Software Assistants for Doctors Are Making Progress

Doctors have long been in the high-stakes information management business. They must quickly sort through a patient’s symptoms, comments, test results, records and history to come up with a diagnosis. The physician brings to each diagnostic encounter a storehouse of knowledge and experience, all that he or she has read and learned over years.

The information overload for doctors is only growing worse. Medical information is estimated to be doubling every five years, and surveys show most doctors can find only a few hours a month to read medical journals. So it is not surprising that automated assistance for doctors has been pursued by researchers and companies for many years. Decision-making in medicine, after all, involves not just time and money, but also human lives.

A worthy goal, but a frustratingly difficult one. Yet in the last few years, real progress is being made in what is called “clinical decision support” technology. And the story in medicine is the same as in so many appliations of modern computing: advances in sensors for measuring, calculating power and artificial-intelligence software are opening the door to a new generation of smarter tools.

The marquee example is I.B.M.’s Watson. After defeating human “Jeopardy” champions, the clever question-answering computer has moved on to medicine. It is working with oncologists at Cedars Sinai Cancer Institute in Los Angeles, and Watson is being trained as a medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

But there are a flurry of other, smaller-scale examples from teams in universities and start-ups. The promising work of one such company, PeriGen, was published recently in the American Journal of Obstetrics and Gynecology and is being presented on Monday in San Francisco at the annual clinical meeting of the Society of Maternal Fetal Medicine.

The company, based in Princeton, N.J., specializes in fetal monitoring technology. The research being ! presented is an assessment by the federal National Institutes of Health, and the company’s software grew out of years of work by physicians and scientists at McGill University in Montreal. The team includes computer scientists, engineers, mathematicians and statisticians, and has been led by Emily F. Hamilton, an obstetrician and gynecologist who is senior vice president for clinical research at PeriGen, and an adjunct professor at McGill.

The software assessed in the N.I.H. study, called Pericalm Patterns, collects and analyzes the data from fetal heart monitors. Traditionally, doctors see the output of fetal heart monitors as wavy lines â€" called tracings â€" printed on paper that scrolls off the machine (roughly similar to the scribblings of lie-detector tests). Physicians are looking for patterns that might suggest the baby is in distress, perhaps suffering from oxygen deprivation. If so, they typically order a Caesarean section, to get the baby out quickly.

The trouble for obstetrician, Dr. Hamilton said, is that most babies, as they are about to be born, exhibit some unusual heart rate patterns. “You’re looking at all those tracings, and you’re applying rules of thumb and a lot of judgment,” she said in an interview over the weekend. “The challenge is to distinguish what is critical from what is just distracting.”

The N.I.H. assessment concluded that the analysis of three human experts agreed with that of the company’s software 97 percent of the time. The data used for this phase of the study was 100 tracings in the final hour before a baby was born. The technology can be used for research to identify characteristic tracing patterns, and in real time to give physicians alerts.

A second phase of the N.I.H. study, which is already under way, will involve 5,000 tracings â€" or about 20 miles of paper. “You can see why that cannot be done by humans. But we’ve reached the point now where we can use modern techniques of statistics and computing to really a! dvance th! e science.”

Better science, Dr. Hamilton said, should pave the way for better, more consistent decision-making in obstetrics. On the one hand, she said, that should mean faster, clearer signals of a baby in distress. On the other hand, Dr. Hamilton said, it should also reduce unnecessary Caesarean-section deliveries. Faced with uncertainty, physicians tend to order a Caesarean to remove any risk to the baby, as well as the risk of malpractice suits.

While leveling off, the rate of Caesareans â€" at about 32 percent of all births in the United States â€" is twice as high as it was two decades ago.

Software Assistants for Doctors Are Making Progress

Doctors have long been in the high-stakes information management business. They must quickly sort through a patient’s symptoms, comments, test results, records and history to come up with a diagnosis. The physician brings to each diagnostic encounter a storehouse of knowledge and experience, all that he or she has read and learned over years.

