In February I visited Japan a few days before the Tohoku earthquake to complete my research on the state of healthcare IT in Japanese hospitals and private practices.
Since then I have worked with the US Center for Strategic International Studies (CSIS) and the Japanese Health and Global Policy Institute (HGPI) to develop a national healthcare IT plan for Japan in response to the earthquake, tsunami and nuclear reactor crisis.
Here's the finished report, issued by CSIS today.
I'm flying to Japan tonight and will be meeting with government, academic, and industry leaders in Tokyo and Kyoto until August 4.
As readers of my blog know, my life is devoted to making a difference. If I can share lessons learned from the US experience to accelerate healthcare IT in Japan, I will have repaid all my Japanese colleagues for the kindness they have shown me over the years.
My blogs next week will be sporadic as I travel the country as a missionary for healthcare IT.
Friday, 22 July 2011
Thursday, 21 July 2011
Preparing for the Future of IT at HMS
Every day I examine my life and think about the roles I serve. I consider all the unresolved issues in my professional and personal life, then ponder the processes needed to address them.
I think about the next week, the next month, and the next year. Hopefully, I'll be able to skate where the puck will be.
As I approach 50, I've become particularly introspective about the challenges in healthcare and medicine that lay ahead.
I believe that Accountable Care Organizations, Patient Centered Medical Homes, and the Partnership for Patients/CMS Center for Innovation will create exponential growth in healthcare IT requirements.
My senior leadership at BIDMC knows that we'll need novel approaches to healthcare information exchange for care coordination and population health management. They know we'll need new analytics which include cost, quality, and outcomes. They want new tools to make these analytics available to every stakeholder, both outside and inside the EHR.
Furthermore, state infrastructure to support "push" and "pull" data exchanges will need to be built. The need for Federal standards and policies will accelerate.
At the same time, the science of medicine at Harvard Medical School (HMS) is becoming more computationally intensive.
The next generation of whole genome analysis requires tools like BFAST that require new approaches to processing and storage infrastructure.
Image analysis also requires new tools such as OMERO for visualization, management and analysis of biological microscope images.
These and other research tools need to run on petabytes of data maintained on high performance storage, backed by thousands of processors, numerous specialized graphics processing units and high speed infiniband connections.
How does this relate to me?
As the CIO of hospitals, the innovation required to support healthcare reform will require increasing amounts of my time.
As the part time (50%) CIO of Harvard Medical School, the tools and technology required to support new scientific approaches will require increasing amounts of my time.
How do I ensure the exponentially increasing needs of the customers I serve are best met?
The answer requires a tough decision.
I believe that Harvard Medical School requires a full time dedicated CIO with a skill set in highly scalable infrastructure and the tools needed to support emerging science.
Thus, I think it best that I pass the baton at HMS to a new IT leader. I will continue to serve the Dean of HMS as an advisor on strategic projects, especially those which require cross-affiliate and clinical coordination. In collaboration with the IT stakeholders of HMS, I will work to find my replacement.
Once my successor is found, I will take on additional challenges implementing the next stages of meaningful use, healthcare reform, and new healthcare information exchange initiatives at BIDMC, in Massachusetts, and Nationwide.
Wish me luck!
I think about the next week, the next month, and the next year. Hopefully, I'll be able to skate where the puck will be.
As I approach 50, I've become particularly introspective about the challenges in healthcare and medicine that lay ahead.
I believe that Accountable Care Organizations, Patient Centered Medical Homes, and the Partnership for Patients/CMS Center for Innovation will create exponential growth in healthcare IT requirements.
My senior leadership at BIDMC knows that we'll need novel approaches to healthcare information exchange for care coordination and population health management. They know we'll need new analytics which include cost, quality, and outcomes. They want new tools to make these analytics available to every stakeholder, both outside and inside the EHR.
Furthermore, state infrastructure to support "push" and "pull" data exchanges will need to be built. The need for Federal standards and policies will accelerate.
At the same time, the science of medicine at Harvard Medical School (HMS) is becoming more computationally intensive.
The next generation of whole genome analysis requires tools like BFAST that require new approaches to processing and storage infrastructure.
Image analysis also requires new tools such as OMERO for visualization, management and analysis of biological microscope images.
These and other research tools need to run on petabytes of data maintained on high performance storage, backed by thousands of processors, numerous specialized graphics processing units and high speed infiniband connections.
