Virtualization Primer

The dictionary definition of “virtual” is being in essence but not in fact.  That’s kind of an interesting state when you are talking about computers.  The reason is that for most folks, a web server or some other mysterious gadget that makes their email work is probably “virtual” to them already because most users don’t see the server itself in action, only its result (a web page served up or an email delivered to their inbox).  Virtualization is one of those “deep IT” concepts that the average person probably doesn’t pay much attention to.  But here is conceptually what’s going on.

Back in the bad old days of computing, if you wanted to have a Microsoft Windows Server installed and available for use, you would go out and buy yourself a physical piece of computing equipment, complete with hard drives, RAM, video card, motherboard, and the rest, and install the Windows operating system to it.  If you needed another server (for perhaps another application like email or to share files), you would go out and buy a new piece of hardware and another license for Windows Server, and away you would go.  This kind of 1 : 1 ratio of hardware to server installation was fine until you had more than a few servers installed on your network at home and the AC couldn’t keep up with the heat output of your computer equipment.

So a bunch of very smart people sat down and asked how this could be handled better.  I’m sure someone in the room said just buy much more expensive hardware and run more applications on the same physical server.  This is in fact the model of larger businesses back in the worse old days of mainframe computing (oh yeah, people still use mainframes today, they just keep them in the closet and don’t advertise this to their cool friends who have iPhones and play World of Warcraft online).

But the virtualization engineers weren’t satisfied with this solution.  First off, what happens when the hardware that everything is running on, fails?  All of your eggs, being in one basket, are now toast until you fix the problem, or bring up a copy of everything on another piece of equipment.  Second, what happens when one of those pesky applications decides to have a memory leak and squeezes everybody else off the system?  Same as number one above, though the fix is probably quicker because you can just bounce that ancient mainframe system (if you can find the monk in the middle ages monastery that actually knows where the power button is on the thing, that is).  Third, mainframes are really pretty expensive, so not just any business is going to go and buy one, which means that a fair amount of the market for server equipment has been bypassed by the mainframe concept.  And finally, mainframes aren’t cool anymore.  No one wants to buy something new that isn’t also cool.  Oh wait, I doubt the engineers that were sitting in the room having a brainstorming session would have invited the marketing department in for input this early on.  But it is true – mainframes aren’t cool.

So, this room of very smart people came up with virtualization.  Basically, a single piece of computing hardware (a “host” in the lingo) can be used to house multiple, virtual instances (“virtual machines”) of complete Windows Server installations (and other operating systems, though Windows virtualization is probably driving the market today).  On top of that, they came up with a way for these virtual machines to move between physical servers without rebooting the virtual machines or even causing much of an impact on performance to the users.  Housing multiple complete virtual machines on a single host works because most Windows machines sit around waiting for something to happen pretty much all day – I mean, even with Microsoft Windows, how much does a file server really have to think about the files that it makes available on shares?  How much does a domain controller have to think in order to check if someone’s username and password are valid on the domain?  Even in relatively large systems environments, there are a considerable number of physical servers that just aren’t doing all that much most of the time.

Virtualization provides a way to share physical CPU and memory across multiple virtual machines, so you can get more utility out of each dollar you have to spend on physical server equipment.  Some organizations are therefore able to buy fewer physical servers each year.  Sorry Dell and HP – didn’t mean to rain on your bottom line, but most IT departments are trying to stretch their capital budgets further because of the recession.  Fewer servers also means less HVAC and power, both of which have increased in cost as energy markets have been deregulated and prices have started to more closely follow demand.  I guess BG&E and Pepco are also sad, but look, some of your residential customers still set the AC at 65 degrees, so just charge them three times as much and everyone is happier!

Most of the leading vendors also offer “High Availability,” which means that virtual machines can automatically be moved between hosts, and if a host fails, the supervising software can restart those virtual machines on an available host in your cluster of hosts.  For those IT people carrying blackberries that have to go to the server room at 3am to reboot physical equipment, welcome to the 21st century.