The information overload for doctors is only growing worse. Medical information is estimated to be doubling every five years, and surveys show most doctors can find only a few hours a month to read medical journals. So it is not surprising that automated assistance for doctors has been pursued by researchers and companies for many years. Decision-making in medicine, after all, involves not just time and money, but also human lives.

A worthy goal, but a frustratingly difficult one. Yet in the last few years, real progress is being made in what is called “clinical decision support” technology. And the story in medicine is the same as in so many appliations of modern computing: advances in sensors for measuring, calculating power and artificial-intelligence software are opening the door to a new generation of smarter tools.

The marquee example is I.B.M.’s Watson. After defeating human “Jeopardy” champions, the clever question-answering computer has moved on to medicine. It is working with oncologists at Cedars Sinai Cancer Institute in Los Angeles, and Watson is being trained as a medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

But there are a flurry of other, smaller-scale examples from teams in universities and start-ups. The promising work of one such company, PeriGen, was published recently in the American Journal of Obstetrics and Gynecology and is being presented on Monday in San Francisco at the annual clinical meeting of the Society of Maternal Fetal Medicine.

The company, based in Princeton, N.J., specializes in fetal monitoring technology. The research being ! presented is an assessment by the federal National Institutes of Health, and the company’s software grew out of years of work by physicians and scientists at McGill University in Montreal. The team includes computer scientists, engineers, mathematicians and statisticians, and has been led by Emily F. Hamilton, an obstetrician and gynecologist who is senior vice president for clinical research at PeriGen, and an adjunct professor at McGill.

The software assessed in the N.I.H. study, called Pericalm Patterns, collects and analyzes the data from fetal heart monitors. Traditionally, doctors see the output of fetal heart monitors as wavy lines â€" called tracings â€" printed on paper that scrolls off the machine (roughly similar to the scribblings of lie-detector tests). Physicians are looking for patterns that might suggest the baby is in distress, perhaps suffering from oxygen deprivation. If so, they typically order a Caesarean section, to get the baby out quickly.

The trouble for obstetrician, Dr. Hamilton said, is that most babies, as they are about to be born, exhibit some unusual heart rate patterns. “You’re looking at all those tracings, and you’re applying rules of thumb and a lot of judgment,” she said in an interview over the weekend. “The challenge is to distinguish what is critical from what is just distracting.”

The N.I.H. assessment concluded that the analysis of three human experts agreed with that of the company’s software 97 percent of the time. The data used for this phase of the study was 100 tracings in the final hour before a baby was born. The technology can be used for research to identify characteristic tracing patterns, and in real time to give physicians alerts.

A second phase of the N.I.H. study, which is already under way, will involve 5,000 tracings â€" or about 20 miles of paper. “You can see why that cannot be done by humans. But we’ve reached the point now where we can use modern techniques of statistics and computing to really a! dvance th! e science.”

Better science, Dr. Hamilton said, should pave the way for better, more consistent decision-making in obstetrics. On the one hand, she said, that should mean faster, clearer signals of a baby in distress. On the other hand, Dr. Hamilton said, it should also reduce unnecessary Caesarean-section deliveries. Faced with uncertainty, physicians tend to order a Caesarean to remove any risk to the baby, as well as the risk of malpractice suits.

While leveling off, the rate of Caesareans â€" at about 32 percent of all births in the United States â€" is twice as high as it was two decades ago.

Disruptions: On the Fast Track to a 3-D-Printed Future

Will the future be printed in 3-D

At first glance, looking at past predictions about the future of technology, prognosticators got a whole lot wrong. The Web is a garbage dump of inaccurate guesses about the year 2000, 2010 and beyond. Flying cars, robotic maids and jet packs still are nowhere near a reality.

Yet the prediction that 3-D printers will become a part of our daily lives is happening much sooner than anyone anticipated. These printers can produce objects, even rather intricate ones, by printing thin layer after layer of plastic, metal, ceramics or other materials. And the products they make can be highly customized.

Last week, President Obama cited this nascent technology last week during his State of the Union address â€" as if everyone already knew what the technology was.

