watson

Tech: The Missing Generation

Peter Cripps comment , , , , , , , , , , ,

I’ve recently been spending a fair bit of time in hospital. Not, thankfully, for myself but with my mother who fell and broke her arm a few weeks back which has resulted in lots of visits to our local Accident & Emergency (A&E)  department as well as a short stay in hospital whilst they pinned her arm back in place.

nhs hospital
An elderly gentleman walks past an NHS hospital sign in London. Photograph: Cate Gillon/Getty Images

Anyone who knows anything about the UK also knows how much we value our National Health Service (NHS). So much so that when it was our turn to run the Olympic Games back in 2012 Danny Boyle’s magnificent opening ceremony dedicated a whole segment to this wonderful institution featuring doctors, nurses and patients dancing around beds to music from Mike Oldfield’s Tubular Bells.

nhs london 2012 olympics
Olympic Opening Ceremony NHS Segment – Picture Courtesy the International Business Times

The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

These three principles have guided the development of the NHS over more than 60 years, remain at its core and are embodied in its constitution.

nhs constitution
NHS Constitution Logo

All of this, of course, costs:

  • NHS net expenditure (resource plus capital, minus depreciation) has increased from £64.173 billion in 2003/04 to £113.300bn in 2014/15. Planned expenditure for 2015/16 is £116.574bn.
  • Health expenditure (medical services, health research, central and other health services) per capita in England has risen from £1,841 in 2009/10 to £1,994 in 2013/14.
  • The NHS net deficit for the 2014/15 financial year was £471 million (£372m underspend by commissioners and a £843m deficit for trusts and foundation trusts).
  • Current expenditure per capita for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.

The NHS also happens to be the largest employer in the UK. In 2014 the NHS employed 150,273 doctors, 377,191 qualified nursing staff, 155,960 qualified scientific, therapeutic and technical staff and 37,078 managers.

So does it work?

From my recent experience I can honestly say yes. Whilst it may not be the most efficient service in the world the doctors and nurses managed to fix my mothers arm and hopefully set her on the road to recovery. There have been, and I’m sure there will be more, setbacks but given her age (she is 90) they have done an amazing job.

Whilst sitting in those A&E departments whiling away the hours (I did say they could be more efficient) I had plenty of time to observe and think. By its very nature the health service is hugely people intensive. Whilst there is an amazing array of machines beeping and chirping away most activities require people and people cost money.

The UK’s health service, like that of nearly all Western countries, is under a huge amount of pressure:

  • The UK population is projected to increase from an estimated 63.7 million in mid-2012 to 67.13 million by 2020 and 71.04 million by 2030.
  • The UK population is expected to continue ageing, with the average age rising from 39.7 in 2012 to 42.8 by 2037.
  • The number of people aged 65 and over is projected to increase from 10.84m in 2012 to 17.79m by 2037. The number of over-85s is estimated to more than double from 1.44 million in 2012 to 3.64 million by 2037.
  • The number of people of State Pension Age (SPA) in the UK exceeded the number of children for the first time in 2007 and by 2012 the disparity had reached 0.5 million (though this is projected to reverse by).
  • There are an estimated 3.2 million people with diabetes in the UK (2013). This is predicted to reach 4 million by 2025.
  • In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 26.0 per cent in 2013 (peak of 26.2 in 2010), and from 16.4 per cent to 23.8 per cent for women over the same timescale (peak of 26.1 in 2010).

The doctors and nurses that looked after my mum so well are going to be coming under a increasing pressures as this ageing and less healthy population begins to suck ever more resources out of an already stretched system. So why, given the passion everyone has about the NHS, isn’t there more of a focus on getting technology to ease the burden of these overworked healthcare providers?

Part of the problem of course is that historically the tech industry hasn’t exactly covered itself with glory when it comes to delivering technology to the healthcare sector (I’m thinking the NHS National Programme for IT and the US HealthCare.gov system as being two high profile examples). Whilst some of this may be due to the blunders of government much of it is down to a combination of factors caused by both the providers and consumers of healthcare IT mis-communication and not understanding the real requirements that such complex systems tend to have.

