As we gather together stakeholders for strategic planning of next year’s priorities, what are we hearing and what we have learned?
1. Clinicians are overwhelmed by the current demands of Meaningful Use, hundreds of quality measures, population health, care management, and patient/family engagement. All of these are good ideas individually but the sum of their requirements overwhelms providers. In an era when we’re trying to control costs, adding more clinical FTEs to spread the work over a large team is not possible. The end result is that providers spend hours each night catching up on the day’s documentation and are demanding better tools/automation to reduce their strain. However, current EHRs are in an early stage of development and are data capture tools rather than customer relationship management systems. As we gather requirements for FY16, we’re thinking about the projects that could be innovative breakthroughs, replacing human work with a next generation of technology and workflow.
2. The consumerization of software (BYOD devices and apps) has created infinite demand and high expectations. The difference between the $2 app and the $2 billion dollar EHR is that the $2 app is easier to use, more convenient and possibly even more useful. There is no question that EHR transactional systems will need to exist to support compliance and regulatory imperatives, but increasingly we’ll look to third party apps to provide modular functionality on top of the transactional systems.
3. The cloud is clearly the way that people want to work. Social networking ideas of collaboration, file sharing, availability anywhere/anytime, multiple device support, and convenience are driving forces. The good news is that Amazon Web Services offers low cost, HIPAA compliant hosting/storage/groupware/mobile support. We’ve learning as much as we can about AWS.
4. It’s increasingly difficult to balance supply and demand for IT. Stakeholders prefer to discuss the vision for the future rather than the details of allocating existing resources in the present. Incremental progress no longer feels satisfactory and users want a big leap forward. The solution to this quandary seems to be spreading work among as many parties as possible - IT, third party solution providers, business owners, power users, and energetic innovators. Unless there is a sense of federated collaboration, build and buy, central and local support, IT will be seen as the rate limiting step
5. ICD10, the Affordable Care Act, Meaningful Use, and the HIPAA Omnibus rule may be the focus of regulators and legislators, but they are not the focus of most users. Stakeholders want to know when their projects will be accelerated and when the distraction of federal regulations will end. Big change management projects in IT are hard on users, forcing them to accept decreased short term service for long term gains. The problem is that the agenda of most IT departments has been co-opted by federal programs and the users are no longer willing to wait. This is one of the reasons I have suggested that Meaningful Use Stage 3 be deferred. Providers and the industry need more time to catch up on all the deferred projects and adjust to the thousands of pages of new regulations that have already been finalized.
With these observations, what are we planning to do in FY16? Over the next month, we will present a 5 page list of “bottom up” stakeholder enumerated high priority projects, categorized as core, advanced, and innovative.
Stakeholders will refine these categorizations and I hope they will collaboratively agree on focus areas for the FY16 and beyond. I look forward to optimizing our governance, our projects, and our vision to accommodate the needs of stakeholders in the post Meaningful Use era.
Wednesday, August 19, 2015
Thursday, August 13, 2015
Unity Farm Journal - Second Week of August 2015
Although there really is no such thing as vacation for a farmer, I am trying to work from home on Mondays and Fridays in August. I saved on commute time and had a few hours free between phone calls to catch up on the University of Massachusetts Farming and Sustainability courses that my wife and I are taking. It’s finals week and my 22 year old daughter was very amused by my comments - “I have a paper to write, a final study for, and 300 pages of reading, where will I find the time?”.
At this point, the course is done and I’ve learned a great deal about post harvest management of fruits and vegetables.
Our barnyard redesign is making good progress and we’ve laid down a new roadbed of crushed rock and top dressed it with gravel. The new hoop house to store all our farm equipment is going up - it’s a kind of barn raising at a small scale. Here’s what the process looked like, including the extra help from the geese
Our barnyard is pure New England soil filled with rocks, roots, and gravel. Pounding 14 footings 2.5 feet deep was really challenging. Some were easy and some required a post hole digger/crowbar/axe combination. It all worked in the end and we’ll add the polyethylene to the frame next Saturday once the wirelock channels for attaching the plastic arrive.
