Tingenes Internet

Teknologirådet inviterede den 4.10 til opstart på et projekt, der har til formål at belyse mulighederne for anvendelsesområder og de særlige sikkerhedskrav, der vil opstå, når 'tingenes internet' meget snart bliver en realitet. Mødet blev indledt at Kim Escherich, IBM, der har ansvar for 'tingenes internet' og 'smart planet' hos IBM. Denne film illustrerer begrebet og IBM's synspunkter på emnet.

Alle IT-firmaer og konsulenthuse er begyndt at interessere sig for emnet – se f.eks. McKinseys blog, Sun's side allerede fra 2003 om 'The Internet of Things' og ikke mindst netværksleverandøren CISCO.

Men kan vi definere begrebet lidt nærmere og lidt mere operationelt? Vi opfatter tingenes internet som de ting – enheder, processorer, lagringsenheder, 'apparater' – der har en IP adresse og som kan kommunikere via internettet. Uanset om det er lukkede, krypterede net, der bruger internetprotokollen eller enheder, der er forbundet i det 'store' internet.

Der er i dag mere end 20 mia af sådanne enhedser, og estimatet for 2020 er 'mindst 50 mia'. Det skal sættes i relatiuon til dagens 2mia registrerede menneskelige internet brugere.

Men allerede i dag har vi 5 milliarder mobil-telefonbrugere, som formodentlig inden længe også vil indgå i det, som IBM kalder 'a system om systems'.

Når vi taler om 'ting' , kan de optræde i principielt 2 forskellige roller: som detektorer eller som 'effektorer'. (Jvfr. Hood & Margett). En detektor er noget, der kan opsamle data, måle, 'se' – og en effektor er en ting, der kan udføre noget: åbne en dør, skifte et signal, starte en motor, manøvrere et køretøj. Men detektorer og effektorer er instrumenter, og for at vi kan anvende dem i et netværk, må der nødvendigvis også være en logik, en intelligens, et program, der baseret på de opsamlede data kan foretag en beregning og ud fra et regelsæt beslutte hvilken effektor, der skal anvendes og hvad den skal gøre. Verden er 'Instrumented, Connected & Intelligent'.

Når man er blevet enige om denne grundlæggende beskrivelse, er det også klart, at 'det semantiske web' spiller en stor rolle i definitionen af data interfaces, snitflader og resultatet af de intelligente processer. Det vil hjælpe os til at sikre, at vidt forskellige 'ting', der er etableret med vidt forskellige formål og med vidt forskellige bruger/kundegrupper potentielt kan kommunikere med hinanden. Eksemplet er f.eks. Velfærdsteknologi, hvor en alliance af producenter af intelligente målesystemer – CONTINUA – har formået at sætte nogle standarder, der sikrer at enhederne kan kobles til f.eks. den samme 'hub' via veldefinerede interfaces. Der er behov for en endnu bredere definition af denne type platform, så den f.eks. også vil kunne tilkoble detektorer og effektorer, der anvendes bredt til overvågning, styring af intelligente huse (Se f.eks. Phillips projekt) , som kan indgå i intelligente grids vaskemaskine, køleskab), åbne garageporten, styre temperatur o.s.v. Se præsentationen om 'intelligent grids' , der beskriver formålet med disse grids og hvilke typer udstyr, man tænker vil blive koblet på dette net. Det ser ovenikøbet ud som om Danmark har en styrkeposition på området, se f.eks. denne præsentation:

Blandt anvendelsesområderne er det naturligvis værd at bemærke, at man f.eks. på fødevareområdet er begyndt at indføre chips, der kan garantere sporbarheden af oprindelsen – ('klap din bøf') – og derved bidrage til større forbrugertryghed, (Se RFID projektet vedr. fisk) - men i en næste version, hvor chippen kan registrere hvad der sker med kødet, hvor frisk det er, om der er giftstoffer eller tilsætningsstoffer, kan man få forbedret fødevaresikkerhed og reducere spild. Man er ikke længere afhængig af en meget grov vurdering stemplet som 'sidste salgsdato', men kan rent faktisk 'se' om kødet er hensigtsmæssigt som menneskeføde. En chip i frosne hindbær vil kunne afsløre forgiftningsrisiko. Undgå spild og effektivisere transport er et stort område, men vi kan også se fremkomsten f.eks. af intelligente betonklodser, der ved præ-fabrikerede byggelementer kan fremskynde byggeprocessen og efterfølgende kontrollere holdbarhed for at effektivisere vedligehold. (Se det nordiske project om sporbarhed og sikre fødevarer)