In addition, at least VMWare offers a way for virtual machines to automatically move between hosts when a particular host gets too many requests for CPU or RAM from the virtual machines running on it.  This functionality helps to improve overall performance which makes all the users happy, and quiets the help desk (a little bit).  Ok, so the users call you about something else, so the help desk is still not any less quiet, but at least you can cross one complaint off the list for the moment.

In sum, virtualization is a smart and efficient way to implement servers today.  I imagine if you work in IT that you are very likely to come into contact with virtualization soon if you have not already.  We converted about two years ago and we aren’t looking back!

Obama & Health Care IT

President Obama’s plan (published here) (the “Plan”) describes a multi-part approach to expanding the amount of health insurance available to those without insurance while attempting to reduce the costs of providing health care to Americans.  A portion of this plan involves the expansion of health information technology to help reduce the costs of administering health care.  On page 9 of the Plan, paper medical records are identified as a health care expense which can be reduced through records computerization.  The Plan cites a study by the RAND group (published here) (“RAND”) that indicates that the processing of paper claims costs twice as much as processing electronic claims.

Estimated Savings and Quality Improvements by Adoption of Health IT

The RAND group suggests that fully implemented health IT would save the nation approximately $42 billion annually, and would cost the nation’s health care system approximately $7.6 billion to implement.  RAND at 3.  According to their review of the literature on health IT adoption, approximately 20% of providers in 2005 had adopted an information system (which may have several meanings from patient reminder systems to clinical decision support).  RAND at 20-21.  Full implementation of health IT would require a substantial number of providers to convert to regular use in order for the total savings identified by RAND to be realized.  RAND estimated that in 2005 there were approximately 442,000 providers in the U.S.; this suggests that about 353,000 providers would need to convert from paper to electronic systems before the full savings to the health system would be realized.  RAND at 20.

Areas of savings in the outpatient setting noted include: transcription, chart pulls, laboratory tests, drug utilization, and radiology.  RAND at 21.  Areas of savings in the inpatient setting noted include: reduction of unproductive nursing time, laboratory testing, drug utilization, chart pulls and paper chart maintenance, and reduction of length of stay in the hospital.  RAND at 36.  Savings on the inpatient side account for approximately 2/3rds of the total savings, and the largest area of annual savings is tied to the reduction in the length of stay of patients as a result of the adoption of health IT.  Id. This overall cost savings is based on adoption of health records by virtually all health care providers in a 15 year period; the total savings to the health system during that time would total about $627 billion.  Id.

The Plan also discusses increasing the quality of health care delivered to all patients through the implementation of disease management programs (which are driven by health data of individual patients to monitor progress and outcomes), and the “realignment” of provider reimbursement with quality outcomes.  Plan at 7.  Realignment typically occurs when health insurance plans pay not for the total visits billed by a provider, but based on some kind of quality measure that tracks how well patients are doing in managing their health condition.  This is also driven by the availability of reliable health outcomes data (for example, the hemoglobin a1c test results of patients with diabetes over time, and the percentage that report a result under the “normal” or expected value).

The Trouble with Adoption of Health IT

Adopting health IT systems, however, is no small feat.  Systems have been available to the health care infrastructure for a substantial period of time (Centricity, a health information system now owned by General Electric, was originally developed by Medicalogic in the mid-80’s and became popular in the 1990s).  See Article.  In 2000, Medicalogic had penetrated the practices of about 12,000 physicians in the U.S., or around 3% of the total market, and was described then as the market leader in electronic medical records (which perhaps a total of 10% of the market had adopted a system by that time).  Using RAND’s analysis, five years passed and 20% of physicians had adopted some form of health IT.

If market penetration is to double every five years, by 2010, 40% of physicians should be using a health IT system, and by 2015, 80% should have adopted such a system.  (Admittedly, this assertion is weak because there is not sufficient data in this article to support this assertion.  In addition, adoption rates tend to follow a parabolic rather than a linear pattern, so that larger numbers of adopters join the crowd as time progresses.  But, dear reader, please feel free to comment with specifics to help improve the quality of this article!)

