Fermi, Filters, and Funky Aftershave

“Where is everyone?”

No, that’s not me looking for people to harass into reading my blog. Those are the words of Enrico Fermi. In case you haven’t heard of him, Fermi was a really famous physicist who was always invited to all the right parties. Oh, he was also pretty much the father of the nuclear age. (I’m not sure what physicist parties are like. Perhaps Kevin can touch on this in his next blog?).

Fermi’s quote has to do with what’s known as the Fermi Paradox. Basically, given that there are tens of billions of planets in our galaxy alone, even if intelligent life is a relatively rare occurrence, we should see evidence of other civilizations all over the place: trashy alien reality television, weird sporting events, unidentifiable fast food wrappers, etc. But to date, nothing, nada, zilch, zippo; thus the paradox.

A scene from ‘Real Housebots of Andromeda 17’

Ok. I know you’re probably thinking: “But what does this have to do with AI?”

I’m getting there. The road to the truth is sometimes long and bendy.

There are a lot of theories about why we don’t see any other signs of life in the universe. It could be that galactic society took one look at us and then strung up the cosmic equivalent of that yellow caution tape around our solar system. Hopefully that’s not the case.

The explanation I’d prefer to focus on today is called the Filter theory. It says that much like the filter that prevents coffee grounds from ruining the creamy goodness of your triple latte mochaccino, there’s a filter that prevents civilizations from reaching a point where they could accomplish troublesome stuff that far far away astronomers could see through their telescopes and remark, “Hey, that’s weird.”coffee-2616923_1920

So if there is some point in the evolution of civilizations where they all tend to wipe themselves out, the question becomes: Are we Earthlings past that point already or are we approaching it?


“That’s all very interesting, but what does it have to do with Artificial…”

I’ll get there. Bendy, remember?

I watch a lot of the History Channel and in the early days of humankind people sought to harness the power of fire so it could be a useful tool versus something that terrorizes them. However, there were many among our ancient ancestors who were concerned that fire was too dangerous and the tribal elders reminded everyone of the consequences of the pointy stick fiasco (I’m paraphrasing).

“Yes, but I still don’t see…”  Bennnn-deeeeee.

And continuing forward through history, every new technological advance has brought with it concerns of filtering ourselves out of becoming the first galactic civilization. So, even though the concern has been there from fire, to gunpowder, to cloning the DNA of dinosaurs as part of a new amusement park venture (that last example may have been from a different channel), I don’t think any of these compare to what is probably the actual filter that all civilizations have to overcome.

Yes, now I’m talking about AI.


Even though we’re probably many years away from a super-intelligent AI, imagine for a minute an AI with the same intelligence as a person. That would still be a pretty big deal because digital circuits operate about a million times faster than organic ones (in other words, us). So pretend you could put this human-level AI on a problem for a week. That would be the same as a person working on the problem for about 20,000 years, or 20 people for 1,000 years, or 50 people for…

“We get the idea.”

Now imagine that whoever gets this AI first has only a six-month head start on their competition. That’s the equivalent of half a million years in human time. What would another country do if they thought we had this capability or were even close to it? I’m not sure, but I don’t think I’ll be moving to Silicon Valley anytime soon.

This was the idea behind Elon Musk starting his OpenAI initiative. Given that he’s been very vocal about the dangers of AI in the past, at first it seems odd that Elon* would start up a company trying to develop an intelligent AI. (* I like to think Elon is the kind of person who would let me call him by his first name if we ever met; plus, “Mr. Musk” sounds like a really cheap aftershave and I’m not sure I could say it with a straight face.)

Elon’s idea was that by being the first to develop an intelligent AI, OpenAI would have enough of a head start to dictate the direction that AI research and development goes in order to make sure it’s used to benefit humankind. Given the history of filtering mentioned above, that plan kind of makes sense.

Hopefully, whoever gets there first—Elon or others—will have humanity’s best interests in mind and we can maybe be the first ones to make it past the filter point.