Intelligent videoovervågning er allerede en realitet, hvor videokameraer kun logger sekvenser, såfremt der optræder overtrædelser af programmerede regler, f.eks. for bilers hastighed, placering på vejen, personers opførsel og adgangsforsøg til specielle arealer, døre el. l.

(Se f.eks. Chigacos intelligente videoovervågningssystem)

Blandt de mere kuriøse er 'intelligent sand', der oprindeligt blev udviklet til militært brug, så et antal små chips, der kan kommunikere med hinanden og som indeholder 'logik' kan bedømme, om en fjendtlig kampvogn eller en deling soldater passerer et område, og herefter via satellit uploade simple måleresultater. De civile anvendelser for dette er f.eks. temperaturovervågning af skove, hvor der er særlig stor risiko for skovbrande, og ved overskridelse af en tærskelværdi uploade GPS-data til en satellit.

Hele transport- og trafikområdet er en klasse af anvendelsesområder for sig – potentielt bruger bilister i en by dobbelt så meget tid på at lede efter parkeringspladser som teoretisk nødvendigt, hvis et system kunne holde styr på ledige parkeringspladser og gelejde søgende biler til pladsen. Det kræver naturligvis at et 'stor' andel af biler og parkertingspladser er udstyret med detektorer , forbundet til en regelmekanisme, der kan styre effektorer i biler.

Man kan forestille sig, at dette system potentielt anvendes til helt at undgå human intervention i biler, der ligesom fly køres automatisk. Se her Google's præsentation af 'driverless cars'.

Hvornår når vi 'the tipping point'? - det tidspunkt, hvor mængden af 'ting' er så stor, at der produceres løsninger ('apps') i en tilstrækkelig kvalitet og med tilstrækkelig lav pris til at sikre den fortsatte udbredelse? ( Der er allerede i dag downloadet 10 milliarder apps!) Er det 'top down' bestemt – som hvor sygehuset eller kommunen beslutter og installerer overvågning af kronikere? Eller det brugeren, der afgør om hun vil ha' de intelligente systemer og enheder? Hvem afgør kvaliteten? Og hvor må man være opmærksom på en potentiel umyndiggørelse af brugeren? Dette er nogle af de spørgsmål, som en kraftig forøgelse af anvendelsen vil rejse.

Det kan i høj grad opfattes som et 'hønen og ægget' problem, at der ikke fremkommer særlig mange løsninger, fordi der ikke er særlig meget efterspørgsel – men at dømme ud fra eksplosionen i antallet af apps til smartphones, vil et mængdemæssigt gennembrud kunne ske når som helst – og især hvis standarder og interfaces er åbne og tilgængelige.

Adgang til data, opsamlet af detektorer, Business Intelligens, data mining og ekspertystemer, der 'forstår' betydning af data og kan træffe automatiserede beslutninger, er en del af web 3.0 konceptet, og jo længere vi når i retning af at kunne lave intelligente tekstananlyser, begrebsanalyser og drage slutninger, jo bedre vil 'tingenes internet' kunne fungere. Men jo mere afgængige bliver vi samtdigt af løsningerne, og det kræver overvejelse, hvorledes vi kan sikre et mere og mere livsvigtigt system. Som Nordahl Grieg sagde: 'Lænker de slaver til dig, lænker de dig til sig'

Crowd sourcing, hvor man i mere community- netværker udvikler og raffinerer løsninger, er også en mulighed. Eksemplet er her fra Japan, hvor Fukushima-katastrofen ikke fra myndighedernes side blev dækket godt nok med præcise målinger om strålingsfare. Her anskaffede en mængde japanerne på privat basis geigertællere, og ved hjælp af et hollandsk web site kunne man nu få aktuelle oplysninger om stråling, vindretning, forecast etc.

