Building Unity Farm - Managing Willful Dogs

Great Pyrenees are a strong willed dog breed.   Historically Basque shepherds left their dogs alone to guard flocks.   The dogs had to make decisions for themselves, sound the alarm to scare away predators, and defend their own food.   This tradition makes them very independent thinkers, frequent barkers, and are rather protective about their food.

The Great Pyrenees that guard our Alpaca sleep much of the day, patrol the paddocks at night, and bark at the threatening sounds they hear, which include marauding raccoons, howling coyotes, deer crashing through brush, teenagers having a distant party, and the wind blowing through the willows.  

They are wonderful dogs, amazing companions to their charges, and very friendly to humans.    I run several miles with them a day, always keeping them on a lead built for two, since they are very willful and are likely to run for miles to keep their territory safe.

Just as raising children can require patience and agility, so does raising dogs.

Just as being an IT leader requires equanimity and consensus building, so does living with Great Pyrenees.  In my career as a CIO. I've learned that raising your voice, diminishes you and accomplishes nothing.  The same holds true with Great Pyrenees

If it's 3am and the dogs are doing their job - barking at sounds that seem threatening.  What do you do?  Yell at them to stop barking?   Lock them in the barn?  Lift them by the scruff of the neck and tell them they are bad dogs?

None of these approaches work.   Yelling is the human equivalent of barking and the dogs think you are raising an alarm.     Willful dogs do not understand punishment or force.

Instead, I use an approach that recognizes them for doing a good job and puts them at ease.    I put on my boots and head out to the paddocks.    I greet the dogs and thank them for raising an alarm.   I walk the fence lines, checking for threats and watch the behavior of the llama and alpacas.    If the threat seems to have passed, I tell the dogs that they are good dogs, doing their job.   I thank them.   I pet them by rubbing their temples.     I nuzzle their heads underneath my neck and tell them the all is well.

Once they understand that I am satisfied with their guarding and have now taken responsibility for the threat they identified, they stop barking and return to their patrols.

This approach of love, reassurance, positive reinforcement, gentle touching, and communication works just about 100% of the time.

Although some believe that management by intimidation achieves results expediently, it does not build loyalty and is not sustainable.     For 15 years I've managed by creating trust and loyalty.  The same approach works with willful dogs.

The January HIT Standards Committee meeting

The January HIT Standards Committee began with passionate remarks from Farzad Mostashari, emphasizing the need to maintain momentum as the country evolves from Stage 1 to Stage 2, from data capture and sharing to advanced clinical processes.   In some ways, the press and policymakers have attention deficit disorder, asking for the improved outcomes of Stage 3 before the foundation of Stage 1 and 2 is widely implemented.    All members of the Standards Committee are committed to continuous forward progress.

Jodi Daniel presented the HIT Policy Committee preliminary 2013 work plan which includes specific tasks in 5 areas

*Measuring clinical quality
*Health Information Exchange
*Safety
*Privacy
*Managing and using patient data
*Accountable Care

Based on this plan, the Policy Committee's  request for comments, input from HIT Standards Committee members, ONC's  Meaningful Use Stage 3 standards gap analysis, and feedback from workgroup chairs, we assembled a draft of priority areas which will be used to create a standards work plan for FY13 and beyond 

There are five general categories of work, each with 5 themes

* Quality and Safety
* Health information Exchange
* Consumer
* ACO/Population Health/Care Management
* Privacy/Security

Doug Fridsma mapped the 25 elements on the Standards Committee priority themes to existing ONC efforts.   As a next step, Doug will turn the priorities into a structured work plan, balancing the need for new standards, the timeframes in which their are needed and the amount of work required given the existing maturity of the standards.   This work plan will be presented at the February meeting.

Next, we reviewed the deliberations of the Standards Committee workgroups which reviewed the Policy Committee's request for comment.    Although detailed comments were provided on every line item, the workgroup chairs presented a high level overview of their recommendations and we discussed their recommendations.   I will present the responses to the policy committee on February 6.

Doug Fridsma and Jodi Daniel offered ONC updates including the status of S&I framework projects some of which are transitioning to public private partnerships.

Finally, Becky Kush from CDISC presented an overview of the Clinical Data Interchange Standards Consortium (CDISC) curated standards.

The day's discussion was a confluence of work priorities some which were reactive to policy committee requests and some of which were proactive to enable future policy goals.

I look forward to the February meeting at which we'll reaffirm the phasing of our FY13 projects, finishing works in progress and taking on new priority efforts.

Consumer Electronics for Home Care

As part of the "sandwich generation"  I serve as healthcare navigator to my parents and life coach to my daughter.  My parents live in Southern California, 4000 miles away from Boston.

I call them each day to ensure they are doing well, exercising, and eating right.   It would be great if an "automated dashboard" or "alerts/reminders" assisted my efforts to support them.

Recently, Hiawatha Bray at the Boston Globe summarized the Consumer Electronics Show in Las Vegas, highlighting the kind of assisted living/healthcare devices we can expect in the home soon.