How does this relate to me?
As the CIO of hospitals, the innovation required to support healthcare reform will require increasing amounts of my time.
As the part time (50%) CIO of Harvard Medical School, the tools and technology required to support new scientific approaches will require increasing amounts of my time.
How do I ensure the exponentially increasing needs of the customers I serve are best met?
The answer requires a tough decision.
I believe that Harvard Medical School requires a full time dedicated CIO with a skill set in highly scalable infrastructure and the tools needed to support emerging science.
Thus, I think it best that I pass the baton at HMS to a new IT leader. I will continue to serve the Dean of HMS as an advisor on strategic projects, especially those which require cross-affiliate and clinical coordination. In collaboration with the IT stakeholders of HMS, I will work to find my replacement.
Once my successor is found, I will take on additional challenges implementing the next stages of meaningful use, healthcare reform, and new healthcare information exchange initiatives at BIDMC, in Massachusetts, and Nationwide.
Wish me luck!
Wednesday, 20 July 2011
The July HIT Standards Committee Meeting
Farzad Mostashari, national coordinator for healthcare IT, began the meeting with a discussion of the issues we have always faced while harmonizing standards. Standards that are widely adopted by the marketplace and are well tested make harmonization easy. However, many standards are mature but not widely adopted or novel but not well tested. We want to encourage innovation and use market adoption as a measure of our success. It's clear that at times we'll have to consider new standards that seem very reasonable for the purpose intended and test them in real world scenarios before forcing top down adoption through regulation. Bottom up adoption of standards that are implemented and improved by stakeholders is a better approach.
Per the Standards Summer Camp schedule, the July HIT Standards Committee meeting focused on
Vocabulary recommendations
ePrescribing of discharged medications recommendations
Patient Matching recommendations
Syndromic Surveillance recommendations
Jim Walker, chair of the Clinical Quality workgroup, presented an overview of the vocabulary work done to support all our clinical coordination and quality measurement activities. The charter for the group was to select the minimum number of vocabulary standards with the minimum number of values to meet the requirements of meaningful use stages 2 and 3. Reducing the number of standards makes mapping between different vocabularies much easier. The workgroup used SNOMED-CT and LOINC wherever possible and tried to select one vocabulary per domain (allergies, labs, medications etc). Examples of their selections include
Adverse Drug effect - RxNorm for medications, SNOMED-CT for non-medication substances, SNOMED-CT for severity of reaction
Patient characteristics - ISO 639-2 for preferred language, HL7 for administrative gender, PHIN-VADS (Centers for Disease Control) for Race/Ethnicity
Condition/Diagnosis/Problem - SNOMED-CT
Non-lab Diagnostic study - LOINC for name, SNOMED-CT for appropriate findings, UCUM for Units
A rich discussion followed. Points of concern included:
*Using RxNorm for all medications including vaccines, even though CVX is the required vaccine vocabulary for Meaningful Use stage 1. We clarified this with an example from Beth Israel Deaconess Medical Center:
BIDMC uses First Data Bank as the medication vocabulary for its internal systems. However, when BIDMC sends clinical summaries, it maps FDB to RxNorm for all drug names. When BIDMC sends immunization records to public health, it uses CVX codes. Thus, the HIT Standards Committee will not specify the vocabularies used within enterprise applications, just those vocabularies that are needed for specific purposes when data is transmitted between entities.
Next, Doug Fridsma began a discussion of our Summer Camp items, noting the many projects of the S&I framework are proceeding according to plan.
Scott Robertson presented the work of the Discharge Medications Power Team. They recommended HL7 and NCPDP script as reasonable standards for sending discharge medication orders to hospital pharmacies and retail pharmacies.
Discussion followed regarding two specific points - their recommendations did not include a specific version of HL7, since existing Medicare Part D regulations do not specify an HL7 version. The power team will make additional more specific HL7 recommendations. There was discussion about the specific aspects of RxNorm that constrain the way dose and route are specified. The HIT Standards Committee members felt additional work was needed before mandating this level of specificity, so our recommendations will include RxNorm for medication name, but not additional specificity for dose and route vocabularies at this time.
