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EC Container 5

Illustration: Hospital ER - Part 1 of 2

Hospital ER

The goal of this scenario is to introduce the concepts of efficiency levels, prediction, context space (the ER entry area), and network visibility (cannot see the parking lot).

There are two key characters, Janet - Director of Ecopoesis at a large health care organization and Richard - Janet's musician husband.

The scene takes place in the ER.


Warren Jones, Lana Rubalsky (2010) "Illustration: Hospital ER", wJones Research, January 18, 2010

Parts: 1 | 2 Next >>


Ecopoesis - The science of creating an efficient ecosystem by enabling biological, mechanical and ecological components to share goals and optimize goal pursuit via cooperative planning.

Richard Meets Janet at the Hospital ER

I was driving to pick Janet up from work at noon as I usually did on Fridays. She was the Director of Ecopoesis (eco po e sis) at Ashtin General, the largest healthcare provider in the county. Ecopoesis or eco-poetry as my son calls it, is the science of creating an efficient ecosystem of biological, mechanical and ecological components by enabling cooperative goal pursuit. Basically, she’s the chief geek, and lately she’s been pretty much consumed with completing the transition from stored-program to stored-purpose based intelligent computers and bringing the hospitals up to level four (L4) efficiency.

L4 is an impossible task, or so I used to think. Now, all you have to do is IC enable everything and let the monkeys tweak the results. No, that’s not really true, I only said it once to Janet when she arrived home very late. She’s responsible for uplifting a very complex system, a network of twenty thousand people and hundreds of thousands mechanical and ecological units. To uplift this system, or make it intelligent as L4 requires, Janet is IC enabling everything to be supported by agent technology, each agent assisting staff, coordinating surgical suites, tracking medical instruments, managing energy or monitoring security. Janet once told me that agents even monitor grass growth and duck droppings, and I don’t think she was being facetious.

I think she believes that the new technology will make the hospital a joyous, efficient running, near paperless world. Though I hope she’s successful, I am still skeptical at times. She’s been at it for nearly four years, first installing the two Automation Appliance machines, then coordinating the arduous effort to connect unit by unit to the agents. With each room and section of the hospital, her team must validate the agent’s ability to optimally pursue goals. So she spends a lot of time computing maximum value plans room by room, department by department and lately, for the entire hospital system.

Once this phase of the project reaches completion, the entire healthcare system will be L4 efficient. People, agents and small mobile transports called bots will work together to eliminate wasted effort via mutual coaxing, smart automation and teamwork. Janet will continue to monitor and control agent learning and performance.

She has told me she also expects to spend a lot of time ensuring the system has enough degrees of freedom to sustain a gradual improvement. You see, if a messenger bot gets blocked by something it can’t understand, it can go online, exchange a brief video and download an understanding of it all in the time needed to slow down. If it finds out it’s an empty Chinese food carton, it won’t slow down. If it determines it’s a baby, it will call for help. That ability to learn on the fly requires certain degrees of freedom such as, learning about new objects and tapping into external learning sources. Most companies, including Janet’s want some level of control over their systems learning. It’s OK for a doctor to read an outside journal and perform a new procedure (as long as his assistant agent logs it), but bots and med techs should stick to the approved hospital plans or ask their supervisor.

So Janet has to make sure the mechanical members of the hospital have just enough freedom to be efficient but not such that they increase liability or replace the grounds maintenance department with a herd of grazing sheep (as I’ve heard the European systems are prone to do).

Eliminating effort may sound boring to you, like the gray haired efficiency expert of the 1960’s. That’s how I imagined it when Janet first took the job five years ago. Maybe it was initially like that, before the L2 project that added IC adaptors to everything and the L3 project that connected each department’s systems to coordinated Lift agents. What I found was that whatever stodgy image of efficiency I may have had couldn’t have been further from the truth. Janet had been working seemingly for months to finish up what she called the last phase, for a while anyway. She called the project “Uplift”, and said that it would bump-up all of the department Lifts into a single agency. There was still one more phase of the project that would coordinate all US, EU, India, China and Brazil hospitals in a government-sponsored L5 Agency for disease and emergency response. But fortunately for us, the government was years behind schedule. Janet hadn’t been able to attend many of my concerts lately. I miss having her around to have drinks with her after the gigs.

