Terrible actions

An American white supremacist, an Israeli Zionist and an Afghan radical are all terrorists. Their origin and religion are not commonalities in explaining their actions. More meaningful is the fact that all are male and between 15 and 25 years old - which are not emphasised in any media discussions.
The common factor is their desire to inflict fear and take extreme steps to obtain their goals. The reasons they are willing to commit violence and how to mitigate those driving forces need to be determined and the constant talk about irrelevancies is a distraction. Chances there are more than one or two factors in play, or more accurately, some deeper similarity than just the surface aspects.
The current measures being discussed - most obvious in the USA across the world - sets the net way too wide to allow a viable response to be developed. All that happens is security theatre at the cost of large amounts of money and inconvenience for enormous numbers of people.
In other words, the current response plays right into the hands of those who wish to negatively impact the lives of their targets.
None of this is new of course, but I think it bears repeating...

Financial momentum

The following is derived from watching some Khan Academy videos on macroeconomics and reading Piketty's book.

From the discussion, the financial health of a country is significantly impacted by the 'velocity' of money within its economy. The videos indicate that the quantity moving is important as well as the speed. This is, of course, basic economic theory arising from Keynes and others.

I am not an economist although I have been trying to build up some knowledge of the principles. However, I am a physicist (or was) and the key factor in the study of motion is 'momentum' or mass times velocity. Which raises the question about the equivalent metric in economics - what does it mean to refer to financial momentum.

This does not mean to say that the analogy is valid but it does prompt the thought experiment to see how far it can be pushed. For instance: is there a economic equivalent of conservation of momentum? Is the net flow of money (wealth?) within a system is constant?

First: the more common important quantity in the physics of motion is the rate of change of momentum or force: F = ma according to Newton. Economics, as with natural language, usually less precise terminology, but forces could be interpreted as changes in the flow of money.

But perhaps 'money' is not the correct entity to use as a measure of an amount of substance in economics. It is representative of a deeper underlying concept - wealth perhaps? "Capital", especially in Piketty's case, refers to something more specific, but it may be meaningful to refer to the flow of wealth or value, with money being the unit of measure. The concept of what exactly is flowing may require more thought.

More basic is that the distinction *must* be made between velocity and speed. The two are NOT the same and the distinction is critical in understanding movement. Speed is a single value and can be added and subtracted simply as a number. Velocity, on the other hand, depends on direction and changes when the direction changes even if the measured speed is the same. And a force is required to change the direction even if the quantity doesn't change. Velocities (or momenta) add as vector quantities and only cancel out if they are in opposite directions. 

The economic equivalent would be the exchange of items of equal value between two entities which would lead to a zero net flow of wealth. Also the net force driving further motion, after the exchange is complete, would be zero so the impact on the larger system can be disregarded. I don't think this is the same in economics - but it should be a point of further investigation. [As a side-note, there is some relativistic influence here since the value of the items will differ for each entity else they would not be exchanging them; another break-down of the analogy or can it be extended into electromagnetism?]

But when there are more than two bodies the direction of flow is not directly opposing and so the net forces do not necessarily cancel out. In physics, the mathematics for a multi-body system can be *very* complicated and there is no general solution to the equations; they must be calculated on a case by case basis and the computation may be difficult.

Hence it is not the flow of wealth that matters, but the circulation which requires a sort of centripetal (or centifugal?) force to maintain. Which is another interesting concept: what does the push of wealth away from the centre, as would happen with high velocities, mean for an economy?

One other point on this collection of ideas before I take it away for more incubation. Wealth at rest, like mass at rest, has inertia holding it in place. It is ballast which requires larger forces to move. According to Piketty it also accumulates (at least within our economic model) which gives it gravitational attributes - the larger the body the faster is gathers more substance to itself and the greater the influence on (particularly moving) entities around itself.

Maybe the analogy is not entirely far-fetched?