Alle disse applikationer stiller krav til indtænkning af beskyttelse af private data. Alle steder, hvor personhenførbare data kan kobles til kritiske målinger, holdninger, handlinger, eller bare geografiske positioner på givne tidspunkter, skal man overveje med henblik på i sin videste konsekvens at lade brugeren selv styre, hvem der kan få adgang til disse data. Sikkerheden i 'tingenes internet' er en udfordring, og 'privacy by design' er et krav. Man kan ikke tilkoble det bagefter, det skal indlejres i løsningen fra starten. Det kan være pseudonym-baseret, det kan være 'trusted 3^rd party', der har nøglen. Og det diskuteres i en anden sammenhæng senere i Teknologirådets spændende projekt.

e-Government - Outlook 2011

It seems to be a common practice for newsletters, newspapers and magazines to publish expectations for how trends in technology is going to affect our everyday life in the coming year.

As Gartner already discovered several years ago, some of these predictions turn out to be mere hype, not yet ready for large scale implementation, while other trends seem to emerge without anybody watching until they are suddenly there.

With a clear risk that some of my predictions will fall in the first of these ditches, I will try to come up with a qualified guess as to what kind of e-Government solutions we can expect to see in 2011 – not in every country – (particularly not my own home country, Denmark, who will be stuck with an election that will be a decisive factor in any kind of new investments in e-Gov) – but at least in some of the other, more advanced countries.

So let's look at:

• The iPad and tablets

• Cloud Computing

• Internet of things

• Social computing and eGov 2.0

• Interactive Health Care solutions

• Mobility and Identity Management

• Business Analytics – 'smart computing'

• Green computing

Everybody is fascinated about the rapid take-up of the iPad. The impact for Government will be clearly best suited for the education and and training area with lost of new teachware applications based on Apps and networking solutions. However, I expect the education sector to focus much more on the Android marketplace due to the pressure on costs, while the iPad will be reserved for the more expensive segments, interactive magazines and business applications, where the tie-in to Apple is of lesser importance. For the real large scale market it is going to be exciting to see if Tata's new 30 $ tablet PC takes off. If this is the case, ICT literacy in the third World may become a reality.

Cloud Computing and eGovernment at this stage seems to a bit of a contradiction; until the privacy issue is solved and firmly agreed upon between EU, US and Asia, Cloud computing in Government has to be restricted to private clouds where the actual location of data can be proved. If however, a new 'safe harbour' agreement can be made between EU and US we may begin to see large scale cloud computing for a lot of central and local government solutions. The pressure on economy and costs inevitably points in this direction, but my best guess is that before Cloud Computing can become a dominating factor for e-Government, at lot of consolidation and a phase of virtualization for major, old fashioned applications has to be made. As the cobol programmers are dying out, there will be a market for new main frame skills as this will be the next step before virtualization and before cloud computing for real.

Internet of things – as RFID enters any business, we can expect a number of new applications for eGovernment: traffic control, customs inspection, fishery inspections, health care provision controlling logistics, food inspection and drug control will be obvious areas, and I expect quite a number of new applications in this area.

Social Computing and eGov2.0 has been on the agenda for quite some time – and even if recent OECD analysis and predictions seem to demonstrate that a large number of public sector managers expect that web 2.0 is just around the corner in several corners, the up-take in reality has been quite slow. Where it has been emerging it has clearly been implemented in a sort of protest against existing 'official' solutions. In UK, for instance, the group that has published a mash up solution to identity which farmers have received the most funding from EU, is one example. 'rate my teacher' in US is another.

In some countries Government has tried to open up databases for the public – but only in a vey limited scale. In Denmark, for instance, the Minister for IT awarded an innovation award to a Danish girl who produced a GPS-based mash up that could tell the shortest distance to a public toilet. Practical, but hardly an example of citizen inclusion. My expectation is that in 2011 the best eGov 2.0 solutions are still left with the rebels.

