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Sep 13 2014

Cosmos Research Center is now an official Minor Planet Observatory

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My backyard observatory, the Cosmos Research Center, has been officially certified by the Minor Planet Center of the International Astronomy Union.  I am now observatory U79.

I have a modest telescope set up on homemade concrete pier in my back yard, and use an Orion Atlas EQ-G mount controlling a Williams Optics 110mm F7 APO Refractor telescope.  I use an SBIG SFT 8300C camera, with a Starlight Express Lodestar guider.  The mount is controlled by EQMOD and Maxim DL, and I do my astronomic analysis using Pinpoint.

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Jul 09 2014

Underground Railroad and Indian Tomahawk Express Cards from Clayton Curtis

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Clayton Curtis Card

I got these photos of some of the original membership cards issued to Clayton Curtis, MD, who is currently with the VA’s Health Informatics’ Knowledge Based Systems as well as the VHA-Indian Health Service Interagency Liaison for Health IT Sharing.

Long story to be told here, but the bottom line is that the VA and the Indian Health Service have been collaborating for 30 years now, while DoD worked really hard to make its systems incompatible.  I was an informal consultant to the IHS while I was at the VA, and found them to be a very dedicated, but underfunded, agency.  So, the cooperation made a lot of sense.

When I went to work on the DoD version of the software (called Composite Health Care System), things were completely different.  They stripped out the communication capabilities I wanted to use to coordinate systems, and made other changes that would make the DoD version incompatible with the VA.

I wish this could be written off as ancient history, but I don’t think so.  DoD is continuing to do its thing with an $11B “rip and replace” waterfall effort, while VA seeks to take an evolutionary approach.

There has to be a better way.  For starters, the folks in Washington should recognize the power of informal organizations active in their formal organization charts.

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Jun 09 2014

The Dangers of Traffic Gridlock during wildfire evacuations in San Diego

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Cocos Fire from OlivenhainThe most remarkable aspect of the 2007 Wildfire evacuations of San Diego was how orderly everything was. Drivers seemed to be more polite with each other than normal.  Talk to someone who has been through a wildfire evacuation and they will likely have some stories to tell about community cooperation, a sense of pulling together. For example, in the May, 2014 fires, the Helen Woodward Animal shelter put out a request for horse trailers to move their horses to safety, and were immediately met with a flood of volunteers with horse trailers. The San Diego Union Tribune (June 7: Cocos Fire Jam to be evaluated) quoted a San Elijo resident about his experiences trying to evacuate during the recent Cocos fire.

Longtime resident Dustin Smith said he packed up his pets and headed off about 4:15 p.m., but couldn’t leave his gated Promontory Ridge community. In front of him was a line of vehicles backed up even before the gate…. He said he gave up, tried again an hour later but found the same situation. Tried again shortly after 6 p.m. and finally found roads clear enough to leave.

Being blocked from leaving your home for 2 hours under any circumstances is a really bad thing, but it is particularly terrifying when there is a wildfire raging nearby, and you don’t know where it will go. My daughter was evacuated earlier in the day from her office at the corner of El Camino Real and Palomar Airport road.  Traffic on the road was so bad that it took her 30 minutes just to get out of her parking lot.  She call 911 to see if they could get some traffic control police to help, but the dispatcher just said, “sorry, all of our officers are busy with other aspects of the fire.” Google Maps traffic reporting was very helpful, and gave citizens a great way to see what was happen and adapt to the traffic flow dynamically.  For example, my wife and I were babysitting our grandchildren May 14th, and I was driving to our normal rendezvous with my son-in-law for a 4:00 handoff in San Marcos.  I was planning on driving over San Elijo road to Twin Oaks, when I got a call from him, saying he saw a fire starting near Twin Oaks (that would become the Cocos fire).   We both knew that this could block the road, and could cause havoc with the traffic flow between us.  So, we both turned around and went home, watching the fire expand, but also noticing that the traffic on Del Dios highway was clear on Google Maps.  My daughter came by around 8 that night, and we had an uneventful handoff. Unfortunately, the past few decades have seen an upsurge in NIMBY activists who fight roads in their area, creating a patchwork of unconnected roads with long cul-de-sacs. Perhaps the risk of traffic gridlock might reverse some of these attitudes, or at least give fire safety folks a stronger position from which to demand better ingress and egress for fire safety.

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May 23 2014

Why you shouldn’t try to defend your house against a wildfire with a garden hose.

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I live in an area where wildfires are part of nature. I am also an “early evacuator” – happy to get out of the way of any potential fire hazards if one is coming my way. I know that there are others who want to stay back and defend their homes, typically with a garden hose.