In her essay How to build the Next Unicorn in Healthcare the entrepreneur Yasi Baiani   sets out six tactical tips for how to build a unicorn* digital startup. In summary these are:

  1. Understand the current system.
  2. Know your customers.
  3. Have product hooks.
  4. Have a clear monetization strategy and understand your customers’ willingness-to-pay.
  5. Know the rules and regulations.
  6. Figure out what your unfair competitive advantage is.

Of course, these are strategies that actually apply to any industry when trying to bring about innovation and disruption – they are not unique to healthcare. I would say that when it comes to the healthcare industry the reason why there has been no Uber is because the tech industry is ignoring the generation that is in most need of benefiting from technology, namely the post 65 age group. This is the age group that struggle most with technology either because they are more likely to be digitally disadvantaged or because they simply find it too difficult to get to grips with it.

As the former Yahoo chief technology officer Ashfaq Munshi, who has become interested in ageing tech says:

“Venture capitalists are too busy investing in Uber and things that get virality. The reality is that selling to older people is harder, and if venture capitalists detect resistance, they don’t invest.”

Matters are not helped by the fact that most tech entrepreneurs are between the ages of 20 and 35 and have different interests in life than the problems faced by the aged. As this article by Kevin Maney in the Independent points out:

“Entrepreneurs are told that the best way to start a company is to solve a problem they understand. It makes sense that those problems range from how to get booze delivered 24/7 to how to build a cloud-based enterprise human resources system – the tangible problems in the life and work of a 25- or 30-year-old.”

If it really is the case that entrepreneurs only look at problems they understand or are on their immediate event horizon then clearly we need more entrepreneurs of my age group (let’s just say 45+). We are the people either with elderly parents, like my mum, who are facing the very real problems of old age and poor health and who themselves will very soon be facing the same issues.

A recent Institute of Business Value report from IBM makes the following observation:

“For healthcare in particular, the timing for a game changer couldn’t be better. The industry is coping with upheaval triggered by varied economic, societal and industry influences. Empowered consumers living in an increasingly digital world are demanding more from an industry that is facing growing regulation, soaring costs and a shortage of skilled resources.”

Rather than fearing the new generation of cognitive systems we need to be embracing them and ruthlessly exploiting them to provide solutions that will ease all of our journeys into an ever increasing old age.

At  SXSW, which is running this week in Austin, Texas IBM is providing an exclusive look at its cognitive technology called Watson and showcasing a number of inspiring as well as entertaining applications of this technology. In particular on Tuesday 15th March there is a session called Ageing Populations & The Internet of Caring Things  where you can take a look at accessible technology and how it will create a positive impact on an aging person’s quality of life.

Also at SXSW this year President Obama gave a keynote interview where he called for action in the tech world, especially for applications to improve government IT. The President urged the tech industry to solve some of the nation’s biggest problems by working in conjunction with the government. “It’s not enough to focus on the cool, next big thing,” Obama said, “It’s harnessing the cool, next big thing to help people in this country.”

obama-sxsw
President Barack Obama speaks during the 2016 SXSW Festival at Long Center in Austin, Texas, March 11, 2016. PHOTO: NEILSON BARNARD/GETTY IMAGES FOR SXSW

It is my hope that with the vision that people such as Obama have given the experience of getting old will be radically different 10 or 20 years from now and that cognitive and IoT technology will make all of out lives not only longer but more more pleasant.

* Unicorns are referred to companies whose valuation has exceeded $1 billion dollars.

Plus Two More

Peter Cripps architecture ,

In my previous post on five architectures that changed the world I left out a couple that didn’t fit my self-imposed criteria. Here, therefore, are two more, the first of which is a bit too techie to be a part of everyone’s lives but is nonetheless hugely important and the second of which has not changed the world yet but has pretty big potential to do so.