Interactive Health Care (formerly labelled Telemedicine) is long overdue and it my hope and expectation that 2011 will see the first real, large scale applications aiming at supporting chronically ill persons in their own home. The cost pressure is simply too massive to let this low hanging fruit untouched. The major problem is not the ICT equipment as such but how to rethink the organizational aspects behind the solution – hot line support services, surveillance personnel, lines of communication with doctors, specialists, hospitals. I dare state that any of the Nordic countries really could start this on a large scale so we could move from the pilot state of affairs where we have been stuck for the last 10 years.

Mobility and Identity Management will most likely be 're-invented' in 2011. Now that most EU countries (expect Denmark) has issued smart card ID-solutions, the next phase will merge intelligent mobile phones with ID-solution and payment cards. This will enable citizens with a limited ICT capability to come to citizen service centre and by means of the mobile get help to access the public services in a secure way. Already in some 3^rd World countries the mobile phone is used as a payment device, and there is no reason why we couldn't use this in other more 'advanced' countries.

Business Analytics and large scale computing (also using cloud scalability) is rapidly gaining momentum in the World of Science. But as a predictiontool for social development, economic trends, electricity usage, flood control, traffic control, disease management, the current state of massive parallel computing and the sw-tools around it will lend itself to better use to formulate and test public policies; from demographic forecasts in the 70'es to climate and emission control in 2011 and beyond is a clear line. We have the tools by now, and particularly the climate issue should make this kind of applications much more attractive as an investment area for politicians that look beyond their own nose.

Green computing is really a combination of virtualization, mass storage, cloud computing – and maybe also open source computing. As computers account for 2% of all electricity consumption and 2/3 of this is really costs of running idle, the ICT industry has to assist in optimizing use of power for ICT. And the public sector seems to be extremely well fitted for being the first area where ICT could be utilized in a much more intelligent way. The next step, as we have seen in some countries, will be to invest in intelligent electricity networks and to use international exchange systems to optimize the use of power.

So there will be a lot to look for during 2011 – as a tax payer I will state that any government has an obligation to review current use of ICT - not as a stand-alone exercise, but in a close relation with the strategies and policies to make the public sector more efficient, fine tune processes and skip outdated procedures, re-use data and information and empower the citizen in a way that will make it much more attractive not only to use self-service, but also to participate socially and assist relatives, neighbours and people in the local community. It will probably be the only way the Western Welfare Society as we know it may survive.

BIOMETRICS - The Danish Perspective

To day I had the pleasure to participate in the network for Biometrics in Denmark. The network was originally established by Frederik Kortbæk, DeLoitte and others, and todays' meeting had 3 major elements, at status report from the Danish National Police on the biometric passports, a presentation on identity management by Omada, and a user report from the leading architect of the Capital Region, the organisation responsible for hospitals for 1.6 mio inhabitants in the Greater Copenhagen Area.

The representative from the Danish Police was Mrs. Lene Gisselø, a lawyer, presented the status of the bio passport. The passport is based on the EU Directive 2252/2004.

The directive is of course based on the increased focus on terrorism, and demanded the member countries to implement a 2-step strategy, first passports with photos of the card holders, which has always been the case in Denmark, and 2. step due in june 2008 to implement biometric fingerprints as part of the passport. (See the Technology Board report on Biometric Passports - where it is pointed out that also illegal immigration is supposed to be less after the bio passes are introduced. )Denmark is lagging behind the original target date, and in spite of a tender issued 2 years ago and supposed to be closed months ago, is still not signed. The tender called for multiple types of equipment to be used by the municipalities, by the foreign office's representations around the World and by the department for immigrants in Denmark. It was stated that one of the reasons for the delay is the lack of funding, as the preferred vendor was well above the allocated budget.

What wasn't mentioned was that in the meantime 20 municipalities out of the 99 already have established a local workplace to issue not only passports, but also driver's licenses, motor vehicle licenses etc. If the budget discussion drags out much longer, the wisest thing to do will probably be to drop the tender and open a new one based on the experiences with the municipalities.

