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The American Experiment

The United States prides itself on many things. The hackneyed list begins with apple pie and often includes military power. I understand people having pride in such lists, but I have to disagree that these are the best and most important characteristics of the American Experiment.

Experiment? Yes, that term applies very well. The Founding Fathers thought that what they were about was an experiment to see if the people could govern themselves. That was a radical notion in the late 1700s--particularly if one put it into practice.

Okay, one might criticize them for not including everyone. Whole classes of people were not permitted to participate in the democratic experiment. The list included women, slaves, Native Americans, men without property, etc. In fact, while the Fathers espoused democratic values and touted the worth of representative government, they excluded most of the people from participating in that process.

Nevertheless, they set in motion a process that over the next centuries did become more inclusive. While we can critique their lack of application of professed universal values and rights, they were intellectually honest to recognize that it was an experiment, and experimentation requires constant evaluation, updates, and even revolutionary change. The Civil War, 1861-1865, was really the Second American Revolution that made a very bloody down-payment on rights that it still took another century to move close to recognition. We are still traveling down that road to fruition.

You may know that I was trained as a historian, so these thoughts easily come to my mind--even when talking with information technologists. (What???) Last night, I attended a function at the headquarters of Research Triangle Park on Open Source All Things that made me think of our shared experiment.

For those out of the know, open source is a set of methods to create, modify, and use things together. It can involve software, data, knowledge, etc. that is free to use but may not be free. "Free" in this context connotes "liberty" and the term "libre" is often used to amplify the meaning, particularly for software. (Check out FLOSS--Free Libre Open Source Software. Thanks to Paul Jones for pointing me there.) It is fundamentally a community-based approach to developing technologies where the code is sharable and improvable by the community. But back to last night.

The program included several speakers, all limited to 5 minutes, to talk about their experience and enthusiasms regarding open source across many domains from software to policy to participation to science. It was a very nerdy event that assumed you had some appreciation and knowledge of the movement. And it is a movement with all the passions we bring to our lives together.

We heard about the emergence of the movement and many of its successful efforts (Paul Jones), how to be a civic geek (Reid Serozi), how to get started and join the movement (Jason Hibbets), the implications for open source in education (Eric Martindale), how open source helps in scientific inquiry (Karen Cranston), how open source can break down information silos in companies (Vincent Belanger), how open source tools continue to leap forward (Carlos Santana), the use of open source in addressing vexing public issues such as global water resources (Ray Idaszak). and where to join and participate in the public access and use of data at Triangle Open Data Day (Ian Henshaw).

It was quite a fire hose of information. The basic message throughout the presentations and discussion was the power of the people using the open source approach to determine their collective future. I don't know if the Founders would have appreciated all of it, but in a way they contributed to it.


TiE Carolinas and Being Human

I attended a meeting on healthcare innovations the other night. It featured a panel discussion of experts who attempted to describe what is happening today at the leading edge of innovation in health information technology. It was an interesting discussion, but the setting was more interesting. The gathering lasted three hours and that provided time for networking over hors d'oeuvres, a full dinner, introducing what the chapter and overarching organization are about, and the panel discussion. (Never having met a cuisine I didm't like, I deemed the food excellent.) 

The hosting organization was The Indus Entrepreneurs of the Carolinas (TiE Carolinas). It is a local non-profit chapter of a global movement fostering entrepreneurship through mentoring, networking, and education. Their website notes that they are "dedicated to the virtuous cycle of wealth creation and giving back to the community, TiE’s focus is on generating and nurturing our next generation of entrepreneurs." TiE Carolinas is one of 57 chapters worldwide. 

Sid Gautam
Taking nothing away from a superb panel and discussion, for me TiE Carolinas was the star of the evening. I've been involved in entrepreneurial efforts off and on since the late 1980s in the Triangle, but I'm kicking myself for never having noticed this group before. The attraction is the sense of community they espouse and practice. At one point, the host invited a Siddhartha B. Gautam to speak a few words before the main program. He was introduced as the author of Happiness is You as well as a business professor. He talked about combining business and personal life. He gave the air of a person with a deep well of joy. (Of course, mentioning the book prompted me later to buy a copy.) He, and other speakers, also spoke about the mission of TiE Carolinas. They mentioned programs for youth mentorship for high school students. They spoke of the informal efforts of the group's members to embrace new entrepreneurs with the skills and connections they would need to succeed. 