Jobs and Growth

I've been reading a bit about economics recently and one clear point seems to be that no qualified economist believes that trickle-down a.k.a supply side a.k.a. neoliberalism a.k.a reagonomics/thatcherism actually works. It does not lead to significant growth, tending instead toward depressing economies and, in general, no new jobs are created.
From a logical point of view it seems to me that this has a lot to do with how well established a business is. New industries create new jobs - entirely new, things that people have not done in the past and are not yet understood well enough to automate. Old, large, established industries have defined processes, tools, targets etc. and tend toward getting more efficiency out of their existing resources. Hence automating, tuning and generally reducing costs - including labour. People may move from one company to another but there are rarely new roles created within the industry as a whole.
In other words, from the government point of view, creating jobs is more likely to arise from supporting small and emerging businesses - especially new industries. In other other words - renewable energy, new technologies, start-ups. Science and other research lead to new ideas and new approaches, especially in the things like uses for big industry waste products, and hence to new industries, growth and jobs.

Security in Office Buildings

I have had occasion lately to enter a number of office buildings for various reasons and the security measures vary enormously. This led me to wonder both how effective and how costly they are.
On entry some corporates have a reception and some do not - depending on whether the general public is likely to appear. Most office buildings these days have some sort of card access in the lifts, commonly with an additional point (using the same card) on the floor as well. I am including the independent barriers before the lifts in this as well. One place even had reception on the first floor - which is only accessible via a secure elevator!
I can see the reason for these - barriers ensure that security officers (if they exist) can see people, unlike security in the lift itself. With multiple people in each elevator it makes sense to have separate access to the floor - it is a challenge point for humans if you do not recognise the person trailing you. Depending on the corporate culture, challenging does actually happen although it is rare if the person looks like they know where they are going (whether or not they actually do).
As a  side-note: there is an increasing trend for new building to have lift buttons outside the actual boxes. I have heard that this is to increase security but I really can't see any obvious way this would be true. More likely it arises from centralising the control software to more efficiently allocate the lifts. Nevertheless I think it is a major backward step in usability. The design really doesn't take human foibles into account and I can see multiple ways the theory could break in practice.
Then of course there are the security guards and pass-cards for temporary access - some of which require a driver's license before being provided. All to ensure that no authorised people are allowed access.
And what are they protecting? An office building - that is - levels and levels of desks with some computers on them. Valuable equipment yes, but rarely critical. Who are they protecting them from? I don't know. I am not sure what the expected attack is supposed to come from or what benefit the attacker is supposed to gain.
Simple thievery could be deterred by much simpler and cost effective means - how much does it cost to have 3 full time security guards + reception staff and how often are they actually required to do anything. The alternative is prevention of attacks on staff, either personal or corporate motivated. However, there are surely simpler and more unobtrusive mechanisms for detecting unauthorised entry. If the police force, surely one of the most targeted groups does not require the same level of control then I can't imagine that the department of Economic Development is in great danger.
All security is a cost-risk comparison and I really can't see the benefit in those terms. So perhaps the reasoning is more about presenting a sense of importance to any visitors.

eHealth taxonomies

For some time I have been interested in IT as used by the Healthcare Industry. This has been in a vague sort of way - mostly just keeping abreast of current developments and reading articles every so often. Last year I attended an event in my home town organised by AIIA which prompted me to look a little deeper. As usual with these things I decided to create a summary of what I knew and hence try to sketch out a mental model of the area. Perhaps even put together a reference architecture or similar.
One thing that quickly became clear was that there are several disparate aspects to the industry, each of which appears to be working in isolation. There are, of course, overlaps and dependencies but - as far as I can tell - everyone working in the area seems to be working only on their own aspect. In addition, and as usual, everyone was treating their industry as if it was completely different from every other enterprise ever undertaken before.
The following table is an example of the sort of sub-domains commonly considered:

Aspect	Description
Electronic Health Records	Enabling the communication of patient data between different healthcare professionals (GPs, specialists etc.)
Digital Service Orders	A means of requesting diagnostic tests and treatments electronically and receiving the results
eMedication & Prescriptions	Suggesting options, printing and/or electronic transmission of prescriptions. Supporting and tracking medication dispensing
Clinical Decision Support	Providing information electronically about protocols and standards for Healthcare professionals to use in diagnosing and treating patients Searchable source of current thinking about health care. E.g. overviews of journals, best practice guidelines or epidemiological tracking
Tele-medicine	Physical and psychological diagnosis and treatments at a distance, including tele-monitoring of patients functions. Innovative use of sensors and data interpretation to deduce patient condition and status without physical presence
Health Information Systems	Business support functions such as appointment scheduling, patient data management, work schedule management etc.
Health Visualisation	Mechanisms for presenting patient details in an easily understandable way, including use of mobile devices, by high-lighting or graphically presenting key information.
Case Management	Ability for healthcare professionals to collaborate and share information on patients through digital equipment. The collection of all information relevant to the current patient situation in a single, usable form.