The New England Journal of Medicine, with a likely more restrictive definition of health IT, found that less than 13% had adopted such a system as of 2008, based on their sample of 2,758 physicians.  Article here.  An article in the Journal of Evaluation of Clinical practice reported that about 18% of the practices it surveyed (847 in total) had an electronic health record in use in 2008.  Article here.  (“JECP”)  As RAND had pointed out in its own literature search conducted in 2005, the definitions of health IT vary widely across the empirical surveys conducted, so an accurate estimate of market penetration is hard to come by.  However, it does appear that the number of practices that have adopted general health IT is not significantly higher than in 2005.

An interesting article suggested that some of the problem with health IT adoption may be regional – that some regions of the country tend to have a slower adoption rate of technology in general, which would tend to slow down the adoption of health IT in those areas.  Article here.  The JECP survey also indicated that specialty practices and smaller practices tend to be slower to adopt health IT as compared to their primary care provider counterparts.  Access to adequate capital to fund health IT purchases is an obvious reason for not implementing such systems.  Id. I would also posit that the adoption of health IT does not generally distinguish health care providers in the market of health care delivery (physicians don’t advertise that they have a health record system).  It would be interesting if patients could receive information on average health outcomes by physician when researching who they want to use for medical services (only possible if health IT is widely adopted and there is general consent to the publication of such data, which today is putting the cart before the horse).

There is, therefore, a market failure in that, if we accept that health IT reduces medical costs or improves outcomes over time, the market has not made a concerted effort to adopt this technology.  The Plan puts forward capital to help implement records and has an incentives component that rewards improved health outcomes.  Time will tell if these investments and market changes will actually reduce health care costs in the U.S.

White House Takes on Cybercrime

According to Yahoo News, President Obama plans to appoint a White House official to be in charge of coordinating the federal government’s response to cybercrime.  This comes after years of reports of identity theft, many tens of thousands of viruses aimed at security holes in mostly Microsoft operating systems like Windows 98, XP, and 2000, and increasing system security problems for infrastructure (like energy companies and utilities).  Click here for an article on hacking into the FAA air traffic control system.  Click here for a summary of attacks on the U.S. Defense Department and the U.S. electrical grid.

The problem is certainly not going away as the shadow market for hacking services is making a profit on the successful attacks of systems.  One matter not addressed today that might help improve security is the need for all information systems custodians to regularly report on security breaches.  The federal government does keep track and report on the number of attacks on federal government systems, but there is no single repository to keep track of attacks on private companies.  There is obviously no incentive for a private company to report security problems as this leads to fewer customers and could put the company out of business.  But even a single, national and anonymous reporting system would be a start to help gauge the depth of the problem.  Security problems are also a relevant consideration for consumers that might be giving data to a company to transact business, such as credit card, health, financial or other personal information.  Consumers should have the right to know about the security practices of businesses, and the effectiveness of these practices in protecting information from unauthorized use.

Furthermore, unless the market reflects the cost of security in the pricing of services, businesses will continue to operate without sufficient security in place, and our economy will continue to be at risk of being shut down by terrorists and hackers.  I suspect that this may be one of the areas where the market failure is so substantial that government intervention is justified to more seriously regulate computer security, especially in critical areas of the economy like banking, infrastructure, and the like.

Maryland Health IT

The governor is poised to sign a Maryland bill into law this week on health information systems.  Click here to see the Baltimore Sun article.  The bill was known as HB706 on Electronic Health Records – Regulation and Reimbursement, was adopted by the House and State Senate by April 10, 2009.  The Act empowers the Maryland Health Care Commission to establish a health information exchange in the State, and to develop regulations that incentivize providers that use an electronic health record.  The incentives are required to have monetary value, and may include such things as increased reimbursement for specific services, lump sum payments, gain-sharing arrangements, and rewards for quality.  Click here for the full text of the enrolled House Bill. By 2015, the bill also anticipates that health care providers will be using an electronic health record that is nationally certified and capable of sharing information with the State’s health information exchange.