Here’s a photo sequence of the recent fires that proves my point. It shows an ember gaining a foothold on a hillside, which engulfs the whole hillside and creates a 100′ tall fire tornado within 15 minutes.

Jeff Anderson, Elfin Forest Recreational Reserve park ranger, took these remarkable images during the recent “Cocos Fire” in North San Diego County.  The fire started quickly in the late afternoon of May 14. The next morning (May 15), it seemed to be fairly tame until about noon.  Then it flared up with a vengeance.  My home was about 1000 feet downwind of the evacuation zone, and we could smell the smoke passing over us, so we were intensely focused on what was happening.

Jeff was on the ridge of the Elfin Forest reserve looking north towards Harmony Grove when he snapped this photo of an ember burning at 12:25:24pm on May 15:

Fire 5-14_254

Just two minutes later, at 12:27:30pm, the fire from the original ember fire spread considerably, and another ember jumped up the hill:

Fire 5-14_256

Four and a Half minutes later, at 12:32:07, the fire engulfed the whole side of the hill. At this point, the flames were probably burning 1200 – 1600 degrees F.

Fire 5-14_262

Eight minutes, later, at 12:40:05, the fire had generated a “fire tornado” about 100 feet high, with winds 50-80 mph. The temperature at the base of the tornado was probably about 2000 degrees F, about one fifth the temperature of the surface of the sun, and the fire was generating its own wind:

Fire 5-14_275

I would ask those who would try to defend their house by playing Rambo with a garden hose, how long they think they would last in the midst of that inferno. It’s not a matter of your skill or machismo, it’s simply a recognition of the overwhelming power of nature.

We also need to recognize that wildfires are a natural part of the ecosystem. We even have a flower, the Fire Poppy, that germinates after wildfires. Here is picture I took of a fire poppy at Lake Poway, six months after the area had been burned in the 2007 Witch Creek Fire:

Fire Poppy

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Sep 15 2013

NTakes: Divergence in Health Information Technology

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Health care still exists in an iPhone versus Android world. We speak of our health care “system,” but that term implies rationality that is lacking when it comes to exchanging data.

Here is a personal example. A friend facing a major surgical procedure decided to secure a second opinion. He requested and received relevant portions of his medical record — on paper, at 75 cents a page — along with a CD containing imaging studies that had been done. His initial care was provided at a major teaching hospital, so he went to a similar medical center for the second opinion. But, when he presented the CD to the consulting physician, the response was, “We can’t use that.” It was in a format not compatible with the IT system at the second hospital.

“They knew where the CD was coming from. Why didn’t they warn me about that in the first place?” my friend wondered.

But, why should that have been necessary? Shouldn’t medical systems speak the same language?

On a much larger and incredibly expensive scale, health information technology has developed along dozens of proprietary lines, making the iPhone-Android divergence seem paltry in comparison. Numerous projects are being undertaken to have these disparate systems become “integrated” — a Rube Goldberg undertaking that by nature is overly complex and destined to be fraught with problems. We need only to look at the decades-long effort to “integrate” Defense Department and Veterans Affairs electronic health records. VA’s VistA is an open system built for clinicians that has proven itself over the years, gaining for VA the title of best health care in the U.S. DoD has gone the commercial, let’s-plug-pipes-and-wires-together approach and is still struggling to have a system its users actually want to use. (See Tom Munnecke’s open letter to Secretary of Defense Chuck Hagel).

Just sitting here at my iMac, I can have Amazon and Facebook connect or instantly send to Twitter an interesting article from almost any website. It’s all in the magic of the URL — a semantic approach to data.

Healthcare IT systems could use some of that magic. But, it will take a different sort of magic for the proprietary firms with mega dollars on the line to be willing to evolve to a more rational, web-like approach to health information.

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Jul 09 2013

Gone Sailing…

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In case anyone is trying to reach me, I will be off the grid until July 20. If any one wants to reach me, ask NSA for their PRISM data about me.

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Jul 08 2013

Hello NHS – Hope You Enjoy VistA

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tom in london phone booth

Hello National Health Service.  I’m glad that you are looking in to the adaptation of VA’s VistA into your IT activities over there.  I’ve been an outside observer and sometimes consultant to various NHS groups for years, and am particularly interested in helping you understand the VistA phenomenon.  Trying to understand VistA by looking at its source code is like trying to understand Wikipedia by studying the PHP of the underlying wiki.  The wealth is in the community of users, not the source code.

