Andy Grove and US Healthcare

The New York Times writes about Andy Grove’s efforts to fix what he sees as wrong in the US healthcare business:

The [JAMA] article, “Efficiency in the Health Care Industries,” was labeled commentary, but it was more akin to a jeremiad. Mr. Grove took dead aim at the lack of efficiency in health care – the amount of time it takes a research lab to turn an idea into a working drug, for instance; and the extent to which medicine lags behind other industries in using technology to store and retrieve data, to the detriment of doctors and patients. He compared it unfavorably to an industry he knows rather intimately, microchips, which has turned efficiency into an art, thanks in no small part to Mr. Grove.

He talked about his quest to find what he called “the Rosetta code” for the health care industry. By that he means the development of software “that takes incompatible systems and translates them into each other, so that one system can automatically read the other.” He thinks there are few things more important for patients than to have any doctor, anywhere, be able to access their medical records, but because the industry is so fragmented, with so many records still in paper form, that is currently impossible.

Integrated Rail Transportation System

Atanu Dey writes:

The crux of my argument is that information and communications technology (ICT) plays a supportive role in an economy. Not unlike in a body, where the nervous system though critical is worthless unless the musculo-skeletal is robust, the digital network is worthless unless there is an underlying non-digital economy of stuff such as manufacturing, agriculture, and services. You need to have factories and farms, roads and railways, schools and shops, houses and hospitals not just broadband digital 3.5G MP3 camera phones for surfing the web.

What India needs to pay attention to is the underlying hard economy which is the infrastructure upon which the soft economy of internet and services can ride. In this one, I will briefly focus on one bit of the hard economy: the railroad transportation system.

Steel wheel over steel rails is the most efficient method of transporting goods and people, especially when both volumes and distances are large. It is super efficient and clean because of a number of reasons. First, because steel wheels over steel rails have very low friction and with aerodynamically designed trains, you can have the least cost per ton per mile. Next, you dont have to use fossil fuels. You can generate electricity using whatever technology and power the trains. Third, you can use the same system the tracks and the signaling and switching system for both passengers as well as goods.

The core of the IRTS is a very fast rail network connecting the major population centers. The backbone of the system is high speed trains that move between metros such as Mumbai and Kolkata (via Nagpur), between Delhi and Bangalore/Chennai (again via Nagpur.) These I call the Cross Links which are different from the Diagonal Links which go between Mumbai and Delhi (via Ahmedabad), Delhi and Kolkata (via Kanpur), Kolkata and Bangalore/Chennai (via Hyderabad), and Bangalore to Mumbai.

Also read a follow-up post by Atanu.

India-China Media Markets

Rafat Ali points to an IHT story and writes:

The story compares the Chinese online/digital media market with the Indian market, and based on raw numbers, China’s way ahead of the game, both in terms of the number of users and revenues. In China, with all its restrictions, total online revenue hit $1.1 billion last year. India, an English-speaking democracy that allows freer flow of information, had online revenue of just $93 million.

Venture-capital firms made $177 million in Internet-related investments in China in 2003 and 2004, four times more than the $44 million India attracted, according to Asian Venture Capital Journal, a Hong Kong-based trade publication.

China’s online revenue – which includes sales from advertising and from Internet gaming and wireless services – grew 35 percent last year to $1.1 billion and will rise 30 percent in 2005, according to MindShare

It is, simply (or not so simply put) an infrastrucutral issue, so in some ways not a fair comparison. Put it another way, you can have a controlled economy, and let the government pump it up, or you can let the entrepreneurs in the economy, with little help from the government, try and build it from ground up.

Personalised Search

Charlene Li offers suggestions to improve Google’s offering:

Improvement #1: Prioritize searching through feeds, bookmarks, and saved sites. As a user, Ive already indicated when certain pages and sites bear greater relevance to me their URLs and content are saved in my browser and RSS aggregator. Personalized search could leverage Google Desktop Search to provide better intelligence on whats relevant and whats not. I expect that Yahoo! is in a prime position to use this technique as it has millions of RSS users on MyYahoo! and also has been encouraging users to save sites to MyWeb.

Improvement #2: Add clickstream data to the personalization engine. Google should be tracking when a users clicks on a link to another site but then quickly comes back to click on another link. The inference: that page wasnt that relevant. One simple step would be to eliminate that link from subsequent queries with refined search criteria. More complex calculations would analyze the semantics of the referred page and eliminate similarly irrelevant pages from future searches. Google should take some notes from Choicestream, which provides personalization services for publishers (it powers the movie and shopping personalization engines on Yahoo!) by leveraging user clickstream data and grouping content into categories.