I arrived at the hospital twenty minutes before noon. Janet said she would be monitoring prediction failures in the ER so I should park near that entrance. I did. As I approached the hospital, a car stopped in front of the ER door, and an obviously scared woman jumped out of the driver’s seat. Without closing her door, she ran around to the opposite passenger door and started to lift an unconscious girl, who I assumed was her daughter.

She did not get very far. As she opened the door, an entry assistant tapped her on the shoulder and with eyes that conveyed both empathy and urgency, convinced the mother to let him take over. The assistant, lifted the daughter from the car and twisted a half meter to place her on a gurney that had locked itself in place just a second earlier. A nurse and doctor began connecting plastic tubes that seemed to have sprung from a Jack-in-the-Box as soon as the girl’s back touched the table. The assistant, with a new expression of melancholy and confusion, nodded to the right toward the patient and to the left toward the open door, carefully removed the keys from a partially understanding mother and proceeded quickly to park the car. The mother woke suddenly from her brief stupor, noticing that her daughter was in motion. She followed her, a nurse and a doctor through the door.

It was then that I noticed my wife, smiling at me, or so I think. Her glance split time between me, a binder she held in her hand and some point above her head, which I knew was the projection in her glasses.

“What are you smiling at?” I asked.

“You … and the performance of the mobile response team” she said. “Do you realize that your mouth has been wide open for the last several seconds and that you are doing that head bop you do when watching a concert?”

“I was?” I responded, just half a question, now that reality was catching up with me. “Nice music, particularly for the outside of an emergency room,” I said. “You saved so much on the project that you decided to put in surround sound?”

“The sound system was actually part of the project,” Janet replied. “Notice anything else?”

“Other than I like the music? I don’t think so … although now that I think about it, I think your med team liked it too.”

“How so?” she said.

“It’s almost certainly my imagination, but it seemed like everyone was dancing to it,” I said. “I know that’s impossible, as they were working, really fast it seems, … the whole exchange with the car couldn’t have taken more than 30 seconds.”

“Twenty-two point six,” she said after a brief eye shift through wryly smiling lips that made me suddenly glad she was nearly finished with work for the day.

“Indeed, … yet despite their speed they seemed to move in concert, like a ballet. When the entry assistant lifted his hand to touch the mother’s keys, it looked as if he was taking her hand to dance. Now that I think about it, everything seemed to happen on beat … patient lift, gurney stop, patient drop, sensors pop, IV stretch, IV in, hands back, gurney go, and finally exit stage right.”

“Honey, I think you are gunning for my job,” Janet said.

“How so?” I replied.

“You just flawlessly described what happened. I think I am going to make you an honorary agent,” she said, again with that wry almost sarcastic smile.

“You mean this was all scripted? The patient, the response, the music?” I exclaimed, while feeling a little duped.

“No, it was real … but the agents predicted the response, arrival time, med tech to assist with patient, the need to drive away the car, doctor and nurse arrival time, gurney configuration, even music.” She continued, “take a look here,” and slid her glasses over my ears so I could see what I vaguely recognized as a prediction table overlaying a 2D diagram of the ER greeting area were we stood.”

“What’s the red X near bottom left?” I asked.

“A pending prediction failure, but I didn’t think we had any,” she said.

Janet quickly scratched “failure list•” on a sheet of paper in her binder with the little dot silently instructing her assistant agent to process immediately and read the ePaper summary result. She then started laughing.

“It seems that the med tech had no place to park. He’s still out there looking for a space and therefore the planned resource gap for a procedure he should have been available to attend.”

I felt embarrassed. “You mean that I caused the prediction failure by parking here?” I said. “Did that mess things up? Will you have to work longer?”

Janet continued chuckling and said, “No. You didn’t mess up anything and I won’t have to work longer. The hospital decided it would cost too much money to fully integrate parking so we did it inexpensively with extra field of view on the security and grounds maintenance cameras. There are blind spots the agents can’t see accurately, so we’ll get a miss now and then. The point is that we have an emergency room that was able to get an unconscious patient in treatment in half a minute and we lost no more than a few minutes in waste resource utilization in making it happen. That, my dear, means we are one kick ass, smooth dancing, L4 organization. For that I deserve a bonus, so you had better be taking me somewhere nice for lunch.”

I bent my nose as Janet gently took back her glasses. I squinted sheepishly as I uttered a response, “Cheeburger Cheeburger?”

“Perfect,” she said.

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