Next, Marc Overhage presented the recommendations of the Patient Matching Power Team. The scope of the Patient Matching work is to provide guidance to implementers who want to understand best practices for the use of demographics in machine to machine matching of patient identity. Per the RAND Report, use of different fields results in variation of specificity and sensitivity. Some fields such as social security number (or a subset of it) greatly increase specificity, resulting in fewer false positives such as matching the wrong patient. However, social security number is controversial because of the potential for identity theft and the fact that immigrants may not have one. The final report will take into account all these observations.
Chris Chute presented the recommendations of the Surveillance Implementation Guide Power Team, which aims to specify one implementation guide for each public health transaction. They are studying the difference between HL7 2.31 and 2.51 as well as considering the potential for public health entities to use CDA constructs.
Dixie Baker presented a project plan for the NwHIN Power Team, which aims to specify a set of building blocks for secure transport of data in multiple architectures.
Finally, Judy Murphy and Liz Johnson presented their plans for the Implementation Workgroup, collecting lessons learned from certification and attestation.
We're on track with Summer Camp. Our next meeting in August will include the final recommendations for
Simple Lab Results
Transitions of Care
CDA Cleanup
Patient Matching
Vocabulary
Every meeting with the HIT Standards Committee (this was our 27th) brings us closer as a working team. We're transparent and passionate, openly sharing all the issues and concerns about the standards we're selecting. Coordination with all the moving parts (ONC, Policy Committee, S&I Framework) keeps getting better and better.
Thus far, Summer Camp is a winner and I am confident we'll meet all our September deadlines for offering recommendations to ONC in preparation for Meaningful Use Stage 2 regulations.
Per the Standards Summer Camp schedule, the July HIT Standards Committee meeting focused on
Vocabulary recommendations
ePrescribing of discharged medications recommendations
Patient Matching recommendations
Syndromic Surveillance recommendations
Jim Walker, chair of the Clinical Quality workgroup, presented an overview of the vocabulary work done to support all our clinical coordination and quality measurement activities. The charter for the group was to select the minimum number of vocabulary standards with the minimum number of values to meet the requirements of meaningful use stages 2 and 3. Reducing the number of standards makes mapping between different vocabularies much easier. The workgroup used SNOMED-CT and LOINC wherever possible and tried to select one vocabulary per domain (allergies, labs, medications etc). Examples of their selections include
Adverse Drug effect - RxNorm for medications, SNOMED-CT for non-medication substances, SNOMED-CT for severity of reaction
Patient characteristics - ISO 639-2 for preferred language, HL7 for administrative gender, PHIN-VADS (Centers for Disease Control) for Race/Ethnicity
Condition/Diagnosis/Problem - SNOMED-CT
Non-lab Diagnostic study - LOINC for name, SNOMED-CT for appropriate findings, UCUM for Units
A rich discussion followed. Points of concern included:
*Using RxNorm for all medications including vaccines, even though CVX is the required vaccine vocabulary for Meaningful Use stage 1. We clarified this with an example from Beth Israel Deaconess Medical Center:
BIDMC uses First Data Bank as the medication vocabulary for its internal systems. However, when BIDMC sends clinical summaries, it maps FDB to RxNorm for all drug names. When BIDMC sends immunization records to public health, it uses CVX codes. Thus, the HIT Standards Committee will not specify the vocabularies used within enterprise applications, just those vocabularies that are needed for specific purposes when data is transmitted between entities.
Next, Doug Fridsma began a discussion of our Summer Camp items, noting the many projects of the S&I framework are proceeding according to plan.
Scott Robertson presented the work of the Discharge Medications Power Team. They recommended HL7 and NCPDP script as reasonable standards for sending discharge medication orders to hospital pharmacies and retail pharmacies.
Discussion followed regarding two specific points - their recommendations did not include a specific version of HL7, since existing Medicare Part D regulations do not specify an HL7 version. The power team will make additional more specific HL7 recommendations. There was discussion about the specific aspects of RxNorm that constrain the way dose and route are specified. The HIT Standards Committee members felt additional work was needed before mandating this level of specificity, so our recommendations will include RxNorm for medication name, but not additional specificity for dose and route vocabularies at this time.
Next, Marc Overhage presented the recommendations of the Patient Matching Power Team. The scope of the Patient Matching work is to provide guidance to implementers who want to understand best practices for the use of demographics in machine to machine matching of patient identity. Per the RAND Report, use of different fields results in variation of specificity and sensitivity. Some fields such as social security number (or a subset of it) greatly increase specificity, resulting in fewer false positives such as matching the wrong patient. However, social security number is controversial because of the potential for identity theft and the fact that immigrants may not have one. The final report will take into account all these observations.