I think this is an interesting development for health care providers.  Most estimates that I have seen show that a majority of health care providers do not use computerized records for keeping track of patient care.  The records systems are relatively expensive (at least in the short term for software licensing, equipment, and the like), most providers are not techno-geeks, there are serious technical security issues that have to be managed (such as those promulgated under the HIPAA security regulations), and in the short term providers are not likely to become more productive or see a substantial increase in revenue from the investment.  This bill, once signed into law, will start to pile on incentives for providers to move to an EHR, particularly if a provider can begin to demonstrate improvements in the quality of care delivered to patients.

The bill also presumes that there is value in a standard health information exchange, which I imagine would act as a clearinghouse for authorized users to access or analyze health information on Maryland residents.  Beyond the obvious privacy concerns (employers firing or not hiring employees with expensive health conditions), having such sensitive information in one place will require a substantial investment in protecting that data from unauthorized access or theft.  I think it is interesting that the State is not just letting the free market address the need for these kinds of information exchanges – Google and Microsoft have both put products in the marketplace for individual consumers to manage health information.  Arguably, such a large scale effort to place all Maryland patient information into a single repository may exceed the resources of private investors or companies expecting to profit from the repository’s development.  The open question is what value such a repository will actually have to individual patients whose data is “on deposit.”  Stay tuned!

Second Life Avatars and First Life Trademarks

More and more, the body of laws that govern our “first lives” are traveling into the world of Second Life, an online virtual world that allows people to own land, buy and sell products for Linden Dollars, and now, register trademarks based on graphics created by a user in Second Life.  Click here to read the full article.

This should probably come as no surprise, given the strong and growing commercial activity within Second Life.  According to their site, in-world users of Second Life are exchange about USD$35 million each month for virtual goods and services.  First life laws on trademarks were created in part to encourage commerce by helping consumers know the actual source for the goods they were buying.  It seems to me that the next step will be first life businesses like Nike and Rolex seeking a way to enforce their trademark rights in a first life court against Second Life infringers.

Sony ebook reader with google

Sony and Google announed today that Google will be making its online PDF library of public domain works available through Sony’s epub reader. Google has well over 500,000 books online as a result of its work to scan public domain works into digital format.

I have used Google’s book search for historical research and it is a great tool for finding books published before 1925. The search tool also gives you results for materials still under copyright but not the entire book in PDF. Will Sony’s reader come in an iPhone flavor? Maybe, but not just yet.

Google Targets Targeted Ads

Big brother is watching your every move on the internet.  And, by “big brother,” some privacy experts mean Google, the internet search engine with a majority of all searches online.  According to Yahoo News (click here for the story), Google has begun a new advertising campaign that uses where you have been to present advertisements to you from AdWords advertisers.  So, for example, if you had previously visited my web site,, and were searching for legal services next month, you might see my Google ad show up in your Google search results, where another user that had never been to my site might not see the same ad.  Read Google’s Blog here.

The controversy for privacy advocates is that people other than you have access to your web history, regardless of whether you wanted those other persons to have access or not.  It is kind of like the FBI agent walking over to the public library and printing out a list of all the books you have taken out in the last year – most patrons of the library (way back in the good old days before the Patriot Act) just would not expect the government to be investigating what books they were reading.  Of course, most of us also probably don’t get all that upset about it, unless the cops have a warrant and are banging down our door at home!

What’s different about this situation, however, is that Google is not a government agency (though Google, like other service providers do comply with warrants from government agencies, or the laws of other nations where they operate, including some of those dictatorships who shall not be named, but whose country’s name rhymes with Whina).  And, Google’s advertisers are generally just other businesses looking for customers.  I think that we have gotten over the commercialization of the internet.  We’ve been living with stupid advertisements from stupider products now for some time.  I imagine that Billy Mays is probably living in your subconcious, too, but it just makes me bound and determined to never buy any crap that guy is pushing on those TV commercials.  I mean, how often do you have a torn US flag that you repair and want to fly in a wind tunnel (even sixty mile per hour winds will not drown out Billy!).