As you can see, the Terex now has a year round home in the barnyard and soon all our machinery will be in this new hoop house, ready to use where it is needed most, next to the animals, outbuildings, and paddocks.
Kathy is hard at work making sun dried tomatoes from the 10-15 pounds I pick every evening.
Next week I'll bottle a few kegs of honey lager and a mild British Bitter. As Fall approaches I'm planning on the Porters and Stouts that will carry us through winter.
During the August vacation hiatus my writing slows, but more IT related posts are in the works about our FY16 application and infrastructure strategic planning process. More to come soon.
At this point, the course is done and I’ve learned a great deal about post harvest management of fruits and vegetables.
Our barnyard redesign is making good progress and we’ve laid down a new roadbed of crushed rock and top dressed it with gravel. The new hoop house to store all our farm equipment is going up - it’s a kind of barn raising at a small scale. Here’s what the process looked like, including the extra help from the geese
Our barnyard is pure New England soil filled with rocks, roots, and gravel. Pounding 14 footings 2.5 feet deep was really challenging. Some were easy and some required a post hole digger/crowbar/axe combination. It all worked in the end and we’ll add the polyethylene to the frame next Saturday once the wirelock channels for attaching the plastic arrive.
As you can see, the Terex now has a year round home in the barnyard and soon all our machinery will be in this new hoop house, ready to use where it is needed most, next to the animals, outbuildings, and paddocks.
Kathy is hard at work making sun dried tomatoes from the 10-15 pounds I pick every evening.
Next week I'll bottle a few kegs of honey lager and a mild British Bitter. As Fall approaches I'm planning on the Porters and Stouts that will carry us through winter.
During the August vacation hiatus my writing slows, but more IT related posts are in the works about our FY16 application and infrastructure strategic planning process. More to come soon.
Thursday, August 6, 2015
Unity Farm Journal - First Week of August 2015
My daughter returns from Japan on Friday and we’ll hear all about her Summer traveling with David, her fiance. They plan to marry next year once Lara has finished her Tufts studies. Lara is a Japanese major. Will they live and work in Japan? The future is theirs to make. We look forward to a wedding on the farm next year!
Although August is typically the hottest point of summer, we’re already preparing or winter.
August is the time that bees need extra nutrition to build up comb and food stores during a dearth of nectar caused by the dry/hot August weather. We’re adding “bee tea”, a mixture of sucrose, spearmint, and bee balm to feeders in every hive. We’re adding pollen patties (a soy-based protein supplement). We’re making sure they have access to flowing water - the various fountains around the farm. We’re very selective in our harvesting of honey, leaving 80% for the bees. This week we harvested 30 pounds, a portion of which became 3 kegs of Unity Farm Honey Lager.
We did an inventory of the creatures living at Unity Farm and the current count is 126
60 Guinea fowl
9 Three year old chickens
9 Ten week old chickens
7 Nine week old chickens
4 Six week old chickens
8 Ducks
3 Geese
2 Great Pyrenees Mountain Dogs
3 Cats
13 Alpaca
1 Llama
7 Pheasants (to be released into the wild Labor Day weekend)
That does not include the 250,000 bees.
Every day these animals need food, water, and attention. The dogs get two runs a day. The geese follow Kathy during her daily routines. The ducks, chickens, and guineas spent 12 hours a day wandering the forest and scratching for worms in the barnyard. Our role is to keep them protected from predators, keep the peace among all the various species/age groups, and to provide medical care for infections or any physical harm they experience. All the poultry free range, so our evenings include herding the young chickens into the coop during the period they are learning how to integrate into the pecking order. This season, we've only lost one chicken, which fell into a 50 gallon watering trough. We’ve since removed the trough, placed all water buckets on wall brackets, and standardized on enclosed watering systems for the birds.