But there was more than business going on at the meeting. At the table where I sat, the conversation over dinner was about family and work rather than work with family a distant second. My dinner companions were sincerely interested in hearing my story and were gracious in their time and attention. The attention was warm and caring. At the end of the program, as I was walking out to my car after dusk, one of the people I had met made a point of walking next to me to ask how I found the evening. He was going beyond politeness. His interest was genuine and he was closely listening to my responses. 

I found the group a welcome tonic to the notion that business is war where we all struggle against each other, even within our own organizations. These were clearly competitive and sharp entrepreneurs, but they had not forgotten they are human beings as well. 


Legacies in Data

We are rapidly moving to comprehensive use of electronic health record (EHR) systems. But what happens to existing, i.e. legacy, data when the process is complete? That's actually a vexing issue for the following sample of reasons:

  • EHR vendors don't like these data because of potential errors creeping in from migrating to a new platform. 
  • Government policy mandates that pediatric data to be available for up to 30 years (age 18 plus 12 years because of chronic medical conditions). 
  • Corporate attorneys fear malpractice suits. If data exist in any form, it's "discoverable"--meaning that it can be used in a malpractice case. 
  • New clinical protocols often come from mining years of data, often using data that no one previously thought was very useful. 
Can we reconcile these conflicting factors? But wait, let's pile on more. All patients have records in some form. In many cases where they are electronic and supported by a commercial EHR vendor, that vendor may not be happy to lose the contract if the organization wants to move to a new vendor. Sometimes the medical records may be held in a proprietary format that requires special knowledge in accessing them. And while the organization may "own" their data, they may no longer have easy access because the old software license has been allowed to expire. These migrations are part of the transformation of medical records and their related data as the nation moves to systems that support wider use of these records for improved clinical care--aka Meaningful Use. The list goes on, and on, but these are the highlights. 

If we could create a "safe harbor" for these records and their data, we could accomplish the following: 
  • Make legacy data available for researchers to study treatments and outcomes to develop new protocols that will improve clinical outcomes--that's saving more lives. 
  • Provide a way for clinicians to access older data on the patient they are treating to understand that person's medical history and inform their treatment--that's better outcomes. 
  • Permit the development of records retention protocols that support the above without opening the clinicians and their organizations to data fishing expeditions in litigation--that can lower tempers and costs. 
  • Provide a set of technologies based on open source software that offer continued access that helps everyone but advantages no one--that's a win for all. 

All the above are possible, but will require discussion and cooperation across the groups involved:

  • Software vendors to provide documentation of their data schemas, perhaps supported by a shared cost pool. 
  • Clinical care organizations to define what they need for reaching back to use legacy data. 
  • Government and other convening organizations to develop comprehensive policies on record retention and availability--much like the current evolution of meaningful use policies. 
The potential solutions are available, but it will take some hard work to reach them. 


Dave's Lookin' for a Job

The title of this post actually has a story behind it. 

In the summer of 1994, I decided to look for a new job. I began in those pre-online days by looking in newspapers and working my network of friends and acquaintances in person. One evening, my wife and I had planned to meet friends for dinner--a couple we had not see in many months after they moved out of our neighborhood. They had already settled in at a table when we arrived. As we strode up, the husband--Vic--asked how we were doing. Without hesitation, even before I could sit down, Julie blurted out, "Dave's lookin' for a job!" As it turned out, Vic was dealing with the loss of his technical staff that day as they departed to start a new company with his blessing. Consequently, dinner turned into a job interview as I said again and again, "Yes, I've done that," when asked if I had direct experience with a particular technology from video editing, programming, database design, telecommunications, etc. In several years working in the private sector, I learned how to master a new technology in a hurry. As it turned out, a few weeks later I was hired by Vic as a temp and began almost two decades at UNC (if you want the specifics, here are links to my curriculum vitae and my LinkedIn profile.) 

For those still with me, I'll try to explain what I might bring to a new opportunity and some hint of what might be interesting to me. 