This certainly provided a business oriented view and is a valid decomposition. To my mind there are a number of overlaps and similarities, at least from an IT point of view, which suggest a different formulation. Hence:

• Health records. Each institution and each practitioner may hold their own or share a patient folder. These may be paper or digitised and will contain both structured and unstructured data. Centrally controlled and shared EHR is a sub-domain which has its own special considerations
• Advanced Diagnostics. In this I include both the Decision Support points listed in the table as well as the use of bulk data for population statistics and reporting - which may be for the clinic, hospital, district or state, depending on who holds the data and the detail available
• Tele-health is an emerging area and jointly includes new sensors and detection methods with back-to-base communications. Of course some sort of mechanism to extract meaningful information important, but even simple alerts based on min-max can be useful in a heart-rate monitor on a bed-ridden patient (wherever that bed may be - at home or in a hospital).
• Medical devices using firmware or similar embedded logic. This includes implants such as pace-makers but also prosthetics and even fitness devices. There is some overlap here with the tele-health category which I may need to be clarified as I follow this track later. The difference at this stage is whether the device is self-contained or reports to some central control (most will do both).
•  Facility management is the bored category. For instance ERP, HR and Asset Management for clinics, hospitals and nursing/aged homes. There are distinct requirements for each type of organisation but there is also a commonality. Items such as admissions and domestic services are shared with the hospitality industry but with key differences which need to be considered.
• Additional and specialist systems are involved when talking about X-ray system controls or Medication tracking etc. These tend to be stand-along applications feeding into the major components or integration/communication patterns between them (e.g. eReferrals). I think this category needs more thought since it is mostly a catch-all at this stage.

I am hoping to create a landscape (perhaps even a map) which describes how all these fit together. And drill down into the concerns of each as I get the time.

eReferrals

Thought progression on eHealth concepts and specifically eReferrals.
I have been a bit about eHealth, which is an area ripe for major growth. I started putting together a slide-pack overview of the concepts involved but I don't think this one fits at the same level - hence here. This post is likely to be little disconnected as I am working it out as I go along.

First question: What is a Referral? (In the health sense) What is the purpose and how is it used? With no direct insight into the industry I need to start at the highest level.
As I understand it, a referral basically represents the hand-over of patient care from one health practitioner to another - at the simplest level. As part of this handover, obviously there are details that need to be communicated. In the traditional method, the referer gives the patient a message to pass, along with themselves, to the receiver (referee?, or is the patient the referee?), often with limited associated details. The assumption that the receiver would contact the sender separately, or directly talk to the patient (the ball being hand-passed).
Doesn't sound like much of system when described like that, but it worked, at least enough, for many decades.
With electronic health records, the patient's full details can be communicated, and any notes or preliminary diagnosis etc., easily - as long as both sides have access to the data - and, presumably this would reduce mis-communication or lost patients.
Pros would include the ability for both doctors and patients to select the best local provider, for many definitions of "best" (most available, highest quality, cheapest etc.) rather than simply going with the usual suspects. Practitioners, or clinics or hospitals, which receive referrals would be able to place specialties, calendars, price-lists, wait times etc, where they can be seen during selection.
The ability for advertising and market forces to enter into this process may be positive or negative. The concept is somewhat unsavory when talking about the health industry - it exists but people often don't like to think about it.
As with most automation there is some loss of flexibility, for instance, if the patient decides not to follow-up themselves. Also with a very manual system, there is built in error correction since people tend to catch and deal with process failures without even noticing that that is what they are doing. That can get lost with automation as people start to depend on the machines. Note: this is true of any automation and is NOT a reason to not do it, it is simply a factor that needs to be allowed for (I keep intending to write about MyKi - which I think fails on exactly this point).