Outlook for Blogs

Michael Parekh writes about a service he’d like:

There are seven key features that this “Outlook for Blogs” should have:

1. It should be web based, not client software based. This way it’s accessible via any PC, mobile device, phone, or other new internet-based gizmo that may come along down the pike.
2. The next key feature, especially if the service is offered by any of the four portal horsemen (YAGM, in no particular order)…MAKE SURE the service is NON-PARTISAN from a portal point of view. It needs to work and play nice with the major offerings from all the blogging services.
3. The user name to the “uber-blog” should be personalizable, accessible, from anywhere on the web and/or blog directories, if the user chooses. This is likely going to be their identity on the web, and a “personal-portal” for others to connect to them, again, if they so choose.
4. Enable monetization mechanisms a la Adsense and Adwords to be managed on any of the external blogs and the uber-blog, again at the user’s discretion.
5. Provide the ability for RSS-type feeds for any sub-blog or the uber-blog.
6. While we’re at it, this “Outlook for Blogs” service should also allow the user to deal with user’s Comments that the user posts on OTHER, external blogs. Specifically, the “comments” service should: (a) automatically keep track of the comments that the user posts on other blogs, along with the CONTEXT of the original post/s that the user is commenting on…and, (b) allow these comments and context posts to be either POSTED or DISPLAYED on the blog of the user’s choice via the “Outlook for Blogs” interface.
7. “Outlook for Blogs” should be search index crawlable…i.e., to facilitate, IF the user chooses, to have any and/or all of their choosing to be indexed on the various search engine index crawlers. This way, the content is accessible to the world, if so desired.

TECH TALK: Next-Generation Networks: Convergence Areas

This weeks Tech Talk is written by Ninad Mehta. Ninad works at Lucent in New Jersey, USA. Ninad and I used to work together at NYNEX Science & Technology during 1989-1991 and we were also room-mates. Ninad has extensive experience in telecom. So I invited him to elaborate on next-generation networks.

Last week, in the tech-talk series on Next Generation Networks, we covered the following topics: Convergence and what it means, the Rationale behind convergence, what is IP Multimedia Subsystem (IMS) and its role in convergence and what would a Converged NGN in the future look like.

Lets do a deeper dive on some of these topics. While we understand that Convergence can have different meaning to different people, in broad terms, convergence is happening in four major areas: Applications, Endpoints, Access Networks and Core Networks. Lets take these one at a time.

Applications convergence is easy to understand by an example such as Unified Mailbox where voice, e-mail, fax etc. all arrive in the same e-mail application inbox. Additionally, you would also want to share data that is common, across all these applications. Application convergence has been happening for many years now.

We have also seen Endpoints converge (mostly into cellphones) so that we can use one device to make phone calls, browse the Internet, send e-mails/SMSs and also perform functions traditionally available in PDAs (such as calendars, contact lists, reminders, to do lists, calculators, etc.). With larger and higher resolution displays becoming common on todays cellphones, portable gaming devices have also started converging into cellphones. We also hear about wireless and wireline convergence in the form of Wifi enabled cell phones that will use the home broadband connection for carrying voice when a wifi network is available. This will reduce the opex costs for the wireless service provider and benefit the consumer in the way of lower per minute charges.

Lets talk about the core network convergence from separate TDM, ATM and IP to a multiservice IP/MPLS network. The main drivers for the convergence in the core are: reduced operational costs, faster and cheaper delivery of new services, customer configurable virtual private networks, etc. British Telecom has launched a major initiative called 21CN for an All-IP network.

What is Access convergence? Here I am talking about the evolution in the access network technology that connects end user devices to the service providers. You might think that with all sorts of broadband options available in the last mile, the access network is NOT converging. This is partly true while the last mile part of the access network seems to diverge into different technology options, the migration of end-user services is clearly from carrying bearer traffic over {analog, cable, wireless, TDM, ATM, Frame Relay, SONET/SDH} to carrying bearer over IP. In other words, instead of having our analog phone carrying analog voice signals to the PSTN network, we are migrating to VoIP. Instead of carrying voice over a GSM/CDMA/TDMA interface, we will be migrating to VoIP over these air interfaces. Instead of analog video carried over cable/FTTx, we are migrating to various forms of Video over IP. This brings up a fundamental question- why bother to supplant all these well-entrenched technologies with IP? Arent the traditional technologies we have been using for decades more reliable and cheaper? Arent IP based devices more expensive and error prone as they have lot more software? The answer to these questions is beyond our discussion in this tech-talk series but the key takeaway is that with proper encapsulation, many services can be carried over IP. Also, beyond the technologies visible to end users, there is convergence happening in the access network to core network interfaces. So, traditional Remote Terminals with TDM and ATM interfaces are migrating to Ethernet interfaces. Moreover, the traditional wireline access network elements and the cellular network elements are also coming together with IP interfaces into the core network.

Tomorrow, we will talk about the next generation services enabled by the NGN and why service providers plan to spend billions in the coming years to build these NGNs.

Tomorrow: Services and Business Models

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