He expressed hope that it was a way to rejuvenate American manufacturing. “A once-shuttered warehouse is now a state-of-the art lab where new workers are mastering the 3-D printing that has the potential to revolutionize the way we make almost everything,” Mr. Obama said. He has pushed new technologies before, like solar and wind power, as remedies for our nation’s problems, and those attempts have only revived the debate about the limitations of government industrial policy.

But this one s! hows more promise. The question is, can the United States get a foothold in manufacturing one 3-D printer at a time

Hod Lipson, an associate professor and the director of the Creative Machines Lab at Cornell University, said “3-D printing is worming its way into almost every industry, from entertainment, to food, to bio- and medical-applications.”

It won’t necessarily directly create manufacturing jobs, except perhaps for the printers themselves. Dr. Lipson, the co-author of “Fabricated: The New World of 3D Printing,” said that the technology “is not going to simply replace existing manufacturing anytime soon.” But e said he believed that it would give rise to new businesses. “The bigger opportunity in the U.S. is that it opens and creates new business models that are based on this idea of customization.”

In addition to the lab that the president mentioned, a federally financed manufacturing innovation institute in Youngstown, Ohio, schools are embracing the technology. The University of Virginia has been working to introduce 3-D printers into some programs from kindergarten through 12th grade in Charlottesville to prepare students for a new future in manufacturing.

“We have 3-D printers in classrooms, and in one example, we’re teaching kids how to design and print catapults that they then analyze for efficiency,” said Glen L. Bull, professor and co-director of the Center for Technology and Teacher Education. “We believe that every school in America could have a 3-D printer in the classroom in the next few years.”

The education system might want to speed things up. The time between predictions for 3-D printers and the reality of what they can accomplish is compressing rapidly.

For example, in 2010, researchers at the University of Southern California said that another decade would pass before we could build a home using a 3-D printer. Yet last week, Softkill Design, a London architecture collective, announced that it planned to make the first such home â€" hich it will assemble in a single day â€" later this year. The home isn’t that pretty, and will look more like a calcified spider web than a cozy house, but it will show it can be done. The cost of 3-D printers has also dropped sharply over the last two years, with machines that once cost $20,000, now going for $1,000 or less. That’s partly because Chinese companies are driving down prices. Yes, China sees the opportunity in these things, even though the technology may undermine some of its manufacturing advantages.

“When it costs you the same amount of manufacturing effort to make advanced robotic parts as it does to manufacture a paperweight, that really changes things in a profound way,” Dr. Lipson said.

This leaves us with one more question about the future: When will these 3-D printers be able to make us flying cars, robotic maids and jet packs

E-mail: bilton@nytimes.com

Disruptions: On the Fast Track to a 3-D-Printed Future

Will the future be printed in 3-D

At first glance, looking at past predictions about the future of technology, prognosticators got a whole lot wrong. The Web is a garbage dump of inaccurate guesses about the year 2000, 2010 and beyond. Flying cars, robotic maids and jet packs still are nowhere near a reality.

Yet the prediction that 3-D printers will become a part of our daily lives is happening much sooner than anyone anticipated. These printers can produce objects, even rather intricate ones, by printing thin layer after layer of plastic, metal, ceramics or other materials. And the products they make can be highly customized.

Last week, President Obama cited this nascent technology last week during his State of the Union address â€" as if everyone already knew what the technology was.

He expressed hope that it was a way to rejuvenate American manufacturing. “A once-shuttered warehouse is now a state-of-the art lab where new workers are mastering the 3-D printing that has the potential to revolutionize the way we make almost everything,” Mr. Obama said. He has pushed new technologies before, like solar and wind power, as remedies for our nation’s problems, and those attempts have only revived the debate about the limitations of government industrial policy.

But this one s! hows more promise. The question is, can the United States get a foothold in manufacturing one 3-D printer at a time

Hod Lipson, an associate professor and the director of the Creative Machines Lab at Cornell University, said “3-D printing is worming its way into almost every industry, from entertainment, to food, to bio- and medical-applications.”