As part of our effort to redesign the barnyard, we now manage manure 1000 pounds at a time using a 12.5 cubic foot dump cart with a trailer hitch attachment for the Terex front loader. In the past we stored 10,000 pounds of manure in a composter in the barnyard and moved it once in the Spring and once in the Fall. Now we can move it in smaller batches, reducing the size of our storage area, and the mess of a 10,000 pound move one Terex bucket at a time. So far, so good.
Kathy and I are continuing our University of Massachusetts Farming and Sustainability Certificate program. Our current course in post-harvest produce management has been very helpful. The hundreds of pounds of fruits and vegetables we've harvested this season are now stored in exactly the right temperature, humidity, and ventilation conditions. With every passing day, we're becoming better farmers and learning from our mistakes. When the zombie apocalypse comes, we'll be sustainable!
Although August is typically the hottest point of summer, we’re already preparing or winter.
August is the time that bees need extra nutrition to build up comb and food stores during a dearth of nectar caused by the dry/hot August weather. We’re adding “bee tea”, a mixture of sucrose, spearmint, and bee balm to feeders in every hive. We’re adding pollen patties (a soy-based protein supplement). We’re making sure they have access to flowing water - the various fountains around the farm. We’re very selective in our harvesting of honey, leaving 80% for the bees. This week we harvested 30 pounds, a portion of which became 3 kegs of Unity Farm Honey Lager.
We did an inventory of the creatures living at Unity Farm and the current count is 126
60 Guinea fowl
9 Three year old chickens
9 Ten week old chickens
7 Nine week old chickens
4 Six week old chickens
8 Ducks
3 Geese
2 Great Pyrenees Mountain Dogs
3 Cats
13 Alpaca
1 Llama
7 Pheasants (to be released into the wild Labor Day weekend)
That does not include the 250,000 bees.
Every day these animals need food, water, and attention. The dogs get two runs a day. The geese follow Kathy during her daily routines. The ducks, chickens, and guineas spent 12 hours a day wandering the forest and scratching for worms in the barnyard. Our role is to keep them protected from predators, keep the peace among all the various species/age groups, and to provide medical care for infections or any physical harm they experience. All the poultry free range, so our evenings include herding the young chickens into the coop during the period they are learning how to integrate into the pecking order. This season, we've only lost one chicken, which fell into a 50 gallon watering trough. We’ve since removed the trough, placed all water buckets on wall brackets, and standardized on enclosed watering systems for the birds.
As part of our effort to redesign the barnyard, we now manage manure 1000 pounds at a time using a 12.5 cubic foot dump cart with a trailer hitch attachment for the Terex front loader. In the past we stored 10,000 pounds of manure in a composter in the barnyard and moved it once in the Spring and once in the Fall. Now we can move it in smaller batches, reducing the size of our storage area, and the mess of a 10,000 pound move one Terex bucket at a time. So far, so good.
Kathy and I are continuing our University of Massachusetts Farming and Sustainability Certificate program. Our current course in post-harvest produce management has been very helpful. The hundreds of pounds of fruits and vegetables we've harvested this season are now stored in exactly the right temperature, humidity, and ventilation conditions. With every passing day, we're becoming better farmers and learning from our mistakes. When the zombie apocalypse comes, we'll be sustainable!
Wednesday, August 5, 2015
The Security of Medical Devices
Last week the U.S. Food and Drug Administration advised hospitals not to use Hospira's Symbiq infusion system, concluding that a security vulnerability enables hackers to take remote control of the system. The agency issued the advisory some 10 days after the U.S. Department of Homeland Security warned of the vulnerability in the pump.
My view is that this will be the first of many advisories
For years, manufacturers of medical devices depended on the “kindness of strangers” assuming that devices would never be targeted by bad actors. EKG machines, IV pumps, and radiology workstations are all computers, often running un-patched old operating systems, ancient Java virtual machines, and old web servers that no one should currently have deployed in production.