Chris Chute presented the recommendations of the Surveillance Implementation Guide Power Team, which aims to specify one implementation guide for each public health transaction. They are studying the difference between HL7 2.31 and 2.51 as well as considering the potential for public health entities to use CDA constructs.
Dixie Baker presented a project plan for the NwHIN Power Team, which aims to specify a set of building blocks for secure transport of data in multiple architectures.
Finally, Judy Murphy and Liz Johnson presented their plans for the Implementation Workgroup, collecting lessons learned from certification and attestation.
We're on track with Summer Camp. Our next meeting in August will include the final recommendations for
Simple Lab Results
Transitions of Care
CDA Cleanup
Patient Matching
Vocabulary
Every meeting with the HIT Standards Committee (this was our 27th) brings us closer as a working team. We're transparent and passionate, openly sharing all the issues and concerns about the standards we're selecting. Coordination with all the moving parts (ONC, Policy Committee, S&I Framework) keeps getting better and better.
Thus far, Summer Camp is a winner and I am confident we'll meet all our September deadlines for offering recommendations to ONC in preparation for Meaningful Use Stage 2 regulations.
Tuesday, 19 July 2011
Planning FY12 Clinical IT Goals
As healthcare CIO's plan for FY12, they all have the triple threat of Meaningful Use, 5010, and ICD-10. On top of that, they'll be asked to lead innovative efforts supporting healthcare reform/patient centered medical homes/accountable care organizations.
In times of great change, governance is absolutely key to align priorities and resources.
Here are the projects that have been discussed in my leadership and governance committees.
Overall clinical IT goal:
Move from the current hybrid electronic/paper medical record to a fully electronic integrated record by 2015 by redefining workflows and then implementing automation in support of meaningful use, healthcare reform, and patient engagement.
To do that requires that we fill our functional gaps. Highlights include
Electronic Medication Administration Records - we will redefine the entire medication management process from doctor's brain to patient's vein then automate it using iPads, smartphones, and novel applications. We will select build/bought solutions in FY12, pilot it in FY13 and then widely roll it out.
Patientsite - we will ensure every BIDMC provider is enrolled and every patient is offered access to our PHR.
IT Resource Prioritization - we will implement a highly functional overall clinical IT governance process that ensures resources are aligned with priorities and interoperability is maximized. Here's a brief proposal for this work
"Currently we have a series of department and domain specific IT committees which plan their individual priorities- lab, radiology, critical care, inpatient, outpatient etc.
These do not report in a formal way to the Clinical IT Governance Committee.
We propose that the Clinical IT Governance Committee should meet 10 times per year (no meeting in August and December due to vacations). At each of these meetings, the Committee should hear from subcommittees to better understand their goals, their project progress, barriers, enablers, staffing, and competing priorities.
The Clinical IT Governance committee can
*Resolve resource conflicts between subcommittees
*Assist with decision making about software build/buy selection in the context of the entire BIDMC application portfolio, ensuring integration and interoperability, along with prudent and equitable use of resources
*Ensure the work to be done is aligned with the Annual operating plan, BIDMC strategy, compliance timelines and staffing levels
*Review the performance/efficacy of each subcommittee based on objective criteria and recommend membership/structural change if needed
*Sponsor those projects which are enterprise-wide and have no specific departmental or domain sponsor - such as electronic medication administration records and inpatient documentation
To kick off this process, we'll begin with an objective review of our existing subcommittees using the characteristics we discussed at our last meeting. We'll schedule our first subcommittees to present their plan in September"
Inpatient clinical documentation - a multi-stakeholder group will study inpatient clinical documentation and specify an ideal workflow for integrated documentation that meets regulatory requirements. We will eliminate paper while also eliminating redundancy in clinical documentation.
ICD-10 - we will continue our work on ICD-10. On Thursday, our statewide CIO Forum will examine ways that the community can do ICD-10 together, reducing the burden for all.
Business intelligence tools - we will implement novel business intelligence tools that are needed to support new payment methodologies such as alternative quality contracts.
We'll do all this on top of the usual infrastructure and application activities that keep the trains running on time. If FY11 was the year of living anxiously, I'm hoping FY12 is a year of great achievement.