Lene Gisselø presented all the security features around the Danish passport and pointed out, that even if the holders' picture and fingerprints were stored centrally during a 3-5 week period until the passport was duly delivered to the holder, there would be no centrally stored register on biometrics of the data – 'even if it would have benefitted the police'. The locally captured data is encrypted, the BAC method used to store the photo, and EAC to protect the fingerprint data. Also Lene G. discussed the enormous task of cross-certifying all passports within the European Community.

From the audience a question was raised why the Police didn't choose the 'Match on Card' method for authentication in stead of 'Match off card'. The issue here is that when the border police checks the passport, the passport officer takes a photo of the visitor, takes a digital print of the fingerprint and then let the SW on his workstation extract the data from the passport, convert to some sort of algorithm (which may vary between the countries), and then makes the comparison based on his local algorithm. This means that the data from the passport has to be extracted and at least for some time resides in another computer. The alternative method would be to have a chip residing in the passport with the capacity to perform the comparison without having to extract any data from the passport. Lene G's answer to this question was that is was what met the EU defined standard specifications. This of course raised the question if other countries in Europe were legally prevented from storing biometric data from Danish passports, and the answer to this is, that probably there is no legislation in place to prevent this. For instance UK and Netherlands have active plans to compare the extracted data with the criminal records. The representative from the Data Protection Agency, Janni Christoffersen, pointed out that although the Privacy Officers' forum, the WP29, was looking at these issues, no common agreement has been reached yet. See this excellent book on other outstanding issues regarding use of biometrics, commented buy the WP29.

The question after the presentation remains that one might wonder what will happen to the tender and the selected solution now 12 months after deadline while the World is changing and technology progressing.

The second presentation on Identity Management from OMADA corporation was an OK run down of the issues of ID management, but it clearly showed the lack of standard solutions in a Microsoft world based on Sharepoint, where Omada clearly filled a gap in providing multiple roles access management admin solutions, deploying even Kerberos in a federated security environment, but compared to the solutions offered by for instance the Tivoli portfolio and a Websphere environment, the presentation was not that ground breaking.

The 3^rd item of the day was presented by Claus Thorsen, who is the lead enterprise architect from the IT department of the Capital Region. (Region Hovedstaden). This is a merger of 3 former counties, the Island of Bornholm and the city of Copenhagen. They are responsible for the health care and the 12 public hospitals int he region, producing more than 800.000 in take patients pr. year.

Claus' topic was based on the defined need for a single sign on solution for use in the hospitals; One hospital department (Gentofte) claimed, that due to the security regulations, logging on/off, changing workstations, registration of patient data at centrally placed terminals etc. required one additional medical doctor.

Against this, the National Health Domain committee has come to the conclusion, that only 1.2 minute pr. day is waisted because of long log-in procedures.

Claus took us through all the tedious steps required to register patient data, and where he hoped that 'some day' a biometric solution would help. One example is the use of the so-called Medical Card, introduced to increase patient security, so that the doctor checks that the right patient is getting the prescribed medicine. In order to access this application, the doctor is required to use his digital signature issued by the hospital. When he has signed and logged in, he has to make an additional log in using the digital signature to access the Medical Card application. But what happens if the doctor is ill and a substitute has to do the checking? You can't have fast track issuance of official digital signatures, and the result is that the doctor's from time to time borrow each other's digital signature. And this is only one example.

The most promising solution at this stage is to use virtual desktops, so that the desktop of each doctor remains 'active' in a sort of private cloud, so that it is much faster to check in at another terminal later. The Virtual Desktop Infrastructure is one possibility, but the enormous variation in clients and PC-equipment makes is complicated and difficult to implement this at a large scale.

So the biometric solution to assist in an almost-automatic sign on, could be helpful. But so far the conclusion is that you cannot just have one biometric solution: In the operations theatre you need to wear a mask, hence you can't use face recognition. If you wear glasses, Iris recognition is a problem, and if you want to avoid congestion, fingerprint readers (and even keyboards) are doubtful. As Claus put it: The problem is, that we are users, we are many , and we are poor!