IBM System/360
Before the System/360 there was very little interchangeability between computers, even from the same manufacturers. Software had to be created for each type of computer making them very difficult to develop applications for as well as maintain. The System/360 practically invented the concept of architecture as applied to computers in that it had an architecture specification that did not make any assumptions on the implementation itself, but rather describes the interfaces and the expected behavior of an implementation. The System/360 was the first family of computers designed to cover the complete range of applications, from small to large, both commercial and scientific. The development of the System/360 cost $5 billion back in 1964, that’s $34 billion of today’s money and almost destroyed IBM.

Watson
Unless you are American you had probably never heard of the TV game show called Jeopardy! up until the start of 2011. Now we know that it is a show that “uses puns, subtlety and wordplay” that humans enjoy but which computers would get tied up in knots over. This, it turns out, was the challenge that David Ferrucci, the IBM scientist who led the four year quest to build Watson, had set himself to compete live against humans in the TV show.

IBM has “form” on building computers to play games! The previous one (Deep Blue) won a six-game match by two wins to one with three draws against world chess champion Garry Kasparov in 1997. Chess, it turns out, is a breeze to play compared to Jeopardy! Here’s why.
Chess…

  •  §Is a finite, mathematically well-defined search space.
  • •Has a large but limited number of moves and states.
  • •Makes everything explicit and has unambiguous mathematical rules which computers love.

Games like Jeopardy! play on the subtleties of the human language however which is…

  • Ambiguous, contextual and implicit.
  • •Grounded only in human cognition.
  • •Can have a seemingly infinite number of ways to express the same meaning.

According to IBM Watson is “built on IBM’s DeepQA technology for hypothesis generation, massive evidence gathering, analysis, and scoring.” Phew! The point of Watson however is not its ability to play a game show but in the potential to “weaves its fabric” into the messiness of our human lives where data is not kept in nice ordered relational databases but is unstructured and seemingly unrelated but nevertheless can sometimes have new and undiscovered meaning. One obvious application is in medical diagnosis but it could also be used in a vast array of other situations from help desks through to sorting out what benefits you are entitled to. So, not world changing yet but definitely watch this space.

The Innovation Conundrum and Why Architecture Matters

Peter Cripps architecture , ,

A number of items in the financial and business news last week set me thinking about why architecture matters to innovation. Both IBM and Apple announced their second quarter results. IBM’s revenue for Q2 2011 was $26.7B, up 12% on the same quarter last year and Apples revenue for the same quarter was  $24.67B, an incredible 83% jump on the same quarter last year. As I’m sure everyone now knows IBM is 100 years old this year whereas Apple is a mere 35 years old. It looks like both Apple and IBM will become $100B companies this year if all goes to plan (IBM having missed joining the $100B club by a mere $0.1B in 2010). Coincidentally a Forbes article also caught my eye. Forbes listed the top 100 innovative companies. Top of the list was salesforce.com, Apple were number 5 and IBM were, er, not in the top 100! So what’s going on here? How can a company that pretty much invented the mainframe and personal computer, helped put a man on the moon, invented the scanning electron microscope and scratched the letters IBM onto a nickel crystal one atom at a time, and, most recently, took artificial intelligence a giant leap forward with Watson not be classed as innovative?

Perhaps the clue is in what the measure of innovation is. The Forbes article measures innovation by an “innovation premium” which it defines as:

A measure of how much investors have bid up the stock price of a company above the value of its existing business based on expectations of future innovative results (new products, services and markets).

So it would appear that, going by this definition of innovation, investors don’t think IBM is expected to be bringing any innovative products or services to market whereas the world will no doubt be inundated with all sorts of shiny iThingys over the course of the next year or so. But is that really all there is to being innovative? I would venture not.

The final article that caught my eye was about Apples cash reserves. Depending on which source you read this is around $60B and as anyone who has any cash to invest knows, sitting on it is not the best way of getting good returns! Companies generally have a few options with what to do when they amass so much cash, pay out higher dividends to shareholders, buy back their own shares, invest more in R&D or go on a buying spree and buy some companies that fill holes in their portfolio. Whilst this is a good way of quickly entering into markets companies may not be active in it tends to backfire on the innovation premium as mergers and acquisitions (M&A) are not, at least initially, seen as bringing anything new to market. M&A’s has been IBM’s approach over the last decade or so. As well as the big software brands like Lotus, Rational and Tivoli IBM has more recently bought lots of smaller software companies such as Cast Iron Systems, SPSS Statistics and Netezza.

