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Archive for the 'Conversations with Tom' Category

Jun 08 2012

Conversation with Joanne S. Luciano about Health Care and Semantic Web

I had the pleasure of talking with Joanne S. Luciano of RPI’s Tetherless World Constellation in Cambridge, MA. on May 17, 2012.

Dr. Luciano has played a leading role in the BioPathways Consortium, in the creation and development of BioPAX and the establishment of the W3C initiative in the Health Care and Life Sciences. She is co-developer of the OWL-based BioPAX pathway ontology which has become the standard for pathway-related bio-research. She has made significant contributions to pathway modeling, and is familiar with systems such as EcoCYC, BIND, WIT, KEGG, SBML, and others. She has intimate familiarity with the relevant tools such as Stanford’s Protégé knowledge acquisition tool and the underlying Semantic Web technologies including OWL and RDF. These skills together with her extensive interactions with the multi-disciplinary community of researchers, places her in a unique position to contribute to projects with her skill, contacts, and know-how. Of particular significance is her ability to effectively communicate with specialists in a range of disciplines (computer science, biology, medicine, physics) which enables effective cross-disciplinary collaborative research.

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Jun 03 2012

Conversation with Bob Frankston, co-inventor of the spreadsheet about complexity and health care

This is a video of a conversation I had with Bob Frankston , co-inventor of the spreadsheet in Newton, MA. on May 17, 2012. Off camera is Yaneer Bar-Yam , director of the New England Complex Systems Institute  and Joanne S. Luciano  of the Tetherless World Constellation at Rensselaer Polytechnic Institute, and Andy Oram of O’Reilly Media.

My summary, such as it is, starts around minute 30:00

Here is a similar conversation with Ward Cunningham, inventor of the Wiki.

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May 27 2012

Conversation with Deborah Estrin about Open M-Health

I had the pleasure of taping a conversation with Deborah Estrin, professor of Computer Science at UCLA at the 2012 O’Reilly Health Foo Camp.

She is one of the founders of Open mHealth:

During their service together on a National Academies committee in 2008, Deborah Estrin and Ida Sim realized that mobile health (mHealth) was an up-and-coming technology, and if we could successfully apply lessons learned from other information technologies, the impact on health could be dramatic. In 2010, they co-authored a position paper in Science Magazine calling for an open mHealth architecture. In April 2011, Deborah and Ida convened a group of experts from the software and health worlds to strategize about how to actualize such an architecture.

Open mHealth aims to bridge the divide between health and technology to enable meaningful collaboration. Our unique role is to work collaboratively with all actors in the mHealth ecosystem to grow shared software and techniques. Open mHealth is part of the solution – whether you’re proprietary or open source, public or private, we can be complementary to, and integrative of, your work.

We also spoke a bit about our shared connection to Internet Pioneer Jon Postel.  She was a “mentee” of his while at USC.  Jon was extremely helpful to me when I was designing the early VistA electronic mail and networking system.  She now holds the on Postel Chair in Computer Networks at UCLA.

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May 23 2012

Conversation with Nicholas Christakis and Tim O’Reilly about creating an Epidemic of Health

I had the pleasure of attending the O’Reilly Health Foo Camp last weekend at the Microsoft New England Research and Development Center (NERD) in Cambridge, MA.  It was a very interesting event, run as an Open Space “Unconference.”

I really enjoyed Nicholas Christakis’ presentation on his latest work relating to social networks and health.   He, along with James Fowler, whom I’ve had a previous conversation about networks )  and about his book release ) are co-authors of Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives.

I spoke with him after his presentation and recorded the conversation on my iPhone.  Tim O’Reilly, CEO of O’Reilly Media and Open Source Software guru that hosted the event, also chimed in.  The basic theme is how can we use social networks to increase our health, what Jonas Salk called Creating an Epidemic of Health.

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Mar 01 2012

Conversation with Issac Kohane about Genomics and Clinical infrastructure

Published by under Conversations with Tom

I had a fun conversation with Issac Kohane, MD, PhD, who is Henderson Professor of Health Sciences and Technology at Children’s Hospital and Harvard Medical School. He is director of the Countway Library of Medicine, and Director of the i2b2 National Center for Biomedical Computing.

Zak talks about the SMART platform for an “App store” approach to health informatics, Semantic Network approaches to health IT, and his work in creating an informatics workbench for bioinformatics called i2b2.

Interviewed with my iPhone on the beach in front of the Scripps Institute Pavillion, overlooking Scripps Pier, in La Jolla, CA.

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Feb 16 2012

Conversation with Tom on Pattern Languages in Health Care

Here is a video of a discussion of Pattern Languages for health at the VistA Expo 2011 in Seattle Washington, Nov 18, 2011.  Alesha Adamson of Open Health Tools and Rick Marshall of VistA Expertise Network joined me to talk about applying Christopher Alexander’s ideas of pattern languages to health care.