My search is not specific. I'm not looking for a particular position, although I'm interested in many kinds of jobs. That seeming paradox explains my approach for almost all of my career. I learned the hard way, and early on, not to get my hopes up for any particular type of job. I started out as a freshly-minted PhD looking for a tenure-track faculty position as an academic historian. I discovered very soon that any open position often had scores of candidates. I did move from temporary teaching jobs to work for a small historical society. During my time there, however, I taught myself how to work with databases and began to realize that there was another path for me. When I switched to information technology, I was open to anything legal that supported the family. 

As it turned out, I managed to find jobs that were inherently interesting and I soaked up technical skills rapidly. By the time I joined UNC, I was conversant in several languages--with the exception of English, none of them human. But I also brought another set of skills honed from holding my own in family dinner table political discussions, challenging my high school English teacher to debate, regaling my fellow college students with ideas I learned in class that day, eventually lecturing and leading discussions with my students as a graduate teaching fellow and faculty member. It gave me practice in listening, engaging ideas, and bringing a group to a shared state of knowledge and even decision. (It also encouraged my mouth to go on and on. Sorry about that.) The result was a mixture of technical knowledge based on experience and the ability to lead a team to find the best solution, a combination that worked well for me over the next 25 years. I'm also accomplished in geek-to-English and English-to-geek translation. 

Most of the positions I gained were with organizations in trouble when I arrived. 
  • Technical teams with months of effort before them and only weeks of time before an absolute deadline
  • Research groups that needed to move from finely-crafted technical solutions to industrial-strength approaches
  • Technical services groups that lacked a coherent mission or business structure
  • Administrative groups that badly needed to clear some dead wood and bring in new management to address tightening budgets
  • Multi-institutional partnerships that lacked the sinews of partnership below some lofty rhetoric
In each case, I helped them bridge those gaps and meet the challenges they faced. I also recognized that once the challenge was met, I was ready for the next set of problems, and looked forward to learning new things. I often joke that, like the old curse, I wanted to live in "interesting times". I also discovered there are levels above interesting: fascinating, then riveting. (Riveting is very bad, but I know how to survive it.) 

So if I can bring lots of experience, technical understanding, an eagerness to keep learning, and organizational savvy, what am I seeking? Clearly, a position where all those are needed and in play. I'm open to contract work or joining an organization as a full-time member. The world has an abundance of challenges. I can't address more than a few, but I hope to make a positive contribution to our human family. 

If you know of a challenge that meets my experience and skills, here's how to reach me: 


Beyond Expertise

Recently, I attended an interesting meeting looking at agricultural health issues, specifically influenza. For those wondering, human beings are only one of the species that can contract influenza and get sick. Farm animals are susceptible as well, particularly poultry and swine. The meeting was a gathering of immunologists, veterinarians, and agricultural specialists looking at how to address the chronic issues of influenza on the farm. We dove into the details involving the genomics of the influenza virus, how vaccines prompt an immune response, and how that response needs to spread through the whole body to provide systemic protection. Despite the advances we have made, the biochemistry of immunization is still a difficult science that features educated guesswork as part of the search for a solution.

As I sat and learned about the issues these experts faced, I began to see a pattern I've observed many times before. They were seeking a technical solution--a set of steps, compounds, or other methods from their toolboxes that could address the need for combating the disease. They dove far down into the details of T-cells, B-cells, and cytokines trying to identify the combination that would step toward a solution. It reminded me of my first success with computers, long before I had any "expertise" in the field. 

Very early in my career as an academic historian, I was working to turn my dissertation into a book for publication. Back then, personal computers existed, but cost was just out of my reach. Happily, the university where I was teaching had a mainframe with a word processing program. I spent months typing in my draft and revising it to prepare for submitting to a publisher. Once finished, I tried to get it printed on a high quality printer because submitting a manuscript on green-bar paper with a dot matrix printer was not going to be even considered. (How far we have come with electronic submissions these days.) 

IBM Selectric Typing Ball
I worked out a deal with the admissions office to let me use one of their letter-quality printers that they used to print out acceptance letters that looked like they were typed on an IBM Selectric. They were all connected to the mainframe because they used admissions  management software. So, I was able to stay into the evening to print out a manuscript that ran a few hundred pages. Problem solved!