A potential problem with this approach is that people don’t want to buy a “bag of bits” and have to assemble their own solutions Lego style. What they want are business solutions that address the very real and complex (wicked, even) problems they face today. This is where the software architect comes into his or her own. The role of the software architect is to “take existing components and assemble them in interesting and important ways“. To that I would add innovative ways as well. Companies no longer want the same old solutions (ERP system, contact management system etc) but new and innovative systems that solve their business problems. This is why we have one of the more interesting jobs there is out there today!

Watson, Turing and Clarke

Peter Cripps comment , , ,

So what do these three have in common?

  • Thomas J. Watson Sr, CEO and founder of IBM (100 years old this year). Currently has a computer named after him.
  • Alan Turing, mathematician and computer scientist (100 years old next year). Has a famous test named after him.
  • Aurthur C. Clarke, scientist and writer (100 years old in 1917). Has a set of laws named after him (and is also the creator of the fictional HAL computer in 2001: A Space Odyssey).

Unless you have moved into a hut, deep in the Amazon rain forest you cannot have missed the publicity over IBM’s ‘Watson’ computer having competed in, and won, the American TV quiz show Jeopardy. I have to confess that until last week I’d not heard of Jeopardy, possibly because a) I’m not a fan of quizzes, b) I’m not American and c) I don’t watch that much television. To those as ignorant as me on these matters the unique thing about Jeopardy is that contestants are presented with clues in the form of answers, and must phrase their responses in the form of a question.

This, it turns out, is what makes this particular quiz such a hard nut for a computer to crack. The clues in the ‘question’ rely on subtle meanings, puns, and riddles; something humans excel at and computers do not. Unlike IBM’s previous game challenger Deep Blue, which defeated chess world champion Gary Kasparov, it’s not sufficient to rely on raw computing ‘brute force’ but this time the computer has to interpret meaning and the nuances of the human language. So has Watson achieved, met or passed the Turing test (which is basically a measure of whether computer can demonstrate intelligence)?

The answer is almost certainly ‘no’. Turing’s test is a measure of a machines ability to exhibit human intelligence. The test, as originally proposed by Turing was that a questioner should ask a series of questions of both a human being and a machine and see whether he can tell which is which through the answers they give. The idea being that if the two were indistinguishable then the machine and the human must both appear to be as intelligent as each other.

As far as I know Turing never stipulated any constraint on the range or type of questions that could be answered which leads us to the nub of the problem. Watson is supremely good at answering Jeopardy type questions just as Deep Blue was good at playing chess. However neither could do what the other does (at least as well). They have been programmed for that given task. Given that Watson is actually a cluster of POWER7 servers any suitably general purpose computer that could win at Jeopardy, play chess as well as exhibit the full range of human emotions and frailties that would be needed to fool a questioner would presumably occupy the area of several football pitches and consume the power of a small city.

That however misses the point completely. The ability of a computer to almost flawlessly answer a range of questions, phrased in a particular way on a range of different subject areas, blindingly fast has enormous potential in fields of medicine, law and other disciplines where questions based on a huge foundation of knowledge built up over decades need to be answered quickly (for example in accident and emergency where quick diagnoses may literally be a matter of life and death). This indeed is one of IBM’s Smarter Planet goals.

Which brings us to Clarke’s third law which states that “any sufficiently advanced technology is indistinguishable from magic”. This is surely something that is attributable to Watson. The other creation of Clarke of course is HAL the computer aboard the spaceship Discovery One on a trip to Saturn that becomes overwhelmed by guilt at having to keep secret the true nature of the spaceships mission and starts killing members of the crew. The point of Clarke’s story (or one of them) being that the downside to a computer that is indistinguishable from a human being is that the computer may also end up mimicking human frailties and weaknesses.  Maybe it’s a good job Watson hasn’t passed Turing’s test then?