Then we’ll be the ones putting up the caution tape.

Well, that’s it for this episode. As always, if you have any questions about AI or Machine Learning, or need some physics party plans (I know a guy), drop me a line.


Not What You Wanted To Hear

Do you like being told no? Of course not. Who does? Maybe crazy people but certainly not your average run of the mill person. We all like to get our way and get what we want. That is human nature. We are needy beings that want want want. However, even Mick Jagger knew that we don’t always get what we want.


Hey now, don’t give me that look. I can see you giving me an eye roll and moving that mouse to close the browser window. Just stop for a minute. I have a point here. I promise.

Our modern culture is built on the premise that anything you do can be made faster and/or more efficient with the incredible power of (fanfare please) the internet. I would venture to say that in a lot of ways this is true and if it doesn’t make it faster than at least it’s more convenient. Shopping is easier, taxi rides are easier, education is more accessible, banking is easier, and meeting new people is as simple as a swipe right. So what about healthcare?

A few posts ago I spoke about how the data we leave behind us can be analyzed to make our healthcare easier and cheaper. As a consequence of that efficiency and cost-effectiveness, we may not get the care we are used to or even the care that we feel we want. This isn’t because we are getting subpar care. It is just that we don’t necessarily need everything that might have been done in the past. It is that efficiency and cost savings at work. That fact is that you as a patient may not have much control over your care at all. That may or may not be such a bad thing but I can think of a few situations where someone might get a little ticked that they are told no. angry-2191104_1920Sadly, in our modern world, some adults seem to turn immediately into toddlers when they don’t get their way. Just watch the customer service counter at your local big box store when someone is told they can’t return the doodad they bought 3 years ago… Epic meltdowns for sure. It’s the kind of stuff viral videos are made of.

Now back to the story. Coordinated care groups, cooperatives of providers, and even the participants within a payer network may not allow a patient access to certain procedures they deem unnecessary or superfluous or allow a patient to see anyone outside of the confines of their group. Why you ask? Because they feel that if they control what procedures are done and who a patient gets to see for a specific procedure then they can guarantee the quality and the cost of an entire episode of care. And if they cannot guarantee it then at least they would have a pathway to open communication to make sure they can adjust or understand better the care a patient receives. So that means that patients can’t really choose who they get to go to or whether or not to get the “extra” tests that somehow make them feel more trusting of the care they are receiving. Despite the fact that healthcare should be all about choices, those choices may start to dwindle and if you start an episode of care, say for a surgery, with one group then you likely won’t be able to move to another.

Now I imagine a lot of you thinking “What is this guy talking about? Of course I can choose what doctors I see and what providers I want to use.” But if you think about it, I don’t mean that you can’t choose what you want, only that you won’t be able to do so without consequences. A doctor who is being paid based on the health outcome of your care will be hesitant to let you out of their “area of influence” so to speak. Also, your insurance company will not be pleased and may force you to pay more if your choice moves you into a situation where quality can no longer be measured effectively. (This brings up the issue of how to measure quality which is not an easy question to answer.) There is a silver lining here though. Remember that things would not be as they are now. If you are in the midst of an episode of care it is likely that the group doing the treating is already pretty good since they will get paid based on the quality of care that they administer and not just by the procedures they complete.

So remember that even though value-based care may mean that you don’t get the same things that you used to, it also means that you are probably getting a better deal anyway. Everyone wins but only if we let the system work for us and try not to work against it. It is hard to lose control (if we even had it to begin with) but giving up some things means we can reap the benefits elsewhere. In this case, your bank account or in a more grandiose fashion the coffers of the whole country. Nothing is ever perfect but if we let the change take hold we can all be better off. In closing, I challenge you not to start humming the Rolling Stones after you read this. I said no. Don’t you do it!

See the theme here?

What’s In Your Electronic Health Record (EHR)?