In times of great change, governance is absolutely key to align priorities and resources.
Here are the projects that have been discussed in my leadership and governance committees.
Overall clinical IT goal:
Move from the current hybrid electronic/paper medical record to a fully electronic integrated record by 2015 by redefining workflows and then implementing automation in support of meaningful use, healthcare reform, and patient engagement.
To do that requires that we fill our functional gaps. Highlights include
Electronic Medication Administration Records - we will redefine the entire medication management process from doctor's brain to patient's vein then automate it using iPads, smartphones, and novel applications. We will select build/bought solutions in FY12, pilot it in FY13 and then widely roll it out.
Patientsite - we will ensure every BIDMC provider is enrolled and every patient is offered access to our PHR.
IT Resource Prioritization - we will implement a highly functional overall clinical IT governance process that ensures resources are aligned with priorities and interoperability is maximized. Here's a brief proposal for this work
"Currently we have a series of department and domain specific IT committees which plan their individual priorities- lab, radiology, critical care, inpatient, outpatient etc.
These do not report in a formal way to the Clinical IT Governance Committee.
We propose that the Clinical IT Governance Committee should meet 10 times per year (no meeting in August and December due to vacations). At each of these meetings, the Committee should hear from subcommittees to better understand their goals, their project progress, barriers, enablers, staffing, and competing priorities.
The Clinical IT Governance committee can
*Resolve resource conflicts between subcommittees
*Assist with decision making about software build/buy selection in the context of the entire BIDMC application portfolio, ensuring integration and interoperability, along with prudent and equitable use of resources
*Ensure the work to be done is aligned with the Annual operating plan, BIDMC strategy, compliance timelines and staffing levels
*Review the performance/efficacy of each subcommittee based on objective criteria and recommend membership/structural change if needed
*Sponsor those projects which are enterprise-wide and have no specific departmental or domain sponsor - such as electronic medication administration records and inpatient documentation
To kick off this process, we'll begin with an objective review of our existing subcommittees using the characteristics we discussed at our last meeting. We'll schedule our first subcommittees to present their plan in September"
Inpatient clinical documentation - a multi-stakeholder group will study inpatient clinical documentation and specify an ideal workflow for integrated documentation that meets regulatory requirements. We will eliminate paper while also eliminating redundancy in clinical documentation.
ICD-10 - we will continue our work on ICD-10. On Thursday, our statewide CIO Forum will examine ways that the community can do ICD-10 together, reducing the burden for all.
Business intelligence tools - we will implement novel business intelligence tools that are needed to support new payment methodologies such as alternative quality contracts.
We'll do all this on top of the usual infrastructure and application activities that keep the trains running on time. If FY11 was the year of living anxiously, I'm hoping FY12 is a year of great achievement.
Monday, 18 July 2011
The Health Insurance Exchange NPRM
Last week, Health and Human Services issued an important notice of proposed rulemaking (NPRM) about Health Insurance Exchanges.
What are Health Insurance Exchanges?
They are state-based competitive marketplaces where individuals and small businesses are able to purchase affordable private health insurance. As Secretary Sebellius noted
"Health Insurance Exchanges offer Americans competition, choice, and clout. Insurance companies will compete for business on a transparent, level playing field, driving down costs; and Exchanges will give individuals and small businesses the same purchasing power as big businesses and a choice of plans to fit their needs.”
Health Insurance Exchanges are abbreviated HIX rather than HIE, reducing confusion with Health Information Exchanges.
The IT portion of the NPRM is interesting - Section 1311(c)(5) requires the Secretary to make available to all states a model HIX web application developed by HHS.
This is not intended to be a single central website for the US. Instead, there will be a set of common web tools available to all states to support health insurance exchange websites. My understanding is that the infrastructure will be service oriented so that states can create their own user experience but leverage complex business logic and administrative tools developed for all.
Massachusetts is part of a six state New England consortium that was awarded an innovation grant of $35.5M to in February 2011 to build a New England HIX by December 2012. For details, see their website. The New England team believes HIX has many components that are common and hence can be developed just once for the region/country. At the moment, HIX has a strong policy directive, appropriate funding, excellent leadership, and multi-stakeholder governance - many of the key elements in my Recipe for Success.
Are there lessons learned from Healthcare Information Exchange (HIE)?
