Tom Munnecke’s Eclectica

I’ve been holding banquets celebrating the folks and the activities of the “underground” efforts of a group of folks who helped build the VistA system.

My next one is June 5 http://2012urr.eventbrite.com/

I was delighted to present a webinar about my experiences in the design of VistA:  “What Worked, and How do we do more of it?”  Here is a recording of the session.   Thanks to the VistA Extensions Network and Fabian Lopez for hosting it, and Open Health News for announcing it.

I think that it is really critical to take a hard look at lessons learned over the years.  Not as an absolute guide to the future, but at least as a guide for understanding the present.

I’m not trying to be nostalgic, but rather convey a sense of the decisions we made back then, and why.  And, maybe, keep future designers from making the same mistakes.

Here is a 1984 letter from Rep. Sonny Montgomery on the occasion of the 1994 Underground Railroad Banquet:  Sonny Montgomery letter to Underground Railroad

He mentions the work of Chuck Hagel, then VA Deputy Administrator, later to become US Senator, who was the first recipient of the “Unlimited Free Passage on the Underground Railroad” certificate.

And, he closes by saying:

The job is not over, and I know that all of you will continue in your efforts to make this the finest medical ADP system in the world.  I pledge to you that I will continue my unwaivering support of your important work and will maintain close oversight of all activities here in Washington and in the field to ensure that our mutual goal is me.”

Unfortunately, Sonny is no longer with us.  We could use another champion on the Hill, if anyone has any suggestions.

I’m planning the next Underground Railroad banquet on Tues, June 5, in conjunction with the 10th anniversary World VistA Community meeting.

If I had to name the folks who had the most influence on my career development, I would have to name Dr. Octo Barnett, director of the Massachusetts General Hospital Laboratory of Computer Science.  Out of his laboratory came the MUMPS computer language, designed specifically for medical information processing,

Here is his 1984 paper 1984 Octo Barnett responds to MITRE report on DoD methodology that takes DoD to task for the way they try to define a hospital information based on the requirements process.   Some tidbits from his paper (I’ll do a full write up later):

He stresses adaptability, flexibility, user involvement, robustness…

In some cases… the requirements are nothing more than vague wish lists… it is even more difficult to understand how DoD could systematically evaluate to what extent the delivered system fulfilled the requirements”

When I worked on the original CHCS proposal effort at SAIC, I had to demonstrate how the software conformed to list of about 150 requirements.  One requirement was that the system should recover from a power failure within 30 minutes, which was a really crucial thing in a hospital.  Another was that the system should be able to ring a bell on the line printer.  (Line printers were a throwback to the batch processing days of old; the requirements also defined card punch procedures, even though we weren’t using cards any more.

The day of reckoning came, and we had DoD, GAO, congressional staffers, and my own management looking over my shoulder as we worked our way through the requirements.  I sweat blood making sure we met the 30 min recovery time requirement, and everyone accepted the demonstrations without any questions or concerns.   We moved on to the bell on the line printer requirement.  I sent a bell code to the printer, but nothing happened.  I tried again, still no bell sound.  Eyebrows were raised; the room went silent as it looked like I might fail this requirement – which was as significant as showing that the system could recover from a power failure.

It was nearly lunch time, so I suggested everyone come back after lunch while we called Digital and asked the Maynard engineers what was going on.  I think we solved the problem by plugging the printer into a different port.  Everyone came back from lunch, I rang the bell, all breathed a sigh of relief, and we were off for the other 148 other requirements for the day.  It was kind of we were all in a puppet show, going through the motions, with no one understanding what was going on.

The more I read the DoD requirements, the more I find that the “emperor has no clothes,”

He goes on to talk about “gold plated” DoD requirements, while explaining the the DHCP system is just a simple beginning.  The question is whether the system can evolve.

The fundamental principle of the VA strategy is that the user community must have an important role in the shaping of their information system, and must have an important role in the evolution of the system over time.  The TRIMIS strategy ignores this user involvement and makes an assumption that the vendor can supply the information system in a well-wrapped package that can easily be fitted into the hospital operations.   I believe that the highest priority should be given to testing these two different strategies in the DOD environment….. what we do know is that this strategy has been associated with an impressive set of functioning medical information subsystems on a very limited budget and with much greater user involvement that appears possible with totally vendor created information systems.

Unfortunately, this parallel test never happened.  While DoD accepted the DHCP software (or was forced to accept by the financial realities of the bidding process), they rejected the idea of user involvement, open source (public domain) software, and shared development with the VA.  This was due to intedepartmental turf wars as well ideological chasms between DoD’s “waterfall” requirements-based design vs. VA’s evolutionary design, starting with “good enough” and moving forward in response to user involvement.

Dances with Meteors

Originally uploaded by munnecket

Here is a fun image I took at Joshua Tree National Park during the Lyrid Meteor showers.

David Brin is one of my favorite intellectual sparring partners.  Luckily, he lives nearby, so he was able to drop in at a children’s science star party I held in June 2007.

Here is a video of David’s presentation to the kids, (mostly K-8).

and here is a portrait I took of him:

I started the Cosmos Research Center in a shed in my backyard, and then got lab coats, a logo, a website, and named myself Executive Director. I really enjoy motivating kids to dig deeper into science, which has also lead to my becoming a NASA/JPL Solar Systems Ambassador.

I had the pleasure of visiting Kitware in Albany, NY, and gave a webinar yesterday on the topic “Towards a Federal Health Information Space.“  Bottom line: health IT, health care in general, and the politics of the beltway all combine to make the notion of a single, monolithic health IT “system” impractical.  An alternative model of a open, adaptable information space, configured as a large scale, fine-grained network of activity and information, gives us a much better foundation for dealing with the issues of complexity, security, and adaptability.  Here are my slides (.pptx version) (many of which I didn’t talk about).  Thanks to Rick Avila, Luis Ibanez, and Wes Turner for lots of great discussions.

Kitware is a very innovative company specializing in open source software.

here is a panorama I shot this week, trying out a new camera on a robotic Gigapan mount. It is at the center of the San Elijo Lagoon, one of my favorite places to hike and and photograph.

and here is the Google Earth version, which shows the panorama in 3D.

I’ve signed up the Cosmos Research Center to be a participant in the MoonKam project, which allows students to take pictures of the moon from the NASA Grail Satellites, Ebb and Flow, that are orbiting the moon to measure its gravity.   Scientist Abby chose the spot and typed in the coordinates for this image.

It is an image of the south pole, of the Schrodinger Crater.  It is on the far side of the moon, so it is not visible from the earth.  I’m going to try to print this in glow-in-the-dark ink so she can put it on her bedroom ceiling.