So, if you go to a web site selling that crap, and search for things like that crap on Google, that stupid web site’s ads will be more in your face than they might otherwise be.  Personally, I think you deserve to be tortured with endless pop up ads for visiting that web site and contemplating supporting Billy Mays’ personal quest to yell at everyone on the planet.  And don’t get me started about ShamWow.  But I digress.

The issue for us users of the internet is how much we are willing to put up with others knowing about us.  I’d be willing to bet most readers of this blog treat the internet as a parking lot under surveillance, and just don’t pay much attention to the cameras.  Our expectations of our privacy on the internet continue to be lowered as social networking and other web sites allow us to live more publicly than ever before.  Google is part of this trend, as is your television, newspaper, trade magazine, your neighbor’s pets, your government – pretty much everybody.  That’s because we need to buy more stuff.  Ask Whina – they are ready to sell you a new flat screen TV that you can hook your internet-enabled new WiFi Macbook Air to while you are reading an advertising-sponsored blog, searching through internet ads on Google for the best deal on the next cool thing.

Coming next month: free clothing sponsored by Google ads that are updated regularly to reflect your geographic location, courtesy of Google Maps!  (Oh John, just been shopping at The Apple Store in Towson, I see…)

Amazon Kindle on iPhone

Yahoo News reported that Amazon has created a new applet for the Apple iPhone that allows users to download kindle-friendly books right to the iPhone for reading.  Others, including Apple itself, have for some time had a way for iPhone users to download certain books electronically, but Amazon getting into the mix this week increases substantially the number of titles that you can purchase and read on your iPhone.  Just one more reason to join the iPhone club.

Online Marketing Update

As a follow-up on a previous post, I decided that I would spend some time with yahoo in order to advertise on that search engine as well.  Unlike google, in order to get yahoo to pay attention to your site, you have to wait for them to get around to index your web pages.  You can submit your site for free, but that just means that they will eventually index your pages.  So, if you are in a hurry, you can pay $49 a year to yahoo and they will index your site within about a week, and come back and visit your site on a regular basis.

In addition, you can pay for search marketing on yahoo, which is similar to how google’s advertising works – you pay per click and for high placement of your advertisement in search results, based on certain keywords that you configure when you create your ad.  One key difference: you have to deposit a minimum amount of money into your yahoo advertising account with a credit card to get started.

It is probably no wonder that google has a larger share of the search market than yahoo today – google indexes automatically and more quickly (my web site showed up in search results in google a few days after I posted content, where yahoo has still not come to visit my site as of today).  But advertising on both is a safe hedge, given that the two are the dominant search engines on the internet today.  I’ll keep you updated as I investigate other search engines and online advertising, including MSN Live.

Marketing a Law Practice Online

I have heard from a number of new attorneys about how to market yourself online through a web site.  I thought I would share some thoughts about this here on my blog, based on my own professional experience as a web developer and entrepeneur.  As always, if I can be of further assistance, don’t hesitate to contact me.

First Things First – Get a Domain Name

You will need to pay to register a domain name, like, with an internet registrar, such as Network Solutions.  This is required in order for all the other computers on the internet (well over a billion) to be able to find your site’s location on the network server that will hold your web site’s files and data.  Network Solutions was the original registrar back in the bad old days, but today there are a number of registrars that you can work with (try searching with google to find others).  Be sure to pick one that looks like they are going to be around for a while (and that may not be the guy that registers domain names for $10 for 1,000 years).

Your domain name should make sense based on the name of your practice, your specialty, and should ideally be short.  Don’t try to use a famous trademark as your domain name or you will get in trouble!  Don’t pick a name that is three hundred characters long, either.  And your name should usually end in .com.  There are other possible domains, like .biz or .tv, but these have really not caught on for the average internet user looking for your site.

Web Site Hosting

Your web site has to physically be located as a set of files on a server that is connected to the public internet.  You will generally have to pay someone who is in the business of hosting sites for this service, unless you have a T1 connection at home with a static IP address and your service contract allows you to host sites.  There are a lot of businesses that offer web site hosting.  You may want to find a hosting company that will support multiple web languages, backend databases, blogging, and other features, even if you don’t need that right away.