If I appear to be a bit tired, it is because I had just spent about 6 hrs on panel discussions… One of these days, I’m going to spend my time listening, rather than talking 🙂

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Dec 16 2011

Conversation with Ralph Johnson about Big Ball of Mud Systems


This is a video transcript of a Skype conversation I had this morning with Ralph Johnson this morning about refactoring VistA. I think that there are some fascinating ideas here about thinking about refactoring in layers, rather than a single lump, as well as the notion of creating a “semantic overlay” layer that would open VistA up to the rest of the Linked Data world (with appropriate security, as already expressed in VistA). Ralph is one of the gurus of object orientated software, agile development, and refactoring. I had a video chat with Ralph Johnson, software refactoring and object-oriented patterns guru, regarding ways of looking at refactoring VistA. He talks about “Big Ball of Mud” systems http://www.laputan.org/mud/ , and ways of managing them, particularly through Shearing Layers http://wirfs-brock.com/blog/2011/08/26/agile-architecture-myths-4-because-you… which were the topic of Stewart Brand’s “How Buildings Learn” book. I talked about VistA patterns of “Creating a Path of Least Resistance” – with the example that the 1978 VistA design meeting created a common date management routine that was Y2K compatible, making it easier to by compatible. I also spoke about the notion of creating a “Shearing Layer” above VistA – a semantic overlay connecting the existing VistA system data dictionary to the outside world, allowing VistA to participate in the Linked Data world, RDF Semantic mashups. This would also have the advantage of extending the current VistA privacy semantics out to the network interface. I also talked about the scale of VIstA being a critical factor that is often overlooked – “bigger is different” and this has both its drawbacks and its advantages.

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Nov 10 2011

Review of Nora Bateson’s Film: “An Ecology of Mind”

Nora Bateson

Nora Bateson

I just finished viewing Nora Bateson’s film, An Ecology of Mind, about her father, Gregory Bateson.  I got some sneak previews of her work in progress last year, and before that,  when I spoke on the Good Ancestors theme at the Metamedia III conference in Eugene.

It was great to see her ideas evolve from a collection of home movies to a very professional film telling her father’s ideas in the context of a young daughter growing up with them.  I recall wondering, “how do you give the viewers time to absorb all this material?” but the wonderful use of graphics opened it up and drew us in simultaneously.  Such is the art of film making.

Gregory Bateson, as an English anthropologistsocial scientist,linguistvisual anthropologistsemiotician and cyberneticist, deserves the designation eclectic.   His quip that “information is the difference that makes a difference” lingers in today’s thinking, as does the notion of the Double Bind.

I particularly liked his discussion of beauty, something that’s been preoccupying me for some time now – how do we design beautiful systems?  Steve Jobs has shown that it can be done.  The question is, can we incorporate it into our other systems, as well?

Gregory Bateson was clearly one who looked at the connectors, not just the dots.  In a world that is over run by the dot-counters, rather than looking at the relationships between the dots, this is an important concept to get out.

I guess I was left with a bit of a “now what” sensation after the film.  I understand the “wholeness” argument, and talk about it all the time in my “toasters and cats” riff.  But how do we take this forward?  (This, of course, is exactly the question Gregory was trying to get us to ask.  The fact that I’m asking it now, well after his death, is testimony to his success)

Nora is married to jazz drummer Dan Brubeck, son of Dave Brubeck, so I was expecting more music in the film than I got.  In particular, I think the opening quotation rather than being silent, could have started a “heartbeat” to the film that would pick up again throughout the film.

I’ll be hosting a screening and a workshop for her in the San Diego area Feb 3-4, so stay tuned.

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Nov 03 2011

Wiki inventor Ward Cunningham in Conversation with Tom at HealthCamp Oregon

I had the pleasure of taping a conversation with wiki inventor Ward Cunningham at Health Camp Oregon in Portland Oregon Oct 22, 2011.  Ward and I had been having Skype video chats, comparing our notes about how his invention of the wiki and my initial architecture for VistA had so many similarities.  Ward is an amazing thinker with a wonderful, generous attitude about technology.  This is one of my favorite conversations to date, both for what he said, as well the responses he drew out from me.

Ward’s initial wiki was just 300 lines of code that he wrote in a couple of days.  My initial “onion diagram” of the VistA architecture held a “virtual machine” of just 19 commands, 22 functions, and 1 data type.”  Wiki grew as a result of the communities it supported; VistA grew a similar community around it.  Ward frequently references language and names of web pages and their effect on the wiki community; I spoke of creating a “speech community” and a language for health with metadata.

We both came to the conclusion that the strength of our designs was based on having only scant resources at our disposal – too much money would have spoiled the integrity of the designs.

I spoke of the need to move forward with a positive vision of health, and using IT as a tool for creating the language and the community to make this a reality in health care, but I didn’t know exactly what button to press to make it happen.

Ward, in his amazing style, said, “Well, we’ve done it twice, let’s do it again!”

Thanks to Nate DiNiro of Open Affairs TV for helping to pull together this video.

Stay tuned.

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Oct 26 2011

Conversation with Ralph Johnson, Ward Cunningham, and Tom Munnecke about refactoring VistA

Ward Cunningham, best known as the inventor of the wiki, invited me to his home for dinner last Friday night. Ralph Johnson, a world-class leader in object oriented programming technology, pattern languages, and refactoring, happened to be his house guest. The after dinner conversation turned to a spirited discussion about how to refactor the VA VistA Electronic Health Record system, so I turned on my iPhone to record the discussion.

Ward Cunningham is also well known for his contributions to the developing practice of object-oriented programming, in particular the use of pattern languages and (with Kent Beck) CRC (Class-Responsibility Collaboration) cards. He is also a significant contributor to the Extreme Programming (Agile) software development methodology.

Ralph E. Johnson is a Research Associate Professor in the Department of Computer Science at the University of Illinois at Urbana-Champaign. He is a co-author of the influential computer science textbook Design Patterns: Elements of Reusable Object-Oriented Software.

Tom Munnecke was one of the original software architects of what is now known as VistA, the VA’s electronic health record, as well as CHCS, a similar system for US Department of Defense hospitals world-wide.

The discussion revolves around the future software architecture of electronic medical records in the federal government, now being coordinated as an open source project as the Open Source Health Record Agent http://osehra.org

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