Not quite yet. The printers jammed after a dozen pages and I'd have to abort the job and start over. The software was so primitive that I had to begin printing the whole file over again from the beginning. (Oh, the limitations!) After many evenings trying, I gave up on printing it out directly from the mainframe. Yet the problem remained. 

Fortuna smiled on me that summer when I agreed to teach for some extra pay. It was enough to buy a microcomputer and high-quality printer. I bought a Kaypro. The only question was how to get my text off the mainframe and onto floppy disks for my machine. Of course, the mainframe took a different size disk and had a difference format for its disks than my little 5.25 CPM diskettes could accept. So, after talking with everyone on campus who might be able to help me, I found one guy who was willing to try to help. (At this point, my wife usually asks, "Is this story going anywhere?")
The Kaypro II

I met him after work one day in the computer center. We tried hooking my little computer to a serial port on the mainframe and sending commands through a terminal emulator to the mainframe. (Sorry, in English, that means my computer would tell the mainframe what to do.) It didn't work. The technician helping me did not understand it and gave me very detailed reasons why this was impossible and that it should work. Those details went right over my head. I just kept thinking, "Man, I just want my manuscript. The reasons it does not work are of no interest to me." 

After several combinations of fixes with continued failure, he thought there might be an issue with the hardware connection and plugged in a diagnostic device that had a built-in keyboard. He could send the command to return with the file and see the characters streaming across a one-line display on the device. He then connected it to my computer to see if my machine could receive the commands and respond correctly, which it did with the characters streaming across his display in the other direction. So, there was no hardware issue on either end, but he could not see the path to a solution. He sat softly muttering as he thought through the possibilities of what could be wrong, going through the variations of the RS-232 communications protocols that had to be the root of the problem. 

My heart began to sink. I could only see me retyping the manuscript over many, many hours. (Remember, there is no auto-correct on a typewriter.) The thought filled me with the dread of wasted, redundant effort. I was desperate. Then, the solution come to me. I hesitated mentioning it to the expert because I didn't understand the nature of the problem we faced. My idea was naive, and who was I to propose it. But desperation drove me forward and I said, "Look, your device can send commands to the mainframe that it understands and return the text of the files. Plugging it into my microcomputer at the same time allows my machine to understand what the diagnostic device sends. Why not use the diagnostic device to send the command to the mainframe to download the file while it's also plugged into my machine which can receive the file?" 

He sat silent for a minute. His hands templed on the point of his chin. "Brilliant!" he whispered. "It could work." And it did. I walked away that day with the full manuscript on floppies and ready for a bit of clean-up before sending to a publisher. 

The lesson I took away from that encounter, is that sometimes the solution to a vexing technical problem has to focus on the goal and not the problem. Success is more likely if you can cross disciplinary boundaries to bring approaches and perspectives that escape the experts. I've tried to follow the experience of that encounter to continue to ask the naive question or make the simple suggestion when dealing with a complex technical problem. Sometimes it is not helpful and I can't avoid feeling the fool. But that is a small price to pay when it turns out to help a group see something with fresh eyes and then they figure it out. 


SwitchPoint 2013

I attended the SwitchPoint Conference as a guest of IntraHealth last week. It is the second such gathering to find solutions that will save lives and improve the health of the poorest regions on earth. 

One of the things I promised my host was to provide some reflections on what I saw and heard. My reflections are my own, based on what I could experience, and informed by my past, So, I may get situations wrong and misinterpret some encounters. My apologies in advance.
Front of the Saxapahaw General Store

First and Lasting Impressions

Funky surroundings. Music. Art. Ubiquitous technology. Ubiquitous. Set in the Saxapahaw Ballroom (it's a dye house that was part of an old mill with remnants of antique machinery here and there), the meeting had an air of 1900 meets the 21st Century. The group's diversity was striking with every continent represented--based on the names and accents in evidence. Everyone had a smartphone and everywhere someone was looking at a personal screen. Lots of tablets--usually iPads. A few laptops, but very few. 

