The Moons of the Month

This weekend is Halloween and I did not find an appropriately thematic cool technology.  Looking out my window at the waning full moon, I realized that I did not know the traditional monthly moon names.  This weekend will you be trick or treating under the Corn Moon, Harvest Moon, or Beaver Moon (the answer is Harvest).  Here's the Farmer's Almanac guide to the names of the monthly full moons.  Enjoy your Halloween weekend.

*Full Wolf Moon – January Amid the cold and deep snows of midwinter, the wolf packs howled hungrily outside Indian villages. Thus, the name for January’s full Moon. Sometimes it was also referred to as the Old Moon, or the Moon After Yule. Some called it the Full Snow Moon, but most tribes applied that name to the next Moon.

*Full Snow Moon – February Since the heaviest snow usually falls during this month, native tribes of the north and east most often called February’s full Moon the Full Snow Moon. Some tribes also referred to this Moon as the Full Hunger Moon, since harsh weather conditions in their areas made hunting very difficult.

*Full Worm Moon – March As the temperature begins to warm and the ground begins to thaw, earthworm casts appear, heralding the return of the robins. The more northern tribes knew this Moon as the Full Crow Moon, when the cawing of crows signaled the end of winter; or the Full Crust Moon, because the snow cover becomes crusted from thawing by day and freezing at night. The Full Sap Moon, marking the time of tapping maple trees, is another variation. To the settlers, it was also known as the Lenten Moon, and was considered to be the last full Moon of winter.

*Full Pink Moon – April This name came from the herb moss pink, or wild ground phlox, which is one of the earliest widespread flowers of the spring. Other names for this month’s celestial body include the Full Sprouting Grass Moon, the Egg Moon, and among coastal tribes the Full Fish Moon, because this was the time that the shad swam upstream to spawn.

*Full Flower Moon – May In most areas, flowers are abundant everywhere during this time. Thus, the name of this Moon. Other names include the Full Corn Planting Moon, or the Milk Moon.

*Full Strawberry Moon – June This name was universal to every Algonquin tribe. However, in Europe they called it the Rose Moon. Also because the relatively short season for harvesting strawberries comes each year during the month of June . . . so the full Moon that occurs during that month was christened for the strawberry!

*The Full Buck Moon – July July is normally the month when the new antlers of buck deer push out of their foreheads in coatings of velvety fur. It was also often called the Full Thunder Moon, for the reason that thunderstorms are most frequent during this time. Another name for this month’s Moon was the Full Hay Moon.

*Full Sturgeon Moon – August The fishing tribes are given credit for the naming of this Moon, since sturgeon, a large fish of the Great Lakes and other major bodies of water, were most readily caught during this month. A few tribes knew it as the Full Red Moon because, as the Moon rises, it appears reddish through any sultry haze. It was also called the Green Corn Moon or Grain Moon.

*Full Corn Moon – September This full moon’s name is attributed to Native Americans because it marked when corn was supposed to be harvested. Most often, the September full moon is actually the Harvest Moon.

*Full Harvest Moon – October This is the full Moon that occurs closest to the autumn equinox. In two years out of three, the Harvest Moon comes in September, but in some years it occurs in October. At the peak of harvest, farmers can work late into the night by the light of this Moon. Usually the full Moon rises an average of 50 minutes later each night, but for the few nights around the Harvest Moon, the Moon seems to rise at nearly the same time each night: just 25 to 30 minutes later across the U.S., and only 10 to 20 minutes later for much of Canada and Europe. Corn, pumpkins, squash, beans, and wild rice the chief Indian staples are now ready for gathering.

*Full Beaver Moon – November This was the time to set beaver traps before the swamps froze, to ensure a supply of warm winter furs. Another interpretation suggests that the name Full Beaver Moon comes from the fact that the beavers are now actively preparing for winter. It is sometimes also referred to as the Frosty Moon.

*The Full Cold Moon; or the Full Long Nights Moon – December During this month the winter cold fastens its grip, and nights are at their longest and darkest. It is also sometimes called the Moon before Yule. The term Long Night Moon is a doubly appropriate name because the midwinter night is indeed long, and because the Moon is above the horizon for a long time. The midwinter full Moon has a high trajectory across the sky because it is opposite a low Sun.

What am I, Who am I, What will I be?

In 1979, as a senior in high school, I watched the movie and TV Series "Buck Rogers in the 25th Century".

The theme song lyrics begin

What am I, Who am I, What will I be?
Where am I going and What will I see?

As a teen applying to college and about to embark on the next step toward adulthood, I deeply pondered these questions.    Today, I still do, although it's 30 years later and I've traveled through many stages of life since then.

Here's my framework for thinking about "What am I, who am I, what will I be?"

1.  My roles through the stages of life  as a son, a husband, a father, a doctor,  and a public figure of sorts.

2.  My job as CIO of provider organizations.

3.  My job as CIO of a medical school.

4.  My volunteer work as a Federal and State convener.

5.  My self, what really makes me an individual
*My outdoor activities including kayaking, biking, hiking, skiing,  and climbing.