The long range solution is probably a combination of RFID active tags and biometrics, but it remains to be seen if this can be implemented in a practical way. Yet the Region intends to start a number of pilot projects, because the problem is real – the workload around log in/log out is simply too heavy – either it takes too long time, or the doctors and nurses are cheating to ensure quality of patient treatment.

To this statement Janne Christoffersen from the Data Security Agency pointed out, that the privacy legislation 'definitely has no intention to be a problem for daily operations, as it only required, that the doctors and nurses only has access to the data, that are necessary!'

'This is exactly the issue,' Claus Thorsen declared, 'For who knows what data are necessary? Take use of Antabuse! If this is an information that is not revealed to the Doctor, the patient might be seriously mistreated!' This seems to be a very central point in designing an up-to-date privacy legislation, that ensures a more holistic treatment of patients.

The next question, equally central for the discussion, is whether Claus' Region are coordination or cooperating with the other regions, and why this is not a centrally managed development program.

The representative from the Health Domain Steering Group - (Digital Health is an organisation supposed to coordinate anything within the health domain) – claimed that they weren't funded to do this, which again lead us back to the fundamental question on whether the Regions should continue inventing hot water all of them or if the Government should step in and define real areas for centralized solutions.

But a very interesting and down-to-earth real-life presentation with lots of areas where a combination of new technology and use of biometrics might be helpful.

Following this presentation, Ulrich Østergaard from CardLab presented the biometric card that they were trying to introduce in a number of countries. As can be seen from their homesite, this seems to be very promising – the card contains an active RFIOD chip, it has a fingerprint reader, which can be used by the proper owner to turn the card on, and can be equipped with various passwords, digital signatures etc. Looking forward to see some pilot projects based on this idea – and of course combined with proper ID/access management systems on the network.

Hospitals of the Futurè

An important part of the Danish Prime Ministers future plans deal with the construction of a number of bright, new so-called Super Hospitals. When he addressed the Danish Parliament on his opening speech first Tuesday in October, the amount of 40-50 Billion Dkr (9 – 10 B US $) was mentioned.

In Denmark the Regions are responsible for hospitals, but they have no tax income of their own, so they are completely depending on the Government allocation of funds. So the 5 regions are looking to negotiations with the Government, and as it looks they are treated rather differently; the regions that have been most eager to close down small and inefficient hospitals stand to gain the most.

In any case the question any Dane should put to his regional politicians, now up for re-election in November, is how they see the future of the hospitals. If this is not discussed, I fear the entire discussion will be around the brick-and-mortar investment, and not about the rethinking of the entire health structure as I feel is highly needed – not least in light of the demographic changes we can foresee, including the lack of doctors, nurses, more elderly, more chronic diseases etc.

So where can we find the inspiration needed before these new super tankers are cast in iron?
Normally you would look to US: http://health.usnews.com/articles/health/best-hospitals/2009/07/15/the-high-tech-hospital-of-the-future.html
But US has its own problems and has a highly different tradition than Northern European health systems, where this is an integral part of our welfare system, hence mainly paid for by the tax budgets. (Try to see the notices from the US Commission on the Future of Health Care from 2008:
http://www.fiercehealthcare.com/story/adaptibility-important-future-hospitals/2008-11-21?utm_medium=rss&utm_source=rss&cmp-id=OTC-RSS-FH0 )

There are sources and best-of-breed examples out there that can easily by reached; the web page for DesignIT has a very interesting article of hospitals of the future.
One of the cases that DesignIT describes is the Il Camino Hospital (Silicon Valley, Ca):