It won’t necessarily directly create manufacturing jobs, except perhaps for the printers themselves. Dr. Lipson, the co-author of “Fabricated: The New World of 3D Printing,” said that the technology “is not going to simply replace existing manufacturing anytime soon.” But e said he believed that it would give rise to new businesses. “The bigger opportunity in the U.S. is that it opens and creates new business models that are based on this idea of customization.”

In addition to the lab that the president mentioned, a federally financed manufacturing innovation institute in Youngstown, Ohio, schools are embracing the technology. The University of Virginia has been working to introduce 3-D printers into some programs from kindergarten through 12th grade in Charlottesville to prepare students for a new future in manufacturing.

“We have 3-D printers in classrooms, and in one example, we’re teaching kids how to design and print catapults that they then analyze for efficiency,” said Glen L. Bull, professor and co-director of the Center for Technology and Teacher Education. “We believe that every school in America could have a 3-D printer in the classroom in the next few years.”

The education system might want to speed things up. The time between predictions for 3-D printers and the reality of what they can accomplish is compressing rapidly.

For example, in 2010, researchers at the University of Southern California said that another decade would pass before we could build a home using a 3-D printer. Yet last week, Softkill Design, a London architecture collective, announced that it planned to make the first such home â€" hich it will assemble in a single day â€" later this year. The home isn’t that pretty, and will look more like a calcified spider web than a cozy house, but it will show it can be done. The cost of 3-D printers has also dropped sharply over the last two years, with machines that once cost $20,000, now going for $1,000 or less. That’s partly because Chinese companies are driving down prices. Yes, China sees the opportunity in these things, even though the technology may undermine some of its manufacturing advantages.

“When it costs you the same amount of manufacturing effort to make advanced robotic parts as it does to manufacture a paperweight, that really changes things in a profound way,” Dr. Lipson said.

This leaves us with one more question about the future: When will these 3-D printers be able to make us flying cars, robotic maids and jet packs

E-mail: bilton@nytimes.com

If You\'re Collecting Our Data, You Ought to Protect It

If You’re Collecting Our Data, You Ought to Protect It

LAST summer, employees at the National Aeronautics and Space Administration received an in-house newsletter illustrated with mock front pages of USA Today and The Washington Post and seemingly hyperbolic headlines like: “NASA Laptop Stolen, Potential Compromise of 10,000 Employees’ Private Information!”

The catastrophizing turned out to be prescient.

On Halloween, just a few months after the newsletter went out, a laptop used by an employee at NASA headquarters in Washington was stolen from a parked car. Subsequently, NASA sent letters to about 10,000 current and former employees and contractors, warning them that the laptop had not been encrypted. The letter explained that confidential details â€" like employees’ names, birth dates, Social Security numbers and, in some cases, personal information from background checks â€" may have been compromised.

When Robert M. Nelson, a solar systems scientist who recently retired after 34 years at the Jet Propulsion Laboratory, part of NASA, received the letter, he felt vindicated. Several years earlier, he and 27 other civilian scientists at the lab sued the agency to try to stop it from conducting open-ended background checks of researchers like them who worked on nonmilitary space projects.

“You’d think an agent of NASA would be a little more careful,” Dr. Nelson says. “Why does NASA need personal data unrelated to our work and then treat it in such a cavalier way that it is stolen from a car unencrypted”

NASA has since notified an additional 30,000 people whose personal information may have been on the stolen laptop, says Robert Jacobs, a NASA spokesman. He declined to provide the job title of the person who left the laptop in the car. But he said that there had been no indication of identity theft and that the agency has encrypted practically all of its 38,000 laptops.

By now, reports of lost or stolen business devices are so common that many people open data-breach notices from their banks, insurers, medical institutions, schools and state agencies with something like resignation. In fact, negligence by employees and contractors has been a more common cause of corporate data breaches in the United States than malicious attacks, according to a study of 2011 done by the Ponemon Institute, a research center on data security, and financed by Symantec, a data security company. Institutions, companies and government agencies often devote more resources to collecting information about employees and consumers than to protecting it, security specialists say.

