in the cloud is infected and can break in to the VM running on the infected machine.

For a side-channel attack the perpetrator has to break out of the VM and infect the base hardware. 

Amazon claim to have solved the side channel attack problem.

Questions to ask:

1. Cost of data stored

2. Cost for VMs used

3. How secure or private is the data

4. Security and privacy guarantees

5. Will PII (personally identifiable information) be protected

6. Can you use cloud for Continuity of Operations Plans

7. Can you store classified data in the cloud (maybe if properly secured, government accredited and private)

8. Are you planning to use a third party service. (you can build your own cloud)

9. Where is your computing (is it US Only - export controls)

10. Get a cyber-security risk assessment. 

Also (not mentioned) - Cost for bandwidth used and data transfers. Also ask about what counts as a Data Transfer. For example AWS won't charge for some data moved around within a region but will charge for transfers in and out of a region.

Data-focused Clouds:

Huge data - Petabytes or larger.

HDFS - Hadoop File System. Not-relational

Relational Databases: Think rows and columns

Accumulo and HBase present structured relational databases delivered via HDFS.

Hadoop is more popular than sector file management system.

Enables automatic parallelization of queries. 

Handles storing, location, replication and processing of your data.

Enables easier identification of patterns across the data. Using Map-Reduce.

Map-Reduce - Good for:

Huge data sets

Disparate datasources

unsure about what data queries will be done.

Summarizing independent processes.

Map-Reduce not good for:

- Relational databases are adequate for the task

- Well defined queries.

What drives you to use the cloud capabilities:

- Unstructured data in large quantities

- Surge events are common

Learn what is possible with Map-Reduce and the cloud capabilities.

Why build your own cloud?

- Security, privacy or proprietary needs not met by existing cloud services.

- Ongoing maintenance costs.

Interesting suggestion (not verbalized) that you want a message queue to handle, arbitrate and allocate processing requests.

Message queuing can be used to scale resources up and down.

General Cloud Questions:

- Will you know where your cloud is physically located.

- Amazon AWS uses regions but are not more specific.

- Who gets access (US or Foreign Nationals)

- How is data ingested?

- How is data stored?

- How is data secured at rest?

- How is data deleted?

- Can you test your data has been deleted or hidden?

- Can you keep your data separated from others?

- Frequency of Hardware upgrades

- Proven VMs?

- Who has done a risk assessment?

Observations:

- Cloud is here to stay

- More projects will involve the cloud

- Need to understand strengths and weaknesses of the cloud

- Learn about cloud capabilities

FedRAMP is a new standardized approach to security assessment, authorization and security monitoring for cloud-prodcuts and services.

Good for low risk government projects. Not for High security applications.

Map-Reduce programs are more complicated if the data is not clean. 

Look at cleaning data on load to simplify queries.

Licensing in the Cloud. Manufacturers (software) have not really setup licenses for cloud services.

Best advice is to consider Open Source  and pay for support.

Security Issues - VMs may be more secure than Shared Hosting. In Shared Hosting the Feds can confiscate a server in a hosting facility. If the server is a shared host then other customers can be impacted.

Service Level Guarantees - What is reasonable? It depends. Worth looking at Service Level Agreements.

Posted via email from ekivemark: pre-blogspot