In the short term, hospitals must do their best to isolate medical devices from the internet and from other computing devices that could infect them. At BIDMC, we have three wireless networks
A guest network for patients and families
A secure network for clinicians and staff
A device network for medical devices that is not connected to the internet or the other two networks.
Further, we use firewalls around medical devices to prevent them from communicating to outside parties.
Over the past few years, I’ve asked medical device manufacturers to give me a precise map of the network ports and protocols used by their devices so that I can build a “pinpoint” firewall - only allowing the minimum necessary transactions from/to the device. Many manufacturers do not seem to know the minimum necessary communication requirements for their products.
A few years ago, BIDMC had a reportable breach when a medical device manufacturer removed our hospital provided security protections in order to update a device from the internet. It took about 30 seconds for the unprotected device to become infected and transmit data over the internet. The Office of Civil Rights adjudicated that it was the manufacturer, not BIDMC, which was responsible for the breach. We were advised to follow any visiting manufacturer reps around the hospital to ensure that they do not remove hospital provided security protections in the future.
Some manufacturers have claimed that adding operating system patches, intrusion detection/prevention and other cybersecurity defenses will require them to re-certify their devices with the FDA.
That is simply not true. The FDA has issued guidance declaring it the responsibility of the manufacturers to secure their devices. No re-certification will ever be needed for adding new protections.
In the short term, CIOs need to build “zero day” defenses, creating an electronic fence around vulnerable devices. In the medium term, manufacturers must update their products. In the long term, medical devices must be designed from the ground up with security as a foundational component.
Whenever I write about a topic, I avoid hyperbole. In this case, the threat is real, I have experienced it myself, and CIOs must act.
My advice, after securing your own perimeter - get the CTOs of your medical devices on the phone and ask them for their security roadmap. If they do not have one, plan to change your vendor. We’re already doing that with some devices because attention to this issue by some manufacturers has been insufficient.
My view is that this will be the first of many advisories
For years, manufacturers of medical devices depended on the “kindness of strangers” assuming that devices would never be targeted by bad actors. EKG machines, IV pumps, and radiology workstations are all computers, often running un-patched old operating systems, ancient Java virtual machines, and old web servers that no one should currently have deployed in production.
In the short term, hospitals must do their best to isolate medical devices from the internet and from other computing devices that could infect them. At BIDMC, we have three wireless networks
A guest network for patients and families
A secure network for clinicians and staff
A device network for medical devices that is not connected to the internet or the other two networks.
Further, we use firewalls around medical devices to prevent them from communicating to outside parties.
Over the past few years, I’ve asked medical device manufacturers to give me a precise map of the network ports and protocols used by their devices so that I can build a “pinpoint” firewall - only allowing the minimum necessary transactions from/to the device. Many manufacturers do not seem to know the minimum necessary communication requirements for their products.
A few years ago, BIDMC had a reportable breach when a medical device manufacturer removed our hospital provided security protections in order to update a device from the internet. It took about 30 seconds for the unprotected device to become infected and transmit data over the internet. The Office of Civil Rights adjudicated that it was the manufacturer, not BIDMC, which was responsible for the breach. We were advised to follow any visiting manufacturer reps around the hospital to ensure that they do not remove hospital provided security protections in the future.
Some manufacturers have claimed that adding operating system patches, intrusion detection/prevention and other cybersecurity defenses will require them to re-certify their devices with the FDA.
That is simply not true. The FDA has issued guidance declaring it the responsibility of the manufacturers to secure their devices. No re-certification will ever be needed for adding new protections.
In the short term, CIOs need to build “zero day” defenses, creating an electronic fence around vulnerable devices. In the medium term, manufacturers must update their products. In the long term, medical devices must be designed from the ground up with security as a foundational component.
Whenever I write about a topic, I avoid hyperbole. In this case, the threat is real, I have experienced it myself, and CIOs must act.
My advice, after securing your own perimeter - get the CTOs of your medical devices on the phone and ask them for their security roadmap. If they do not have one, plan to change your vendor. We’re already doing that with some devices because attention to this issue by some manufacturers has been insufficient.