At the moment, HIE has less of a strong policy directive (Meaningful Use Stage 1 only requires a single test of HIE), funding is limited considering the scope of work necessary to connect every provider/payer/patient, the domain is highly complex creating a shortage of excellent leaders, and governance is still evolving.
CareSpark, one of the early HIEs recently closed it doors because it lacked significant adoption and a sustainable business model.
A lesson learned from the HIX effort is that HIE needs a urgency to implement the technology and an audience that wants to adopt it.
Are there common components that could be developed just once?
Yes - gateways provided by a Health Information Services Provider (HISP), provider directories, certificate management, a standard for transfer of care summaries, and consent guidance that empowers the develop of local consent frameworks.
Hence, the work by the Direct project, the Summer Camp of the HIT Standards Committee, and the projects of the Standards and Interoperability Framework.
It will be more difficult to create national components that can be repurposed locally because of the heterogeneity of use cases for HIE in every locality. Thus, HIX, which provides uniform functionality across states does not precisely provide a model for HIE, but in the next year all the use case work, the standards work and the policy work (meaningful use stage 2) will converge so that HIE will have as many "recipe for success" factors as HIX has today.
What are Health Insurance Exchanges?
They are state-based competitive marketplaces where individuals and small businesses are able to purchase affordable private health insurance. As Secretary Sebellius noted
"Health Insurance Exchanges offer Americans competition, choice, and clout. Insurance companies will compete for business on a transparent, level playing field, driving down costs; and Exchanges will give individuals and small businesses the same purchasing power as big businesses and a choice of plans to fit their needs.”
Health Insurance Exchanges are abbreviated HIX rather than HIE, reducing confusion with Health Information Exchanges.
The IT portion of the NPRM is interesting - Section 1311(c)(5) requires the Secretary to make available to all states a model HIX web application developed by HHS.
This is not intended to be a single central website for the US. Instead, there will be a set of common web tools available to all states to support health insurance exchange websites. My understanding is that the infrastructure will be service oriented so that states can create their own user experience but leverage complex business logic and administrative tools developed for all.
Massachusetts is part of a six state New England consortium that was awarded an innovation grant of $35.5M to in February 2011 to build a New England HIX by December 2012. For details, see their website. The New England team believes HIX has many components that are common and hence can be developed just once for the region/country. At the moment, HIX has a strong policy directive, appropriate funding, excellent leadership, and multi-stakeholder governance - many of the key elements in my Recipe for Success.
Are there lessons learned from Healthcare Information Exchange (HIE)?
At the moment, HIE has less of a strong policy directive (Meaningful Use Stage 1 only requires a single test of HIE), funding is limited considering the scope of work necessary to connect every provider/payer/patient, the domain is highly complex creating a shortage of excellent leaders, and governance is still evolving.
CareSpark, one of the early HIEs recently closed it doors because it lacked significant adoption and a sustainable business model.
A lesson learned from the HIX effort is that HIE needs a urgency to implement the technology and an audience that wants to adopt it.
Are there common components that could be developed just once?
Yes - gateways provided by a Health Information Services Provider (HISP), provider directories, certificate management, a standard for transfer of care summaries, and consent guidance that empowers the develop of local consent frameworks.
Hence, the work by the Direct project, the Summer Camp of the HIT Standards Committee, and the projects of the Standards and Interoperability Framework.
It will be more difficult to create national components that can be repurposed locally because of the heterogeneity of use cases for HIE in every locality. Thus, HIX, which provides uniform functionality across states does not precisely provide a model for HIE, but in the next year all the use case work, the standards work and the policy work (meaningful use stage 2) will converge so that HIE will have as many "recipe for success" factors as HIX has today.
Friday, 15 July 2011
Cool Technology of the Week
I'm a Sci-Fi fan and the works of Frank Herbert (the Dune series) have always been some of my most treasured reading material. I was particularly fascinated (from an engineering perspective) by the concept of the Stillsuit worn by the Fremen which recycled lost body water to aid survival in the harsh desert climate of Dune.
Now, the Stillsuit is a reality and Nasa astronauts are testing a self contained device powered by the principles of osmosis that recycles urine into an sweetened, electrolyte-balanced sports drink.
Some may joke that Gatorade's color and flavor make it a natural for such "recycling" already, but the engineering behind body water recycling is serious business.
As a doctor, I know that drink urine in a dehydration emergency is a losing battle - the solute load is too high and your body will get thirstier and thirstier.
