Monthly Archives: May 2016

Software Engineering in Health Systems Workshop 2016 – Where Engineering is Not Enough

This weekend I had the opportunity to attend the Software Engineering in Health Systems (SEHS) Workshop in Austin Texas. Through a series presentations, panels, and group discussions on a range of health care systems topics two main themes seemed to arose:

  1. Health care is an information intensive domain in which contemporary software engineering techniques are ill-equipped to operate. Systems engineering techniques seem to handle the problems more easily (though significant work is required).

  2. Though health care professionals and engineers seem to collaborate in these environments, they each fail to fully grasp the perspective of the other; this results in “half-way” solutions which, address an immediate need but are brittle and ultimately result in system instability.

The good news, in my opinion, is that the solutions to these problems do not require tremendous innovation in science or engineering. Instead, they require the correct allocation of human resources to the right problems.

In fact, allocation of resources (including humans) is one of the three main views (others are static and dynamic structures) from which you can consider the architecture of a software system; these problems are architectural in nature.

I think, the solution to (1) is to bring software engineers to tables in which systems decisions are made. Kevin Sullivan made this point beautifully in one of the workshop discussions. He indicated that software engineers are trained to think about systems issues already; if they can be part of the discussion about the socio-technical systems in health care then we will begin to see progress.

(2) is a matter of education; interestingly though, I think, the problem cannot be addressed by another classroom course in a standard undergraduate education. In my experience, the knowledge required to understand the complexity of the operations being carried out in both health care and software engineering requires a more tacit type of knowledge one can only acquire by activity being part of the environment. Joachim Reiss, VP of R&D at Siemens Health Care, made this point exquisitely clear in his keynote presentation: we need to get engineers into hospitals and health care providers into design labs.

Of course, neither of these problems are trivial, they involve complex social and political structures that make change, especially social change, tremendously difficult. This is simultaneously a great and maddening realization. It is nice to know that we are very capable effecting massive change in health care systems through social change, however it is clear from history (and recent events) that social change can be extremely difficult to enact on a large scale. Sadly, as much as I wish we could, we cannot rely strictly on engineering to get solve this problem for us.

Finding Twitter Conversations

A Twitter conversation is a series of tweets that usually revolve around an initial tweet. The initial tweet is defined as the root of the conversation, and the rest of the tweets in the conversation would “stem” or “branch” from the root. Finding the root is relatively simple. For example, to find the root of a conversation (or conversations) about “warfarin” a keyword search is performed. Any tweet containing the word “warfarin” would be considered to be a conversation root. The trick is how to define and find “branching”. Branches are tweets that can form a coherent conversation when attached to the root.

Natural Language Cues

One technique is to look for linguistic and textual cues to indicate possible branches. Possible initial branches are replies to the root. Replies to the root tweet cannot be found directly. They can only be found through replies to the user that tweets the root (root user) through the @ symbol (or other variations). So a @root_user string would indicate a reply to the root user, which could be a reply to the root tweet or a reply to another one of the root user’s tweets. Also, any @ in the root tweet indicates that the root user is replying, to another user, with the root tweet. These users being replied to could also potentially write tweets related to the root tweet (reply-to tweets). Figure 1 below illustrates the different components of a twitter conversation.

Example Tweet Conversation-1
Figure 1: Example Twitter Conversation

To find whether a reply or a reply-to tweet is a branch of the root tweet (and therefore part of the conversation), further natural language analysis is required. Such tweets must form a coherent conversation with each other and with the root. The key for finding coherent conversations is to find terms that are possibly related that would act as links between the tweets. For example, a drug and an adverse drug event (ADE) could be related terms. Using such links as a starting point, dependency parsing algorithms would do the heavy lifting of connecting individual tweets into a conversation. The shortest dependency path measure [Liu and Chen 2013] (see figure 2 for example) could be used to find terms with a high probability of being related terms.