Thursday, July 30, 2015
Unity Farm Journal - Fourth Week of July 2015
Kathy and I have been hard at work with our University of Massachusetts coursework on farming and sustainability. Our first course, Post-harvest Handling of Fruits and Vegetables, has been a rigorous combination of science and practical experience. The online learning content is complemented by real world assignments. Last weekend, we were to acquire the fruits/vegetables we eat in a week and then sort them according their genetic, metabolic, and storage characteristics.
When you live on a farm, there’s no need to drive to Whole Foods, you just grab a picking basket. Here’s what we picked last Saturday morning.
The analysis involved separating these vegetables and fruits (tomatoes) into categories for storage in our 4 different cooling zones - our commercial walk-in refrigerator, residential refrigerator, root cellar, and mud room.
Here’s the completed analysis. Let’s hope we survive the grading process!
This week, I’ve been redesigning the barnyard based on the workflow and processes we’ve implemented over the past two years. How do you provide four seasons of animal and plant care with the following equipment (length x width x height in feet)
Terex Front Loader plus Snowblower attachment 12x5x7
SnowEx Sand spreader 5x3x3
Campbell Hausfeld Power washer 3x2x3
ExMark mower 7x4x3
Small farm cart 3x4x2
Medium farm cart 3x4x2
Large farm cart 3x4x2
Mobile Hose winder 2x3x2
SuperSplit Log Splitter 8x3x4
Manure cart 2x2x2
Wallenstein Chipper/Shredder 4x4x4
Answer - put it inside a 24x17x10 hoop house next to the barnyard that will serve as an all weather equipment depot.
I’ve cleared the entire area behind the duck house and chicken coop of wood, manure, and planting supplies so that we now have a 100x50 foot section of flat land.
Over the next few weeks, I’ll haul gravel to create an all weather driving surface in and out of the hoop house while also preparing for a possible future pig housing area where the wood is now stacked. Manure management will be done with a cart with a 1000 pound capacity that I can haul behind the Terex.
August is a great time on the farm - warm weather with limited planting/harvesting, so there’s time to do design work.
I’ll keep a photographic record of my progress.
When you live on a farm, there’s no need to drive to Whole Foods, you just grab a picking basket. Here’s what we picked last Saturday morning.
The analysis involved separating these vegetables and fruits (tomatoes) into categories for storage in our 4 different cooling zones - our commercial walk-in refrigerator, residential refrigerator, root cellar, and mud room.
Here’s the completed analysis. Let’s hope we survive the grading process!
This week, I’ve been redesigning the barnyard based on the workflow and processes we’ve implemented over the past two years. How do you provide four seasons of animal and plant care with the following equipment (length x width x height in feet)
Terex Front Loader plus Snowblower attachment 12x5x7
SnowEx Sand spreader 5x3x3
Campbell Hausfeld Power washer 3x2x3
ExMark mower 7x4x3
Small farm cart 3x4x2
Medium farm cart 3x4x2
Large farm cart 3x4x2
Mobile Hose winder 2x3x2
SuperSplit Log Splitter 8x3x4
Manure cart 2x2x2
Wallenstein Chipper/Shredder 4x4x4
Answer - put it inside a 24x17x10 hoop house next to the barnyard that will serve as an all weather equipment depot.
I’ve cleared the entire area behind the duck house and chicken coop of wood, manure, and planting supplies so that we now have a 100x50 foot section of flat land.
Over the next few weeks, I’ll haul gravel to create an all weather driving surface in and out of the hoop house while also preparing for a possible future pig housing area where the wood is now stacked. Manure management will be done with a cart with a 1000 pound capacity that I can haul behind the Terex.
August is a great time on the farm - warm weather with limited planting/harvesting, so there’s time to do design work.
I’ll keep a photographic record of my progress.
Wednesday, July 29, 2015
When the Healthcare System Works
I was recently at a meeting where a colleague described a recent interaction with BIDMC.