Remember the days when people used to write on paper with a pen or pencil. Will the pen and pencil someday be in the Smithsonian Museum of History?

Future Smithsonian Exhibit

I guess my typing class in ninth grade is paying off after all. What’s the point of studying for spelling tests when we have spell check on our computers and at our fingertips? Spellcheck even tries to help guess what we are spelling by presenting suggestions for us to choose from or just changing the word automatically for us. Take the abbreviation “EHR” for example, the computer helps me out every time by reorganizing the letters for me into what it thinks I meant to spell.

Writing activates parts of our brain involved in thinking and memory. It helps one think more thoroughly about the information one’s documenting. Since writing is slower and more tedious, it makes it harder to take notes verbatim. Therefore, one has to actually process the information and summarize it in a way that makes sense to us and forces our brain to engage with the information. A draw back, everyone’s handwriting is different and not everyone’s handwriting is legible to read (the unofficial term for bad handwriting—chicken scratch).

Unamused chicken. 

This makes the reader have to decipher at times the written word. Hmm…. almost like the computer spell checker does for words it does not recognize.

On the other hand, typing encourages verbatim notes without giving much thought to the information. This mindless transcription can lead to a lack of meaningful understanding of the information. Although typing allows words to be documented more quickly and more legibly, that doesn’t mean what is written is any more understandable. This can be especially noticeable when there is redundancy in text data, incorrect concepts are used, or references are made to data that was accidently or intentionally copied from other sources, i.e. another office visit’s notes.

Now that we can access our medical records electronically through our doctor’s patient portal and they are legible to read, have you ever sat down and read the medical note your provider wrote about you? Putting aside the medical terminology, how did it flow? Computer technology makes it very easy to cut and paste or copy and paste data from one location to another. While this technology is great to help save time, especially if you are a slow typist or very busy, it can have it consequences if not done correctly or quality checked for accuracy. Providers are not only expected to see and care for many patients throughout their day, but they are also required to make sure whatever is done is also documented clearly in the patient’s medical record. As technology makes things easier and faster for us to do our jobs, it also makes it easier and faster, when in a hurry or busy, to make factual errors, or use boilerplate or copious amounts of text of little relevance to the individual patient.

Back to question about reading your medical record. Have you? Being a nurse, I have seen records where a person’s age and sex changes within the same office visit note (date of service) and social histories or physical exam documentations appear to stay the same from one office visit to the next. I have seen words misspelled or spelled correctly, but the wrong word was used in the sentence which can lead to confusion. You know, like when you send a text to someone and the word you typed is changed by your smartphone and now the message you sent to your friend sounds encrypted and you don’t even recognize what you said even though you sent it.

I have also seen records that have diagnoses listed when the note within the visit states they have been ruled out. And by the way, according to CPT® there are specific rules about billing ruled out diagnoses, depending if the service was performed inpatient or outpatient. Yes, many of the mistakes are human errors that are easy to make when using technology such as, copy & paste, spell check, etc. Technology is great, but the human is still necessary (as referenced in our Machine Minded blog).

The bigger concern about inaccurate or not up-to-date information within our charts rears its head when your medical information is needed for emergencies or you need it to qualify for other services. Have you ever tried to get life insurance? You can be denied life insurance or your premiums could be more expensive depending on your medical diagnoses. Also, it seems like identity theft is always in the news nowadays. Guarding your health insurance card is just as important as guarding your credit cards. Someone else’s diagnoses or allergies in your medical record could harm you, especially if you are unconscious or unable to communicate. On the plus side, with the implementation of the EHR, information is more accessible at the patient level. It is no longer a black box of unknowns. This in turn, allows the patient and their provider(s) to work together better as a team to make sure data is accurate. The next time you look at your medical record online, take a moment and read it.



Disclaimer: This Blog is for educational purposes only as well as to provide general information and a general understanding of the topics discussed.  The Blog should not be used as a substitute for legal advice and you are advised to seek additional information from your insurance carriers, Medicare and/or Medicaid agencies for additional criteria and regulations regarding these services.