Music permeates and punctuates everything. Usually a mix with a wide variety of sampled sounds. It's not an add-on, it's organically integrated into the experience. During presentations, visual art--usually digital--is included and occasionally incorporated into presentations or musical interludes. There is an activist aesthetic in play, often with stylish logos or icons as well as personal fashion. As one participant put it, "Art is the common language of technology now." 

Undercurrents are still working, however. Attendees have an underlying passion, a drive to find the solution to vexing challenges in global health and recognize the substrata of challenges in economic development. Economic determinists would find that gratifying, but these are people who are combating those realities. They are seeking solutions that rely on available resources in their host environments and find the patchwork solutions delightful and beautiful--no matter how many paper clips and how much duct tape (literally!) are involved. These anti-cool solutions of low-tech are the best responses as reckoned by these high-tech enthusiasts. While personal styles reflect the global village and the insouciance of tech, these are determined people. Listen for even a few minutes and the movement culture begins to emerge. 

Conference or Chautauqua?

They are all learners. Again and again are presentations where they experimented, failed, prototyped, deployed, failed, and cycled iterations as they closed in on the solutions. "Africa has more pilots than the United States"--referring to projects not aviators--was a refrain either said out loud or implicit in many conversations. Several times, the more experienced people talked about the growing maturity of the movement as these lessons percolated and spread from group to group. 

The conference reminded me of the American chautauqua of a century and more ago, where people of diverse backgrounds and ages came together to share what they have learned and learn what they share. Like the American Populists of the late 19th Century, these people live in a movement culture. (Many thanks to Larry Goodwyn's The Populist Moment to describe the phenomenon.) Activism, art, music, and a post-industrial infusion of technology--a lot of technology--combine in a heady brew. The audiences listen in rapt attention to the presentations (mercifully short and pointed) to find out what was done here and there. 

Between presentations and "ensembles" (essentially panel discussions) are musical interludes that do more than provide a stretch break for the audience. The music comes from the shared evolution of rhythm and beat of the urban West and rural areas in the developing countries. These connections work at an intellectual and visceral level simultaneously. The beat supports the body moving and the emotions flowing, paradoxically taking the edge off and allowing everyone to return with determined, aware mindfulness. 

Lessons Drawn 

We're on our own was a theme that lasted from front to back. The situation of people short on resources, knowledge, and know-how could be glimpsed by those who came to understand that a home-made hammer was the high-technology solution available for some. The iron age and wireless routers can rest side-by-side in a collapsing of epochs that is the modern world. The notion that if it can work in Africa, it can work everywhere was proudly offered as proof of the utility of these solutions. 

The open question was how could these solutions and approaches be brought to serve industrialized communities with their own systems of economic production and distribution. The issue of convergence was not brought up--meaning the narrowing of means and outcomes as the rest of the world catches up in material circumstances with the industrialized regions. I guess the distance is so great to the people working in sub-Saharan Africa or south Asia that it has yet to appear. Yet, some of the people living there are more advanced in the use of texting than even 12-year-old Americans. It might be an interesting area of exploration. 

One take-away notion was the rise of the app. It was not a dominant feature of the conference, but was an enticing idea by one presenter/musician who is finishing a book on it. The app seems to have all the characteristics needed for success in the regions these folks hope to serve. It can be platform-independent; with the latest tools for creation the barriers to entry are low; it can provide its own sustainability through low pricing and wide deployment; it can work over wifi, cellular, or no network; and it is battery-powered when the electricity inevitably goes off. Watch this space. 

How to scale solutions was a repeated theme, but the solutions still remained merely promising. The inventions and innovations were still in gestational stages of evolution and not fully ready for deployment. Sustainability was another open question, but some seemed to think that government policy was one of the paths. Several times the notion of a shift in policy or investment would change the issue on the ground at scale. Few, however, seemed to see entrepreneurship as an answer--even social entrepreneurship. Maybe I missed that discussion. 

Underlying Meanings

Everything is Local. 
The underlying theme of the conference was figuring out how to make do with local materials and local effort--assisted with tips and tools from agencies in the developed areas of the planet. Repeatedly, speakers and participants offered stories of ad hoc remedies and solutions that could scale if the right circumstances arose. (See Von Hippel, Eric.) 