She had a traumatic injury on a weekend afternoon and suspected a fracture. Rather than visit an emergency department filled with high acuity patients, she visited the BIDMC Urgent Care center, knowing they could do imaging and place a cast if necessary.
The facility is within a few minutes of her home and the parking is free. She was seen within a few minutes and x-rayed. The emergency physician on shift apply a cast, and arranged a followup appointment with a specialty orthopedist at BIDMC, Boston.
The next morning, she received a call from the urgent care center asking if her pain was under control and if she felt any numbness/tingling from the cast (no). She was also asked if the followup appointment was still convenient. She asked if it could be changed to the BID-Needham location as that was closer to her home (and the parking is free). The appointment was made instantly for the following day. A permanent cast was placed and the orthopedist will care for her until she is fully healed and functional.
The entire care process was documented electronically and available to the patient via smartphone, including the clinician notes.
As I’ve written about several times in the past, this “care traffic control”, directing the patient to right intensity of care, then closing the loop for followup care is the future of medicine. It’s high quality, lower cost, and improves outcomes. The IT systems required to do it are more about workflow and process than the simple capture of records. As we envision the next generation of electronic tools, support for team based care with handoff management and closed loop communication among the stakeholders will be the most important new features.
Here’s a personal example of another way the healthcare system should work. As I mentioned last week, I have an arrhythmia for 15 years, but it has never been captured. Last week I put an ECG monitor from AliveCor on my phone. Over the weekend, I was able to capture a Lead I tracing of the arrhythmia on my phone, send it electronically to my PCP and Cardiologist, and receive a recommendation for next steps - all within an hour.
Here’s the tracing of the arrhythmia, which has a rate near 160 beats per minute. p waves are present, so it’s an atrial tachycardia, which is benign (as opposed to a ventricular tachycardia which could be life threatening). It could be atrial flutter, but I think that is unlikely because I do not have any underlying heart disease.
Here’s the tracing of my baseline ECG, normal sinus rhythm without any abnormalities.
My cardiologist recommended beta blockers or calcium channel blockers.
My PCP noted that my problem list now has three things on it
1. Glaucoma
2. New onset hypertension
3. Atrial Tachycardia
4. History of Lyme Disease (now Western blot negative, so it is resolved)
5. Low vitamin D (easily fixed with 2000 units of Vitamin D per day)
Beta blockers will improve the glaucoma, treat the hypertension, and prevent the atrial tachycardia. I’ll see my PCP tomorrow morning and be started on beta blockers.
All of these interactions were done from my smart phone, with telemetry provided by me from a wearable sensor. No phone calls, proprietary equipment, or paper-based records were involved. I have an electronic record of the entire interaction.
Next steps for me including recording the arrhythmia with the AliveCor device while measuring my blood pressure with the Withings BP cuff. During the tachycardia episodes I am lightheaded, likely due to low blood pressure.
From an IT perspective, I’m reaching out to AliveCor to determine if we can upload the ECGs directly into the BIDMC electronic record, just as we do with blood pressure and scale data with our new app BIDMC@Home.
I look forward to healthcare system that combines electronic tools, patients/families, and navigation by a team captain to all the right resources. It’s not just a dream, it is beginning to happen today.
She had a traumatic injury on a weekend afternoon and suspected a fracture. Rather than visit an emergency department filled with high acuity patients, she visited the BIDMC Urgent Care center, knowing they could do imaging and place a cast if necessary.
The facility is within a few minutes of her home and the parking is free. She was seen within a few minutes and x-rayed. The emergency physician on shift apply a cast, and arranged a followup appointment with a specialty orthopedist at BIDMC, Boston.
The next morning, she received a call from the urgent care center asking if her pain was under control and if she felt any numbness/tingling from the cast (no). She was also asked if the followup appointment was still convenient. She asked if it could be changed to the BID-Needham location as that was closer to her home (and the parking is free). The appointment was made instantly for the following day. A permanent cast was placed and the orthopedist will care for her until she is fully healed and functional.