*My Japanese traditions including playing the Shakuhachi,  drinking tea, burning incense,  appreciating the traditional arts,  and living a simple Asian lifestyle.

*My black clothing

*My Vegan diet

*My gardening throughout the year, appreciating every variation of the seasons in New England.

In 1979, I could never have answered the question as completely, but now I truly know what makes me an individual and who I am.

What will I be?  I hopefully have many years to find out, but being satisfied with the journey is all I can hope for.

The October HIT Standards Committee meeting

This month's meeting focused on the planning for standards which will support meaningful use stage 2 and 3, as well a review of NHIN Direct and its future plans to provide simple transmission of data among stakeholders.

We began the meeting with Jamie Ferguson's Vocabulary Workgroup report.   He highlighted the work that has been done to reduce the intellectual property barriers which have slowed the creation of centralized, web-based resources containing all vocabularies, codesets, and mappings needed by eligible providers and hospitals to achieve meaningful use.  Several financial models have been considered, including federal government funding of vocabulary licensing fees and the establishment of a single administrative group to centrally collect a single fee from providers in return for providing them all the meaningful use vocabulary resources they need.    We discussed two related issues 1) identifying who pays licensing fees and we determined it should be those who generate data not those who receive it or manipulate it as a business associate of the data generator.  2) identifying the need for proprietary code set vendors to create free mappings to federally mandated standards.   For example, RxNorm includes proprietary medication codesets and the vendors of these codesets should offer free mappings from ALL their proprietary codes to RxNorm codes.

Next, Liz Johnson updated the group on the Implementation Workgroup activities.   She highlighted the need for hearings, to be held in December or January, on five topics - the role of RECS in attaining meaningful use, certification experiences, lessons learned from early adopters seeking meaningful use attestation in 2011, experience with performance/quality measures, and the status of health information exchanges.   I discussed two barriers to certification - the fact that the syndromic surveillance implementation guide in the Final Standards Rule is incorrect.   It was updated via an interim final rule  so that has been addressed.   Also that the NIST testing tools for e-prescribing transactions did not include the XML forms of NCPDP standards.   On October 24, NIST issued version 1.1 of those tools, addressing the issue.

Paul Tang and George Hripcsak then presented the guiding principles behind Stage 2 and 3 meaningful use.   Summarizing the key points
*Some aspects of stage 2 will be incremental changes to stage 1 (i.e. raising the thresholds)
*Some will be a stepping stone on the way to stage 3
*Stage 3 will likely including outcomes measures as well as process measures.
*Stage 2 and 3 will likely require analysis of data across a community and not just within an institution, increasing the amount of HIE enablement to be demonstrated.
*Patient engagement in future stages will clarify methods to share data with patients - "access/download" which is real time on demand, "copy" which is a point in time summary of available information including specific use documents/datasets.

Our discussion included the need to clarify the term "document".  Most people concurred that "document" meant a collection of data elements, in electronic form, capable of many reuses.   Ideally, the standards committee will suggest a common container for assembly of structured and unstructured information that does not require creating numerous standards for individual document types.

Arien Malec then updated the group on NHIN Direct.   The consensus of the Direct collaborators is to require secure email (SMTP/TLS/certificates) as the backbone but allow SOAP (XDR) or SMTP at the edges.  This means that senders and receivers can decide how to transmit/receive data (SMTP or SOAP) as long as they have a way to communicate with the SMTP backbone.   Finally, an exception was made for those senders and receivers who agree to use SOAP from point to point by previous agreement.  This approach enables existing vendor products which already support SOAP to continue to do so, while enabling innovative approaches using secure email.   Specifications will be finalized by next month and live implementations will be evaluated by the Standards Committee in March.

Doug Fridsma reviewed the current state of the Standards and Interoperability framework, noting that it now has a set of tools and processes to support health information exchange project development including use case writing, harmonization, implementation guide writing, reference implementation and testing.   Priorities will focus on Meaningful Use data exchanges and the Virtual Lifetime Electronic Record (VLER) project.   Much discussion followed about the best way to incorporate the HIT Policy Committee, the HIT Standards Committee, NHIN, and the Standards and Interoperability Framework into a more coordinated set of activities.   The Concept of Operations document which guides the Standards and Interoperability Framework is being updated to knit all these activities together and we will discuss that at our November meeting.

The November and December meetings will be teleconferences, so I look forward to hearing you all on the phone.

Surescripts goes beyond e-Prescribing

In my many blogs about standards, I've concluded that content and vocabulary standards are well specified but transmission standards are not.   We've required the basics of security but have left the actual transmission up to each set of trading partners.   Approaches include REST, SOAP and  SMTP/TLS.

NHIN Direct is a project to create implementation guides and running open source prototypes which facilitate transmission.