By way of introduction, as a VA employee, I was one of the original software architects for VistA.  I then moved to Science Applications International Corporation (SAIC) in San Diego, Ca. where I played the same role for the US Dept. of Defense’s Composite Health Care System (CHCS).  These are the two largest health care systems in the US, so I’ve seen issues of scale, portability, bureaucratic infighting, and no end of technical argument about how to do things.  Internationally, I’ve designed or consulted on health IT in France, Spain, Switzerland, Finland, Japan, Australia, and Nigeria.  I’ve testified before the US Senate Committee on Veterans’ Affairs on the Future of Health IT.

I spent some years looking at future technology for the VA (here are some of my papers), then took an early retirement from my position as VP and Chief Scientist at SAIC to broaden my interests of applying technology for humanitarian, philanthropic, and educational uses.  I took a year as a Visiting Scholar at Stanford University’s Digital Visions Program, founded a humanitarian think tank called the Uplift Academy, in which I’ve developed a workshop format I call Slow Conversations.

I was one of the initial members and leaders of the Underground Railroad, the “skunkworks” group that did the original design of the system that was to become VistA.  I gave an Unlimited Free Passage certificate to Chuck Hagel, then of the VA, now US Secretary of Defense.   The Hardhats were another group, consisting of the programmers who were doing the actual implementation of the technology.  The Underground Railroad included a more eclectic group of people interested in the broader aspects of the issues of the role of Health IT in the VA.  Here are some videos of speeches at some Underground Railroad Banquets over the years.

As Chief of Conceptual Integrity of the Underground Railroad, I took the the ethos we were building very seriously.  In addition to my programming interests, I was a keen student of linguistics, particular the Whorf/Sapir hypothesis, Ludwig Wittgenstein, and S.I. Hayakawa.  I was building a speech community to talk about health, across the organizational stovepipes so prominent in large bureaucracies.

Some topics that might interest folks:

Here is my presentation to the US Senate Veterans Affairs Committee on the Future of Health IT.

I talk a bit about the VistA Ethos in this conversation with Ward Cunningham, inventor of the Wiki.

A conversation with Philip Longman, author of Best Care Anywhere, documenting the VA’s dramatic transformation, in part triggered by the introduction of VistA.

An interview with Ross Fletcher, MD, Chief of Staff of the Washington VA Medical Center, discussing how VistA represents a new health care model.

I’ve started the New Health Project to look at the broader implications of health care and information technology.  We’ve had two workshops in California, and one at the W3C offices at MIT. Speakers have included Sci Fi writer/futurist David Brin, Sci Fi writer Vernor Vinge, who coined the term “Technological Singularity,”  Peter Norvig, Director of Research at Google, and others.

I would be very interested in helping NHS understand the VistA Ethos, as well as establish a bridge between US and NHS to continue the conversation.

P.S. The world of VistA as seen within Washington DC beltway is radically different from what happens in the field.  DC operates from a top-down “power” model, while VistA thrived as a bottom-up “energy” model.  So, while I’m sure that there is lots of value to power-based London/Washington connections, the real value to accrue would come from connecting a broader group of the folks who are actually using the software.

I would be happy to help communicate and hopefully, enhance, the VistA ethos.

 

 

 

 

 

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Jun 05 2013

Interview with Gio Wiederhold, Stanford Professor of Computer Science

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While I was in San Francisco to attend another conference,  I stopped by the home of Dr. Gio Wiederhold, professor of Computer Science at Stanford.  He was very helpful to me in my early days of the design of VistA, so it was fun to have some time to do this oral history interview of him:

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Mar 27 2013

There’s Gotta Be a Better Way

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100,000+ pages of federal legislation controls our health care system today.  We are increasing the number of disease categories 10-fold, moving towards a disease coding system (ICD-10) that names 150,000 categories, including categories such as W59.83D “Subsequent encounter of being crushed by other nonvenomous reptile.”  An enormous array of standards committees seek to define coding systems, exchange mechanisms, privacy and security, and medical knowledge bases.

One way to look at this is to marvel at the scale of it all.  Perhaps when we reach 200,000 pages of legislation and 1.5 million terms for how to be sick, we will finally get a handle on the US health care system.

Another way to look at it is that we are trying to get out of hole by digging it deeper.  What we see are the symptoms of the Humpty Dumpty syndrome: we have broken health care into so many pieces that even with “all the kings horses and all the kings men” we can never put it together again.

Continue Reading »

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Nov 27 2012

Google Reinvents Microsoft BoB

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I just ran across Google Sandbox, a weird graphical interface that reminds of Microsoft Bob

Bob was a Really Bad Idea, and failed miserably.

 

 

But apparently Google is trying to reinvent the idea, adding a twist to make the scene twirl as you try to access it, so it becomes a cat-and-mouse chase to try to get the mouse on the appropriate icon.

Seems like folks are just trying to make things more complicated nowadays… sorry that Google is heading down this path.

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