The entire care process was documented electronically and available to the patient via smartphone, including the clinician notes.
As I’ve written about several times in the past, this “care traffic control”, directing the patient to right intensity of care, then closing the loop for followup care is the future of medicine. It’s high quality, lower cost, and improves outcomes. The IT systems required to do it are more about workflow and process than the simple capture of records. As we envision the next generation of electronic tools, support for team based care with handoff management and closed loop communication among the stakeholders will be the most important new features.
Here’s a personal example of another way the healthcare system should work. As I mentioned last week, I have an arrhythmia for 15 years, but it has never been captured. Last week I put an ECG monitor from AliveCor on my phone. Over the weekend, I was able to capture a Lead I tracing of the arrhythmia on my phone, send it electronically to my PCP and Cardiologist, and receive a recommendation for next steps - all within an hour.
Here’s the tracing of the arrhythmia, which has a rate near 160 beats per minute. p waves are present, so it’s an atrial tachycardia, which is benign (as opposed to a ventricular tachycardia which could be life threatening). It could be atrial flutter, but I think that is unlikely because I do not have any underlying heart disease.
Here’s the tracing of my baseline ECG, normal sinus rhythm without any abnormalities.
My cardiologist recommended beta blockers or calcium channel blockers.
My PCP noted that my problem list now has three things on it
1. Glaucoma
2. New onset hypertension
3. Atrial Tachycardia
4. History of Lyme Disease (now Western blot negative, so it is resolved)
5. Low vitamin D (easily fixed with 2000 units of Vitamin D per day)
Beta blockers will improve the glaucoma, treat the hypertension, and prevent the atrial tachycardia. I’ll see my PCP tomorrow morning and be started on beta blockers.
All of these interactions were done from my smart phone, with telemetry provided by me from a wearable sensor. No phone calls, proprietary equipment, or paper-based records were involved. I have an electronic record of the entire interaction.
Next steps for me including recording the arrhythmia with the AliveCor device while measuring my blood pressure with the Withings BP cuff. During the tachycardia episodes I am lightheaded, likely due to low blood pressure.
From an IT perspective, I’m reaching out to AliveCor to determine if we can upload the ECGs directly into the BIDMC electronic record, just as we do with blood pressure and scale data with our new app BIDMC@Home.
I look forward to healthcare system that combines electronic tools, patients/families, and navigation by a team captain to all the right resources. It’s not just a dream, it is beginning to happen today.
Thursday, July 23, 2015
Unity Farm Journal - Third Week of July 2015
In yesterday’s blog post, I wrote about mobile devices and my own blood pressure variability.
The one time that my blood pressure is normal is during a day of farm work. After hauling wood, planting/harvesting, caring for animals, maintaining trails, and repairing infrastructure, I’ll walk down our farm road through the orchard on the way back to the house. All the tension of the week fades away with walk along the road.
Last week we moved 10,000 pounds of manure from the barnyard compost area to wind rows near the orchard. We use “llama beans” to amend the soil in our hoop house and supplement our trees/squash beds. A heavy rain made the manure very heavy and on the way to the wind rows, a buried underground stump collapsed, causing the Terex front loader to tip over with a 1000 pound load. Luckily I was standing nearby and the opened the emergency exit for the driver who exited unharmed. We used a truck and heavy duty nylon webbing to pull the Terex back into the upright position. No harm done!
With the manure cleared, we’re redesigning the barnyard so that we can install a 17’x24’ hoop house for equipment storage - moving the Terex out of the barn and the mowers out of our pasture lean-to’s. We’re also creating an area that might be used for pigs in the future. We’ve scaling back our wood storage to just 4 cords (from 8 cords). We’re re-grading/leveling the barnyard and applying gravel to the working surfaces to minimize the low spots that become mud wallows. With every passing season we’re learning more about how to run a farm and optimize the physical arrangement/equipment to minimize maintenance tasks.