Content of Your Web Site

Your web site should be straight forward for your users to get around, and should have a basic navigation scheme that highlights your skills, services, and a way for users to reach you.  Think of what you would put on a brochure that you would mail to prospective clients and put that on your site.

Be careful about the graphics or other art that you place on your site.  Using other people’s art without a license or express right can get you into trouble, especially if your site gets a lot of traffic.  There are a number of services that you can purchase that will allow you to create a web site from a template (this service is often wrapped up in the hosting of the finished web site itself).  Be sure to read the contract before you sign up for the service.

Meta Tags

Meta tags are a special hidden indexing tool that helps internet search engines like yahoo and google to properly index the content of your site.  These are placed in the header section of each web document, and are basically a list of the words that describe the content of your site, like “attorney,” “copyright infringement,” “tenant and landlord,” “intellectual property” and so on.  You may or may not have the ability to add this to the header of the documents that you post, but check with your service provider or hosting company about editing these tags.

Blogging and Dynamic Content

Once you have your site up on the internet, you need to make a note on your calendar to update the content of your site on a regular basis.  And by regular, I do not mean once every thirteen years.  You should have a section of your site for news, and you should post updates to this section on things that are going on with your firm.  You can also create an online blog, like this one, and post news and updates to it.  This is good for several reasons.  One, the search engines stop by your site regularly and they see what is on the site.  New content will get indexed by them, which helps to increase the chances that someone searching for you will find your web site.  Two, people that actually do come to your site will think you actually still exist and are actively working as an attorney.  And three, the more content you have overall, the more established you will appear to others that might be researching you, including other attorneys, especially if you can demonstrate some expertise in your area of the law.

Online Adverts

Google, Yahoo, and MSN probably make up 95% of all the searching of the internet today, with Google making up nearly 60% all by themselves.  All three of these allow you to pay for advertising, which basically helps to make sure that, based on the keyword search, your web site will show up towards the top of the search results.  Generally speaking, this is the entire web search game.  If your site is indexed but consistently appears as search result 624,691,504 out of 624,691,505 results, no one will ever find your site via a search engine.  That makes the search engine pretty much useless to advertise your site, and by extension, makes your web site kind of useless (I mean, people will find your web site if you meet them in person and give them your business card with your web address on it, but how many people can you meet in person to do that?).

Of the three, I would recommend starting with google.  The cost to run an ad with keywords is generally minimal to start, and you only pay if someone clicks on your ad and comes to your site.  Now, not many of the clickers will become customers, but you don’t need a million customers to start.  In fact, you may only need just one.


Some web site hosting companies will provide you with statistics on your web site’s utilization.  These stats are very helpful as you begin to develop your site and want to measure how successful your efforts have been, because you can compare site activity before and after you begin advertising in various places.  Also, most web servers will allow you to collect referer data, which you can use to see how people get to your site, such as a search engine or other web site address that has a link to your site.

So, for example, if you are advertising on google, google will tell you how many times someone clicked on your ad in a given period.  You can then query your web site itself to see how many people used google to search for you and what search terms they used to find your site.  If your google had got 2 clicks in a month, but people got to your web site via a google search 60 times, you might need to change your ad on google, or change the keywords that you are advertising to match how people got to your web site.

Or, if you are advertising on yahoo, but all of your referers are from MSN or AOL, you might stop advertising on yahoo and start advertising on one of the other search providers or services.

Market From Multiple Angles

Marketing is all about advertising in multiple ways at the same time.  So, if you are considering building a web site and advertising from it or about it, also think about other places you can get the web address in front of your prospective customers.  Also, think about what’s cost-effective for you, especially if you are just starting out as an attorney.  Ads in a major newspaper that you run weekly for a year are going to cost thousands of dollars, and it is very hard to measure what impact these ads are having on those that contact you.  But, you can put your web address on your business cards, stationery, on other materials that you handout to prospective clients, perhaps on direct mailings that you send to prospective customers, and as a tattoo on your forehead (that will go over well in court!).

Good luck in your efforts and contact me if I can be of service.

Tim Faith, esq.