Social Value of Online Communities

Social media might be taking precedence in our lives these days, but there is another form of online communication that we used to (and for some of us still) rely on for exchanging knowledge or receiving emotional support from strangers – the online forums or bulletin boards. For example, Stack Overflow features a Q&A platform for software developers to exchange coding knowledge. Slickdeals, a deal and promotion-sharing forum, on the other hand, has a typical forum structure that has threads, original posters, and responses to those original posters.

Various streams of research have been conducted on online communities, from motivations behind participants in contributing time and knowledge in helping strangers, to the economic value of such contribution. What is lacking is the social value of online communities. Scholars Goh, Gordon and Agarwal (2016) aim to bridge this gap by looking at how an online community addresses the health disparity of rural and urban populations. They are also the first to quantify the social value of online communities.

Their assumptions are as follows: there is limited access to resources such as specialized care, information, healthcare programs, and social support groups in rural areas, which creates significant disadvantages for rural patients. Therefore, rural patients tend to have decreased health status and health functioning, possess less health knowledge, and have lower health-seeking skills, beliefs and self-efficacy. Together with other health capability gaps, rural patients are more likely to have poorer health statuses and higher mortality rates than urban patients. Given rural patients’ disadvantage relative to the urban patients, these researchers suggest that online communities can reduce the health capabilities gap experienced by rural patients by enabling the exchange of social support, in the form of both health information exchange and emotional support. Moreover, to the degree that community interaction has a relatively more positive effect for rural patients, they hypothesize that online communities generate social value by reducing rural–urban health disparities.

To prove their hypothesis, they collected message data on a rare disease online forum posted by 111 rural patients and 527 urban patients from October 2005 through June 2009. They adopted a network methodology in studying the knowledge and emotional exchange among original posters and responses. To illustrate, each node in the network represents a patient who participated in the forum. There is directionality associated with support provisions such that a supportive tie between a patient who posts a thread and a response from another patient is represented by a directed dyadic tie, where the arrow points toward the originating poster and the arrow head terminating at the recipient (e.g., a patient whose initial post generates a reply in the thread would have a tie that is directed toward her).  If their hypothesis is correct, it should show that the rural nodes are more likely to be recipients and urban nodes are more likely to be providers of social support.

Their findings suggest the following: the probability of a node with an incoming tie is 7 percent higher for a rural node as compared to an urban node. In other words, all else equal, a rural patient is more likely to receive support compared to their urban counterparts. They also find that rural patients are less likely than their urban counterparts to provide support.

The research suggests that support online flows in one direction

Taken together, these results show that the likelihood of an urban patient responding to a rural patient is higher than the likelihood of responding to another urban patient, all else equal, and therefore providing support for the claim that there is a net surplus of social support flowing from urban to rural users.

Their results yield implications for policy makers and practitioners concerned with meeting patient needs and overcoming disparities in medical access. Entities responsible for resource allocation decisions, such as governments, community agencies, and public health facilities should leverage the powerful role that online collectives can play. Online communities can serve as a low cost alternative to or as a complement to existing health programs. For instance, healthcare entities can have professional nurses or doctors participate in these communities by providing information in addition to regular patients. Such information shouldn’t replace necessary office visits. Rather, it can guide the patients in the right direction and serve as a conduit towards further examination.



Goh, Jie Mein; Gao, Guodong (Gordon); and Agarwal, Ritu. 2016. “The Creation of Social Value: Can an Online Health Community Reduce Rural-Urban Health Disparities?” MIS Quarterly, (40: 1) pp.247-263.

Disclaimer: This Blog is for educational purposes only as well as to provide general information and a general understanding of the topics discussed.  The Blog should not be used as a substitute for legal advice and you are advised to seek additional information from your insurance carriers, Medicare and/or Medicaid agencies for additional criteria and regulations regarding these services.

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