“This is an unfortunate but perfectly cautionary tale of not only how we should look more carefully at protecting data after it is collected,” says Lee Tien, a senior staff lawyer at the Electronic Frontier Foundation, a digital rights group in San Francisco, “but also how the data is to be safeguarded before we collect it to make sure it isn’t used improperly or disclosed accidentally.”

Dr. Nelson and his colleagues at the Jet Propulsion Lab, which is operated for NASA by the California Institute of Technology in Pasadena, didn’t set out to become crusaders for workplace data privacy and security. Initially, they wanted only to challenge NASA’s background checks, arguing that civilian scientists had a right to keep their romantic, psychiatric and other intimate information private from the government. Besides, they contended, the space agency would not be able to safeguard the information.

The scientists took their case all the way to the Supreme Court, only to lose. In 2011, the justices unanimously ruled that NASA had legitimate reasons to look into personal issues, like whether an employee had received drug counseling. A federal law called the Privacy Act of 1974, which restricts how government agencies share a person’s data, the justices said, should protect the information obtained in background checks.

“They were clearly wrong,” says Marc Rotenberg, executive director of the Electronic Privacy Information Center, an advocacy group in Washington that filed a friend-of-the-court-brief in the case. “Exactly the problem people anticipated came to pass.”

Privacy advocates say that one obstacle to improving workplace information security is a lack of consequences for employees who compromise personal data. In 2009, for example, the Government Accountability Office issued a report, titled “NASA Needs to Remedy Vulnerabilities in Key Networks,” which urged the agency to institute whole-disk encryption for all of its laptops. Unlike simple computer login passwords â€" which can often be guessed or bypassed to get to readable files â€" disk encryption scrambles files so they can’t be read without the correct key.

NASA eventually required the Jet Propulsion Laboratory to encrypt its laptops. But at the time of the Halloween theft, not all laptops at agency headquarters itself had been encrypted. Susan Landau, a Guggenheim fellow in cyber security, privacy and public policy, says companies and agencies are unlikely to improve data security without the threat of penalty.

“What are the personal consequences for employees who allow data breaches to happen” Ms. Landau asks. “Until people lose their jobs, nothing is going to change.”

Mr. Jacobs declined to comment about whether NASA had disciplined the employee who left the laptop in the car, saying the issue was “covered by privacy.”

DR. NELSON did not emerge from his data rights battle unscathed. Caltech issued disciplinary citations to five employees of the Jet Propulsion Laboratory, including Dr. Nelson, who had used their nasa.gov e-mail addresses to send messages to thousands of colleagues about the Supreme Court decision. An employee who commits a second offense after receiving such a warning could be fired, Dr. Nelson says.

Lawren B. Markle, a spokesman for Caltech, says the employees used government resources, paid for by taxpayers, “to spam thousands of individuals, government officials and agencies, other businesses, and colleges and universities” with their political views.

“As a federal contractor,” Mr. Markle wrote in an e-mail, “we cannot allow the government resources entrusted to us to be used in this manner and particularly not to lobby for political positions.”

He added that a second warning would not automatically lead to dismissal. “The outcome would depend on the severity of the conduct and the history of the employee’s service,” he said.

The five employees have filed cases with the National Labor Relations Board, saying that they were unfairly disciplined because the e-mails were work-related.

“In the short time since the Supreme Court decision, tens of thousands of people have had their data compromised,” Dr. Nelson says. “For warning about what would eventually become true, we received disciplinary citations.”

An administrative judge is to rule on the matter in the coming months, but a Los Angeles office of the labor relations agency found merit in the scientists’ cases, concluding that Caltech unlawfully issued disciplinary warnings for the e-mails, says Mori Rubin, the regional director of the office. Her office also concluded that Caltech had disciplined the scientists for practices that other employees routinely undertook without penalty.

Such are the risks of taking a public stance on privacy.

E-mail: slipstream@nytimes.com.