All of which is somewhat off my original train of thought - as usual.
The point is that this entire process is very basic Case Management and there are dozens of applications available off-the-shelf that can handle it. The major problem is simply ensuring both (all three if you consider the patient as well) have access to the same data - and that is the point of NEHTA and PCEHR. Referral is the transfer of ownership of a case (medical case in this case) from one practitioner to another. Ownership may be passed to an individual, a group (such as a hospital or facility) or a queue (such as a clinic for the first available receiver). This is slightly different to allocating an activity within the case to an external agency while retaining ownership. An example of the latter is requesting pathology or radiology tests. In that case, the referring doctor retains control while requesting services from the lab.
Another, similar analogy is Incident or Ticket Management. In that case the GP represents level 1 support. They perform triage and initial diagnosis, they can resolve most straightforward cases immediately while passing complex or specialist issues to level 2 support. Level 2 specialise in specific concerns and have greater resources, tools, skills or experience on the particular type of problem. Major or recurring problems may be passed to Level 3 which in this analogy would be hospital (acute care) or other facility (chronic care). To stretch a bit further, level 4 would be the biomedical research institutes who may publish papers on interesting case studies.

The point though is that, from my distant and inexperienced view, this is a solved problem. The high level processes and effective techniques are known. The devil in the details is how to set this whole system up for the medical profession which tends to be very conservative with its processes - and rightfully so given the stakes involved.

Organisational Organisms

The idea of treating an organisation as if it were an individual - with emotions, intelligence, personality and so forth is not new. I know that Douglas Hofstader touched on this (or more than touched) in his book "The Eternal Golden Braid". This analogy could be carried further; although it correlation may become a little stretched.

The idea of a organisational 'physiology' was one that I have been exploring; mostly to see how far the thought could be carried.
Consider that any group of people operates within a particular environment and that environment includes a number of other groups of greater or lesser similarity. There is competition and co-operation between the organisation and a Darwinian like process works to ensure the survival of the fittest. None of this is new and in fact it forms the basis of various economic theories.
But what if we take the thought and consider it in a less metaphorical way.

Any organism requires sustenance to survive, usually in multiple different forms. It requires some way to interact with its environment and hence some way to detect it; senses in other words. Generally organisms create waste products and have mechanisms for re-production.

For an organisation, at the naive level, money is its sustenance - but that is like claiming that living things are dependent on carbohyrates. They power the entity but there are considerably more complex interactions involved - chemical for organisms and financial for organisations. The financial aspects are no more the reason for an organisation's existence than chemical reactions are the reason for an organism. I include enterprises such as banks in this, they use money in the same way bees use honey, but only a relatively small amount is used to keep it running.

The basic element of the organisational organism is the people. They are the cells in the body and ideally should all be working for the good of the whole, but in reality they tend to be working to maintain themselves within the larger group. They are sustained by the flow of nourishment (commonly money, but perhaps other intangibles for non-profit organisations) which is made easier to obtain by being part of the group than being independent. In return they provide something that is useful to the group and are often clustered in teams with related purpose. Occasionally one of these groups develops a pathology or cancer which threatens the whole but usually they operate in co-ordination.
As usual the larger the organisation/organism the more difficult it is to have each part operate in harmony. A nervous system/communication is required to co-ordinate operations and perhaps a central decision making unit. In this analogy, general operations represent reflex actions - perhaps referring back to middle management as autonomic nervous system while governance level management represents the co-ordinating and decision making sections of the central nervous system.

Shifting to another area (and still pushing the limits out of the metaphor), all organisms need some way to sense their environment and detect areas of high nutrient density. Customer feedback, competitor analysis, and market surveys represent a sense of smell for our corporate entity. It detects residual pieces of what has been around. Hearing and sight are much more immediate senses and I can't think of any specific analogues in the corporate world. Much of the recent work in IT with "Big Data" can be considered as developing more sensitive smell, with the same fault of detecting things that are not there or no longer relevant.

There are probably a number of correlations that can be made, but one that I think might prove particularly intriguing is the possibility of psychoanalysing an  organisation. I suspect that this would only be meaningful for really large, complex groups - such as a nation. A small team is more likely to act, and re-act, like a simple organism. But the psychology behind the interaction of countries could be really interesting. Maybe something for another post sometime...