Keep It Simple.
While the challenges are staggering, there is faith in the simple solution if taken to scale. In fact, the assertion is that if the solutions are not simple they will fail. Simplicity mirrors the material conditions of the challenge and must be heeded. If the tools and resources are not at hand, keep looking to find them. 

Build for Scaling
No matter how small and seeming insignificant the idea, it needs to be scaled to address the mountain of challenge facing the people in need of solutions. The question is how to do that. Often people voiced the need for a policy shift or initiative to get governments to back an initiative, whether workforce development or shifting economic incentives. But some did see a potential network effect, depending on situations and circumstances. Information creation and access was the quiet message. 

Fail Fast
Few used the word "failure" to describe pilots and other efforts that did not achieve the hoped-for results. But the word hovered in the air during many sessions, but with more of the sense that entrepreneurs use it as the pathway one travels. My guess is that the term has such emotional freight and connotes such despair that many avoided it. Yet, the most successful and scalable approaches told stories of revising and even starting over before progress was achieved. 

Final Words
I was privileged to encounter these hundreds of people who work to raise the health circumstances of billions. They admit they have not found the solutions, yet. But they are relentless in trying. Read more at The SwitchPoint Reader. I recommend it highly. 


The Alphabet Soup of HIEs

I've been looking into HIEs (that's Health Information Exchanges) lately to prepare for a lecture to my students. I've been tracking the area since the late 1990s and have tried to keep up with all the acronyms. Here's my initial stab at the pre-history: 

The current initiatives coming out of the ARRA and HITECH legislation are a collection of standards, protocols, legal agreements, specifications, and services that enables the secure exchange of health information using the Internet as the pathway and technology. Getting even to the point of talking about a national HIE has grown from a number of starting points.

Back in 1990 the Hartford Foundation offered grants to several states and cities to set up community health management information systems to create central repositories for individual-level demographic, clinical, and eligibility information. Those data were to be used by stakeholders such as local agencies, payers, employers, and researchers for assessment activities. Secondarily, they were to create transaction systems to facilitate billing and patient eligibility information to reduce costs. Hampered by primitive technology, especially to costs for networks and related technology but also discovered that the lack of standards for data integration hampered their efforts. Moreover, they ran into political resistance from some providers who even got a law passed in Iowa to prevent the exchange from succeeding because of privacy and security concerns as well as ultimate control of the data—issues that persist even today. Finally, they never grew beyond the grant-funded approach to become self-sustaining.

Another effort was the community health information networks, CHINs, that were primarily commercial endeavors. The prioritized savings rather than quality assessment objectives. They took a very different approach and emphasized data transfer as their mode of sharing rather than having a centralized repository. Nevertheless, most did not make it out of the 1990s. The transaction costs, when affordable, could not support the system or meet business objectives. The costs needed to be borne by a larger market.

RHIOs were the first effort to start getting notice, and support, by the federal government. Because they offered services across a wider area, many linking communities together, they spread the risk. Nevertheless, they took millions to start and millions more to keep operating—difficult to raise and sustain. Competitive pressures between hospital systems kept the bar of mistrust high and stymied many efforts at data collaboration. Again, the issue of who controls the data tended to limit access and therefore success of the exchanges. Finally, the fear of legal liability from unlawful disclosure added another chilling effect.

To Err Is HumanIn the mix of these efforts was the 1999 NIH report, To Err Is Human, that suggested that as many as 98,000 people die as a result of preventable medical errors—issues that sharing health information should be able to mitigate. In fact, they followed up in 2001 with a supplemental report advocating the sharing of healthcare information in some sort of exchange.

The above initiatives were focused on community and regional collaboration. Why not reverse the direction and focus on the patient? A big boost to the idea of personal health records as the lingua franca of health information exchange was started by the Markle and Robert Woods Johnson foundations in the mid-2000s. (I attended the first couple of meetings they had and felt some of the enthusiasm.) The idea was to empower patients to have their own “personal health record” that contained all information relating to their healthcare. Generally, these efforts were started by individuals who were patients with serious chronic conditions, their family members who needed to care for someone, or they were started by behemoths like Microsoft or Google. The legal issues were potentially eliminated because the patient controls their own data in the first-person, but the approach would not provide societal benefits of aggregating the data for improving clinical outcomes or reducing costs. Finally, there were the persistent technical and logistical issues of providers tapping into the PHRs.