A version of this article appeared in print on February 17, 2013, on page BU4 of the New York edition with the headline: If You’re Collecting Our Data, You Ought to Protect It.

Rise of Drones in U.S. Drives Efforts to Limit Police Use

Colin Diltz/The Seattle Times, via Associated Press

A Seattle police officer, Jim Britt, with a drone in October. Seattle later banned use of the devices.

They can record video images and produce heat maps. They can be used to track fleeing criminals, stranded hikers â€" or just as easily, political protesters. And for strapped police departments, they are more affordable than helicopters.

Watching You

Some police departments and other law enforcement agencies have been eager to showcase their drone programs, via YouTube:

• On the Seattle Police Department
• From the Mesa County Sheriff’s Office in Colorado
• From the United States Border Patrol

Drones are becoming a darling of law enforcement authorities across the country. But they have given rise to fears of government surveillance, in many cases even before they take to the skies. And that has prompted local and state lawmakers from Seattle to Tallahassee to outline how they can be used by police or to ground them altogether.

Although surveillance technologies have become ubiquitous in American life, like license plate readers or cameras for catching speeders, drones have evoked unusual discomfort in the public consciousness.

“To me, it’s Big Brother in the sky,” said Dave Norris, a city councilman in Charlottesville, Va., which this month became the first city in the country to restrict the use of drones. “I don’t mean to sound conspiratorial about it, but these drones are coming, and we need to put some safeguards in place so they are not abused.”

In Charlottesville, police officers are prohibited from using in criminal cases any evidence obtained by drones, also known as unmanned aerial vehicles. Never mind that the city police department does not have a drone, nor has it suggested buying one. The police are not barred from using drones for other efforts, like search and rescue.

Mr. Norris said the advent of new policing technologies poses new policy dilemmas for his city.

Charlottesville permits the police to install cameras temporarily in areas known for drug dealing, but it has rebuffed a police request to install cameras along its downtown shopping corridor. It has also chosen not to install cameras at traffic lights to intercept speeding cars, as is common elsewhere.

“Drones are capable of taking surveillance to a whole new level,” Mr. Norris said.

Last week, the Seattle Police Department agreed to return its two still-unused drones to the manufacturer after Mayor Michael McGinn answered public protests by banning their use. On Thursday, the Alameda County Board of Supervisors in Oakland, Calif., listened to the county sheriff’s proposal to use federal money to buy a four-pound drone to help his officers track suspected criminals â€" and then listened to raucous opposition from the antidrone lobby, including a group that uses the Twitter handle @N.O.M.B.Y., short for Not Over My Back Yard.

This week, members of Congress introduced a bill that would prohibit drones from conducting what it called “targeted surveillance” of individuals and property without a warrant.

A federal law enacted last year paved the way for drones to be used commercially and made it easier for government agencies to obtain them. The Department of Homeland Services offered grants to help local law enforcement buy them. Drone manufacturers began to market small, lightweight devices specifically for policing. Drones are already used to monitor movement on the United States’ borders and by a handful of police departments, and emergency services agencies around the country are just beginning to explore their uses.

The Federal Aviation Administration has received about 80 requests, including some from police and other government agencies, for clearance to fly drones, according to a Freedom of Information Act request filed by the Electronic Frontier Foundation, which seeks to limit their use for police surveillance.

Law enforcement authorities say drones can be a cost-effective technology to help with a host of policing efforts, like locating bombs, finding lost children, monitoring weather and wildlife or assisting rescue workers in natural disasters.

“In this time of austerity, we are always looking for sensible and cost-effective methods to improve public safety,” said Capt. Tom Madigan of the Alameda County Sheriff’s Department. “We are not looking at military-grade Predator drones. They are not armed.”

For now, drones for civilian use run on relatively small batteries and fly short distances. In principle, various sensors, including cameras, can be attached to them. But there is no consensus in law on how the data collected can be used, shared or stored.

A version of this article appeared in print on February 16, 2013, on page A1 of the New York edition with the headline: Lawmakers Set Limits on Police In Using Drones.