My parents use ADT for home security, so why not use that infrastructure to report on their movements, their use of appliances, and the contents of their refrigerator.

I already have a proxy for this kind of home care monitoring.    One of my avocations is meteorology and I provide the weather monitoring services for my town (Sherborn) and my parents town (Palos Verdes).   Part of that telemetry includes the interior temperature of the building housing the equipment.    Since it's network connected, I can watch my parents home to make sure it is warm in the winter and cool in the summer.

I've found this environmental monitoring to be a very helpful indicator of their well being.

I look forward to the day when home sensors offer a full report that our parents got out of bed, ate breakfast, used exercise equipment, watched television, and generally moved throughout the house in their usual pattern.

Some may consider this kind of monitoring to be an invasion of privacy, but for increasing numbers of older Americans, such tools can help them stay in their own homes longer and offer peace of mind to the family members who support them.

The Rand Study and the impact of EHRs on Healthcare Costs

Last week, Rand published a study in Health Affairs (ANALYSIS & COMMENTARY: What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology),  revising its original 2005 healthcare IT cost savings research.

The New York Times wrote about it.

Several publications asked me to comment and here's what I said:

"We're still at an early stage of EHR implementation, healthcare information exchange connectivity, and decision support.

Meaningful Use Stage 2 in 2014 will take us to a new level that will begin to reduce redundancy, over treatment, and waste.

Stage 3 in 2016 will take us even further by enhancing outcomes.

We're on a journey and I have every expectation we'll change the practice of medicine to improve its value (quality/cost).    We're moving as fast as we can to accomplish this and I believe by 2016 we'll realize the improvements we're seeking from the meaningful use foundation we've built.    Expecting significant cost reductions by 2013 is not realistic at this point in the process."

Many people are working tirelessly to implement EHRs, HIEs, and PHRs.   Think of our work like creating the interstate highway system.   Soon we'll be able to drive at high speed from coast to coast.  In the meantime we need to realize that every day gets us closer to our goal.   We need to keep our eyes on the prize and keep building.

Building Unity Farm - Managing Wood

Farm properties commonly include meadows, pastures, woodland, wetland, and rocky rolling hills.   Unity Farm has all of these ecosystems.  We've recently re-surveyed all our wetlands to ensure we comply with appropriate environmental regulations that guide where we can plant, farm, and raise animals.  

Our plans over the next year include adding year round growing capacity via a high tunnel/hoop house, adding an acre of high bush blue berries, creating a mushroom growing shed, expanding our orchard, and refining our kitchen garden.

All of these activities are ideal for the spring and summer.   Wintertime is perfect for managing wood.

Unity Farm has 12 acres of white oak, red oak, hard maple, cedar, and poplar.     Oak and maple make excellent firewood.  Cedar contains aromatic oils and burns hot/fast making it a great firestarter.   Poplar does not generate much heat, so it's not an ideal firewood.  However, it is excellent for cultivating oyster mushrooms (hence the mushroom growing shed)

How do you manage 12 acres of forest with multiple different woods harvested at different times?

I approached the problem just as I would approach data storage architecture.   First define requirements and input/output streams, then design the appropriate information lifecycle management infrastructure.  Here's how I thought about it

Cache - the wood you'll use today and later this week
Nearline - the wood you'll use this month and this season
Archive -  the wood you'll use next year and next season
Swap space - the wood you cut or moved today that needs to be stored before putting it in cache, near line, or archive storage.

With this model in mind, I organized the woodcutting area of the farm in .5 cord of cache, 1.5 cords of near line, 1.5 cords of archive, and .5 cords of swap space.    This ensures I have 2 cords for current use and 2 cords for long term use.

Each Saturday I take my farm wagon (holds 700 pounds of wood) onto the trails I've built into our upper forest (5 acres) and lower forest (7 acres).    Using a Stihl M290 chainsaw I cut a few hundred pounds of oak, maple and cedar from fallen trees, de-limbing using my Scandinavian Forest Axe and bucking them into 18" segments.   I secure the logs onto the wagon using ratchet tie downs.

I pull the wagon over our trails back to our wood processing area shown above.   I use a 24"x12" hard maple round as the base for log splitting with my splitting maul   For very thick logs, I use two splitting wedges and the hammer portion of the splitting maul.   I keep everything sharp with a file  and axe stone 

Once the logs are split, I stack them appropriately into the 4 areas listed above.    I have dedicated near line and archive storage for each type of wood - oak, maple, and cedar.

 My rule of thumb is that wood should age at least a year between cutting and burning.   The only exception is old fallen cedar which seems to burn well immediately, although I use it sparingly because the burning oils pop and spark in the fireplace.

 To avoid repetitive motion injury I limit my wood cutting to 1/2 cord per day and my splitting to 1/4 cord per day.    At present all my storage areas are full and we have a roaring fire at the farm every winter night.