We did our annual vet visit for a full physical exam of all the animals this week. The 14 camelids (alpaca/llama) are entirely healthy. We gave the rabies and clostridial vaccines, checked their nutritional status, and carefully examined eyes/ears/teeth. The only issues were that the llama is slightly overweight (but no change from last year) and one of our older alpaca has irritated eyes that we’re treating with ophthalmic ointment. Our young alpaca continue to grow like weeds. Danny (4 weeks old) is now 35 pounds and Sunny (1 year old) is 85 pounds.
The geese continue to follow us around the farm. It’s as if we have 5 dogs - two Great Pyrenees plus 2 buff geese and 1 tuft goose.
The young chickens are learning the ropes of farm life, roosting in the coop night, staying safe from hawks during the day, and avoiding conflict with the other birds.
At midsummer, the hoop house is filled with peppers, tomatoes, cucumbers, eggplant, and beans. I fill a basket with fresh food every night. Kathy is busy pickling and preserving the foods we’re not eating now.
The weekend ahead includes harvesting our garlic, potatoes and squash. I’ll plant a few beds of lettuce and chard for early Fall picking. We’ll spin frames of honey and bottle in anticipation of mead making and honey lager brewing this Fall.
I’m working remotely on Mondays and Fridays in August. Although it seems early, the planning for harvest and the winter ahead is already in progress.
The one time that my blood pressure is normal is during a day of farm work. After hauling wood, planting/harvesting, caring for animals, maintaining trails, and repairing infrastructure, I’ll walk down our farm road through the orchard on the way back to the house. All the tension of the week fades away with walk along the road.
Last week we moved 10,000 pounds of manure from the barnyard compost area to wind rows near the orchard. We use “llama beans” to amend the soil in our hoop house and supplement our trees/squash beds. A heavy rain made the manure very heavy and on the way to the wind rows, a buried underground stump collapsed, causing the Terex front loader to tip over with a 1000 pound load. Luckily I was standing nearby and the opened the emergency exit for the driver who exited unharmed. We used a truck and heavy duty nylon webbing to pull the Terex back into the upright position. No harm done!
With the manure cleared, we’re redesigning the barnyard so that we can install a 17’x24’ hoop house for equipment storage - moving the Terex out of the barn and the mowers out of our pasture lean-to’s. We’re also creating an area that might be used for pigs in the future. We’ve scaling back our wood storage to just 4 cords (from 8 cords). We’re re-grading/leveling the barnyard and applying gravel to the working surfaces to minimize the low spots that become mud wallows. With every passing season we’re learning more about how to run a farm and optimize the physical arrangement/equipment to minimize maintenance tasks.
We did our annual vet visit for a full physical exam of all the animals this week. The 14 camelids (alpaca/llama) are entirely healthy. We gave the rabies and clostridial vaccines, checked their nutritional status, and carefully examined eyes/ears/teeth. The only issues were that the llama is slightly overweight (but no change from last year) and one of our older alpaca has irritated eyes that we’re treating with ophthalmic ointment. Our young alpaca continue to grow like weeds. Danny (4 weeks old) is now 35 pounds and Sunny (1 year old) is 85 pounds.
The geese continue to follow us around the farm. It’s as if we have 5 dogs - two Great Pyrenees plus 2 buff geese and 1 tuft goose.
The young chickens are learning the ropes of farm life, roosting in the coop night, staying safe from hawks during the day, and avoiding conflict with the other birds.
At midsummer, the hoop house is filled with peppers, tomatoes, cucumbers, eggplant, and beans. I fill a basket with fresh food every night. Kathy is busy pickling and preserving the foods we’re not eating now.
The weekend ahead includes harvesting our garlic, potatoes and squash. I’ll plant a few beds of lettuce and chard for early Fall picking. We’ll spin frames of honey and bottle in anticipation of mead making and honey lager brewing this Fall.
I’m working remotely on Mondays and Fridays in August. Although it seems early, the planning for harvest and the winter ahead is already in progress.
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