HIEs attempt (through the HITECH Act and Meaningful Use) to provide a set of incentives and penalties for non-compliance in adopting a standards-base EHR as well as strike a balance between personal information security and community information use. Some have called this a utility model similar to past regulated monopolies in electrical power and telephony. 

I'll explore the path traveled so far in a future post. 


Four Dots

A few years ago, I was asked to make a presentation to all the UNC Chapel Hill information technologists. It was an annual gathering of all the central campus IT folks plus all the IT staff members across the colleges, schools, and department from every part of campus. Needless to say, I was a little "excited" as I mounted the stage. My talk was really about how things are speeding up and that change is now the norm. In some ways, that was an easy sell to the people in the room, but I wanted to go a step further.

After talking about the invention of speech, writing, movable type, telephony, and the web (taking many cues from writers stretching from Thomas Kuhn to Clayton Christensen), I came to the last segment. I called it "Four Dots". It's a puzzle that many people have seen, but I added a twist at the end. Here's a video that helps you understand my approach and goal.

I've engaged many groups over the years with that bit of fun. One person took it in and sat quietly for a minute, then said only, "Zen, very zen." I think he meant it as a compliment. I've found in my professional life to lose oneself in the moment of a meeting, particularly when addressing a vexing issue, opens me and others to novel solutions.


Data Source: Earth

Well, it's been a while since I posted on this blog. I guess I'm a practitioner of "slow blogging" in the same vein as the slow movement. I highly recommend Carl HonorĂ©'s book, In Praise of Slowness to get the scope of the full phenomenon. But slowness is not the point of this post. 

Let me begin this way: I conducted an interactive session this week at the Public Health Preparedness Summit in Atlanta about NCB-Prepared. Gary Smith from SAS Institute ably  assisted from Cary as we demonstrated the current state of our system. Because many in the audience might be unfamiliar with our project, I decided to provide an overview of our perspective and then move on to who we are and what we are about. 

I started with a picture of a place. Of course, it's NASA's famous "Blue Marble" image. According to their website, "Using a collection of satellite-based observations, scientists and visualizers stitched together months of observations of the land surface, oceans, sea ice, and clouds into a seamless, true-color mosaic of every square kilometer (.386 square mile) of our planet." It's a bit like our approach to bring together disparate sources of data to construct a meaningful representation of a situation. But back to the session. 

Earth from Space
Gesturing to the image, I simply stated that this is our data source. Earth generates data every day in colossal amounts as life continues. We human beings capture only a small part of it. We use even less. Much less. 

Nevertheless, the founding notion behind our project is that a fundamental shift has taken place in our history within this generation. The move from data placed on paper to data placed in electronic storage systems may portend advances as great as the invention of writing or the creation of the printing press. (But you have to remember that the printing press prompted 300 years of religious wars in Europe as everybody argued over whose interpretation of the Bible should be considered the true one.) The new development in our time is that data in electronic form offers the possibility of remote access or efficient transfer. I've written previously on the ways to get over the hurdles to share data. The current reality is that we are awash in data but often don't feel wet. 

NCB-Prepared takes a comprehensive view of the biosphere since all life is interconnected. This is our data resource. We consider all data relevant to our mission, but not all data is of equal importance. So, we begin with lofty notions about the amount of data we need—in a word, MORE. We cannot have too much data because we consider our tools up to the task. 

Hubris? Perhaps. But our future as a species is closely tied to our mastery of the data universe we live in. Our project is a direct response to that challenge. Our planet can support our species continued existence or leave us behind. That notion was fed into my thinking by a book that I read while still a graduate student in the late 1970s. James Lovelock published Gaia: A New Look at Life on Earth in 1979. Among many of the points he made was that life on this planet is based on a complex set of feedback mechanisms that preceded human beings and will probably succeed them as well. In a sense, our species is a temporary resident here and our the length of tenure partly depends on us and how we act. 

Something will eventually kill all of us, hopefully in the distant future and one-by-one. To prevent a different outcome, we need to see the threats coming in order to (at best) prepare and (at worst) to mitigate the damage.