This osmosis approach ensures the free water exceeds the solute load, hydrating the body instead of further compromising it.
A self contained body fluid recycler for astronauts and survival - that's cool! Frank Herbert would be proud.
Now, the Stillsuit is a reality and Nasa astronauts are testing a self contained device powered by the principles of osmosis that recycles urine into an sweetened, electrolyte-balanced sports drink.
Some may joke that Gatorade's color and flavor make it a natural for such "recycling" already, but the engineering behind body water recycling is serious business.
As a doctor, I know that drink urine in a dehydration emergency is a losing battle - the solute load is too high and your body will get thirstier and thirstier.
This osmosis approach ensures the free water exceeds the solute load, hydrating the body instead of further compromising it.
A self contained body fluid recycler for astronauts and survival - that's cool! Frank Herbert would be proud.
Thursday, 14 July 2011
Reflections on Google+
Over the past week, over 100 of my friends, colleagues, and staff have sent me invitations to Google+ and my "Circles" are growing.
Google has an amazing capacity to create simple, clean, and highly functional user interfaces that work well with every browser I own (Safari 5.05, Firefox 5.0).
I'm on LinkedIn, Plaxo, Facebook, and Twitter not because I spend a great deal of time on social networks but so that I can communicate with folks who prefer those approaches over email.
To be honest, I've found Facebook's user interface to be cumbersome - you've got a wall, an inbox, invitations, events etc. It's challenging to know what to click and the sheer amount of traffic in difference places can be daunting to manage.
Google+ uses Gmail for invitations, has full integration of Google+ features into the iGoogle portal, and has just the right amount of functionality for me to organize my social network into manageable groups.
The "Circles" concept is a good one - I can place any contact into a group of interest - in my case that's Family, Friends, Federal work, State work, Harvard work, and Healthcare Work. I can follow "Streams" of postings in each of these circles, making it much easier for me to catch up on communications by focusing on topics or clusters of people. The "Sparks" feature that includes information collections on specific topics to be watched, read, or shared is less useful to me, since my reading time is generally more goal directed.
I admit that I'm a lumper rather than a splitter. In 1995, I switched to Windows 95 and Office 95 so that I would have a single integrated suite of products created by the same manufacturer to do my work. Over the past few years, I've used Mac OSX, Keynote, Pages, and Numbers for the same purpose.
I can definitely see the value of doing email, search, and social networking with a single integrated suite from one vendor.
Google's previous efforts, Wave and Buzz, did not attract my attention. Google+ is definitely a Facebook upgrade. It's a winner and I'll be organizing my social networks there because Google+ is fast, intuitive, and part of my existing Google workflow.
Google has an amazing capacity to create simple, clean, and highly functional user interfaces that work well with every browser I own (Safari 5.05, Firefox 5.0).
I'm on LinkedIn, Plaxo, Facebook, and Twitter not because I spend a great deal of time on social networks but so that I can communicate with folks who prefer those approaches over email.
To be honest, I've found Facebook's user interface to be cumbersome - you've got a wall, an inbox, invitations, events etc. It's challenging to know what to click and the sheer amount of traffic in difference places can be daunting to manage.
Google+ uses Gmail for invitations, has full integration of Google+ features into the iGoogle portal, and has just the right amount of functionality for me to organize my social network into manageable groups.
The "Circles" concept is a good one - I can place any contact into a group of interest - in my case that's Family, Friends, Federal work, State work, Harvard work, and Healthcare Work. I can follow "Streams" of postings in each of these circles, making it much easier for me to catch up on communications by focusing on topics or clusters of people. The "Sparks" feature that includes information collections on specific topics to be watched, read, or shared is less useful to me, since my reading time is generally more goal directed.
I admit that I'm a lumper rather than a splitter. In 1995, I switched to Windows 95 and Office 95 so that I would have a single integrated suite of products created by the same manufacturer to do my work. Over the past few years, I've used Mac OSX, Keynote, Pages, and Numbers for the same purpose.
I can definitely see the value of doing email, search, and social networking with a single integrated suite from one vendor.
Google's previous efforts, Wave and Buzz, did not attract my attention. Google+ is definitely a Facebook upgrade. It's a winner and I'll be organizing my social networks there because Google+ is fast, intuitive, and part of my existing Google workflow.
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