Figure 2: Example of a Shortest Dependency Path for a part of the Last Tweet in Figure 1

Tweet Networks

Reply and Reply-to tweet network extend beyond the root tweet as each reply and reply-to tweet to the root can have its own reply and reply-to tweets. Reply and Reply-to tweets can form interesting networks. Well connected users or central users in such a network can be very important parts of a conversation and deserve special attention. These networks are directed graphs where each node would represent a user, and each node would be a tweet pointing from the sending user towards the receiving user. There are two main measures of centrality for each user in a reply and reply-to directed user network. Closeness centrality measures the average shortest path between a user and all the other users in the network. Betweeness centrality measures the number of shortest paths where a user is in the shortest path between two users. It is usually expressed as a probability that a certain user will be in the shortest path between any two users in the network. Both measures point out users that maybe central and important part of a conversation. The tweets of these users could form the main parts of a conversation. Figure 3 illustrates one example of these networks.

Example Tweet Network
Figure 3: Twitter Users’ Tweet Directed Graph Network


Liu, Xiao; Chen, Hsinchun; AZDrugMiner: An Information Extraction System for Mining Patient-Reported Adverse Drug Events in Online Patient Forums, ICSH 2013, LNCS 8040, pp. 134-150, (2013)

Debriefing on the Apple-FBI Debacle: The Aftermath

The Event

As many of you may have heard, in February the FBI requested that Apple make a modification to their systems to allow them to have access to an encrypted iPhone — which swiftly invoked the ire of the security community. Many experts asked why the FBI would even ask such a “ludicrous” and “short-sighted” question. They questioned the FBI’s understanding of basic encryption principles and quipped that the decision must have been made by a politician since no security expert would have made such a request. They further pointed to the past revelations about Snowden’s leaks and how many government associations have recently (and continue to) abuse the powers they have been given in this area.

Many worried that such a request would set a precedent, and even the FBI director admitted that it most likely would.

Apple responded in kind and denied the request. This signaled the start of significant political posturing by both players to garner support for their cause. The security community and many industry leaders quickly sided with Apple.

Ultimately the FBI elected to contract a third party who used an unknown exploit to gain access to the device. Both parties ceased their posturing and stood down.

The Aftermath

Three months later we observe the resulting fallout of this debacle.

Before this event even happened, trust in the U.S. government was near an all-time low, and this event did little to instill further confidence.

Beyond this, some have claimed that Apple “won” the battle as they did not provide the requested modifications — The FBI found another way around that did not require a court decision. This may be premature.

What Apple did do was prevent (for the time being) the FBI from having easy access to any iPhone they want in a systemic manner. This is important since the previous abuses of power stemmed from easy and systemic access to data (with or without warrants.

Prevention of such access requires the FBI to treat each case as its own separate issue:

  • Get the physical device
  • Get a warrant to gain access
  • Breach that specific device
  • Search for the evidence they need

The difference is in the difficulty and the case-by-case nature. It is not easy to do this process for 100,000 devices at one time. And it should not be. That is beyond the scope of a single case and some would say borders on surveillance-level.

As with most things, there is no black-and-white. There is always a trade-off between privacy and security, and it is not always clear which path should be taken.

What must be considered is that each breach of privacy for sake of security is a one-way transition. By breaching privacy through court-order, or through legislation, a precedent is set. This makes subsequent and wider-scope breaches easier. Alas there is an opportunity cost to our drive for total security. By resisting the FBI, Apple has resisted the erosion of privacy on a systemic level. Access to the device was still gained, but not through systemic means.

Furthermore, this event has heightened the awareness of privacy in the general populace. This can only be taken as a good sign. One should take their privacy seriously and be critical of any institution that intends to infringe on it. Not only did individuals take measures to secure their privacy, but other institutions did too. WhatsApp decided to strengthen their encryption as a direct result of the Apple case.

Unfortunately, the lack of precedent also means that this particular conflict may arise again in the future. And that future may include some event that spurs the government to forgo long-term thinking and rationality for a short-term solution to their immediate problems… Because, that hasn’t happened before.

All-in-all the result is favourable to both parties. Apple is enshrined as an advocate for privacy and maintains its position without alienating their consumers, while the FBI was able to ultimately gain access to the device in question.

As for the future? No-one knows.