Surescripts is partnering with Kryptiq to create a commercial product that leverages the existing e-prescribing connections in clinician offices and NHIN Direct to create a healthcare information exchange.

I believe this commercial effort is complementary and not competitive with state healthcare information exchanges and the stimulus funds given for states to accelerate interoperability.

NEHEN connects 10,000 providers in Massachusetts, but that leaves 10,000  doctors, mostly in small practices, unconnected.

Our vision is to connect every provider with every provider.

Of the unconnected providers, the majority using EHRs have e-prescribing capabilities.   Connecting e-prescribing providers with the state health information exchange backbone is a win/win division of labor among NEHEN, Surescripts and other vendors.

Here's the detailed announcement of Surescripts' vision for federated, network of networks health information exchange.

High Performance Computing and the Latest Applications

Last week, I keynoted the Harvard High Performance Computing Summit and updated the attendees on the latest research computing and novel applications at Harvard Medical School.

1.   Orchestra - is our 6000 core high performance computing infrastructure that is shared by all research departments.  They key to its success has been the sense of community we've developed around a shared utility.   The school funds the power/cooling/hosting/basic infrastructure as well as an expert staff to serve the faculty.   Researchers use their grants to add computing power and storage to the community utility instead of building small clusters under desks and in local mini-data centers.

2.   Novel Sources of Data  - The American Recovery and Reinvestment Act (ARRA) and its related healthcare IT regulations are encouraging clinicians and patients to record healthcare data in electronic form.   With proper privacy controls and institutional review board oversight, this new data can provide support for comparative effectiveness research, population health monitoring, and pharmacosurveillance.

3.   Mining those novel sources of data with Shrine - Petabytes of data does not change healthcare, but transforming that data into information, knowledge and wisdom does.   Shrine enables researchers, with appropriate oversight and approval,   to study the de-identified data  of 10 million patients at Harvard affiliates.

4.  Building collaborations with Profiles - The path to wisdom requires that researchers ask the right questions.   Assembling a team of colleagues into an optimal multidisciplinary combination is easy with our Profiles social networking application.   It mines the literature, Harvard directories, and the connections among all Harvard faculty to identify the right people to ask the right questions.

5.  Sustaining the research infrastructure and applications with an NIH compliant, researcher  friendly business model is challenging.   Computing power, data, tools, and collaborators are great but they must be supported with operating budgets, grant dollars, and philanthropy.   Harvard has retained an expert consultant and is moving forward on an aggressive schedule (60 days) to analyze all the potential sustainable business models (direct grant funding, indirect overhead, chargebacks, school operating budgets, transaction fees, subscription fees) that will support growth in infrastructure and staff over time.

The high performance computing summit was a great opportunity to share ideas and learn from each other.    I look forward to sharing the sustainable business model for research computing as it is finalized by the end of 2010.

Cool Technology of the Week

Last week, I met with Patientsafe Solutions, a San Diego-based startup founded by serial entrepreneur James Sweeney.

Their idea is simple - leverage the iPod Touch 4G form factor and the iOS 4 SDK to create an all in one mobile device for healthcare.   Their work thus far has included medication management workflow including bedside medication verification and electronic medication admission records.   Their future vision encompasses numerous aspects of nursing workflow, pre-admission testing, admission, discharge and home care.

Here's an overview of their initial PatientTouch product.

In the past, nurses have told that they really did not want to carry devices, which have the potential for getting in the way of the nurse-patient interaction.

Today, the ubiquity of smart phones makes the notion of carrying a pocket sized device more palatable.

Imagine one device that is rugged, lightweight, secure, and easily cleanable for supporting medication workflow (positive patient ID, eMAR, medication verification),  laboratory workflow (positive patient ID, front end labeling),  alerts/reminders, and voice over IP communications via hospital WiFi networks.

An iPod touch in every clinician's pocket, fully connected to hospital information systems and other caregivers.   That's cool.

Making Pesto

The temperatures in Massachusetts are dropping into the mid 30's every night and the days are growing short.   It's time to harvest the last of our summer planting before the first hard freeze of Fall.   Although I'll keep oak leaf and red fire lettuce growing under the cold frame for another month, our bush-sized basil plants need to be harvested before they wither from the nightly low temperatures.

What do you do with 20 pounds of basil?   Make enough pesto to last all winter.   As vegans, we'll be eating pesto pizza, pesto linguine, and pesto covered toasted breads as the weather gets cold.

My wife has diligently plucked all the best leaves, visited Trader Joe's to stock up on pine nuts, and bought a box of Yellingbo olive oil.   Here's our recipe:

Vegan Pesto

2 cups fresh basil leaves
1/3 cup organic extra virgin olive oil
1 cup pine nuts
1-2 tablespoons garlic
1/3 cup nutritional yeast

Combine all ingredients except oil in a food processor until nuts are ground. Add oil until texture is creamy. Pesto should still have some texture (not too pureed).  Freeze extra in small containers for future use.