”Il Camino Hospital is a completely wireless hospital that is well on its way to becoming paper and film free. The hospital estimates that the new system has saved them 120,000 dollars a year in medical costs and 300,000 dollars a year in avoidable errors.
The hospital’s wireless technology includes:
· Voice-activated communicators: Nurses and doctors use a small voice-controlled, hands-free device that they wear around the neck to communicate with each other. The device is made by Silicon Valley start-up Vocera Communications Inc.
· Biometric supply cabinets: A device that enables authorised personnel to open doors or cupboards for medicine and other medical items by reading a thumbprint.
· Automated laboratory system: Laboratory tests go through various ‘stations’ that together make up an automated production line. Staff calls it ‘race track’. Automisation is made by · Beckman Coulter Inc.
· Tablet PCs and handhelds: Doctors test small, tablet computers and handhelds devices. In time, these will replace the clipboard. These devices are manufactured by Hewlett-Packard Corp.
But this system would appear to be particularly exposed to terror attack or technical failure – unfortunately key considerations in the future. How will medical staff cope if the system goes down? Will they be able to treat patients? While innovative, this hospital must also be fool proof. Otherwise technology will control people rather than vice versa.”

But we don't need to go to US to find fine examples of forward oriented hospitals: In Glasgow, for instance the Homeopathic Hospital has an interesting, holistic approach that could very well be part of the design principles for Hospitals for next several decades.

In Taiwan, the Chiang Gung memorial hospital with 8.800 beds has a very advanced deployment of RFID for controlling logistics, likewise an important part of the future High Tech Hospital, where the focus is on accountability, quality, saving human resources for the health and care oriented tasks.
Asia seems to be really pushing the uptake of new technology when they plan for future hospitals;
See for instance these award winners Asian hospitals: http://www.hospitalmanagementasia.com/awards/winners.htm . Not so surprisingly, there is a number of Singapore, Taiwan, Philippine references, but China and India is beginning to appear on this list as well.
Construction of hospitals is indeed a hot topic in these mega-countries.

In Sweden, Karolinska Sjukhuset, already a leading Nordic hospital in many specialties, is constructing a new site where the use of microelectronics and Gene technology is being deployed at a World record level. See for instance this description on their use of ICT.
Hospital trends in Europe can be found here: http://www.reportlinker.com/p07613/Hospital-Trends-Europe-2004-2009.html .
Since 2006 IBM has been running a Health Competency/Innovation center for the Latin speaking countries out of Barcelona. The center benefits from cooperation with the Hospital of Barcelona, one of Spain's most modern hospitals.

Each of the hospitals awarded in US, in Asia, being recognized as World leaders, contribute to the picture of the Hospitals of the Future, yet no hospital alone seems to have it all.
Given the pressure from the Climate debate and the mentioned adverse demographics plus not least the current financial crisis, new aspects has to come into the design principles.
And of course IT is going to play a major role. (See this New Scientist Article)

But in line with IBM's recent announcement of the Smart Planet initiative, I recommend that we look at the entire value chain of 'Health' – and not only look at the Hospital and the IT infrastructure: It has to be regarded as it is: A system of systems.
A Hospital is but one (important) station en route from disease to cure, but it doesn’t solve the long range development in human habits: from eating and drinking to travelling and social interaction.

The brick-and-mortar thinking should be replaced by thinking intelligent buildings:
imbedded control of material, light, control of electricity, water, sewage..

Around the hospitals we have a huge logistic task: transporting patients in and out, particularly in light of many more ambulant treatments, but also emergency systems, evacuation plans, logistics for delivery of goods, linen, visitors etc.

And we have the internal communication and collaboration between all the different stakeholders, doctors and nurses,, including admin, records management, knowledge management – and, not to forget: Electronic Patient Records that can be exchanged, distributed and disseminated with full compliance for data protection.

Another subsystem is the flow in and out of highly advanced diagnostic systems, surgery, remote collaboration, robotics. The advanced RFID plus asset management can take care of hospital beds, instruments, (patients), all sorts of critical material.

The final major sub-system is of course the entire process of a patient's engagement, not least how the out-patient services are provided, how collaboration can be obtained between hospitak satff and primary care, between patient and local government social services, including telemedicine and a holistic treatment of cronic patients in their own home, something we have been engaged in in far too many 'pilot projects' – now it is the time to deliver.

Or as Obama has put it: It's time to Change. This is understandable if you look at the status reports from 2008. So we Northern European spoiled citizens must cross our fingers that his medical plan for US comes true, because that would create yet a stronger, global drive to real forward thinking hospitals in the future.