CMIO teahouse menu

How can tea improve clinical decision support? How does it help change organizations? Are you kidding?

Links to some of these teas:

CMIO’s take? Those of you who have worked with me know that one of my favorite things is to have 1:1 meetings in my office and serve tea. Taking inspiration from my spouse who enjoys throwing cocktail parties and creating a fanciful drink menu, I recently put together a CMIO’s teahouse menu. I hope you enjoy it.

“The useful part of a pot is where there is no pot” -Audrey Tang, Digital Minister of Taiwan

Hollowed out
clay makes a pot.
Where the pot’s not
Is where its useful.

Poem 11

Thirty spokes
meet in a hub.
Where the wheel isn’t
Is where it is useful.

Hollowed out
clay makes a pot.
Where the pot’s not
Is where its useful.

Cut doors and windows
to make a room.
Where the room isn’t,
there room for you.

So the profit in what is
is in the use of what isn’t.

Taken from Ursula LeGuin’s version of the Tao Te Ching

https://www.wired.com/video/watch/wired25-2020-audrey-tang-taiwan-covid-19-pandemic

Watch this video/ read the transcript. I love this for several reasons:

  • The Taiwanese are my people
  • “Digital Minister” is the best title of all time
  • Taiwan’s national response to COVID is a model for the world (Taiwan: fewer than 1 death per 100,000 vs USA: 66 deaths per 100,000)
  • The transparency of information and the building of trust: the government published its COVID and mask data with open API’s so private industry and nonprofits could build 100’s of apps to improve healthcare and the commonwealth
  • The POETRY of Taoism!

CMIO’s take? It is worth a watch. Informatics applied effectively at the national level. And, bonus: mindful Taoist philosophy applied to transparency of information. Zowie!

Here’s your moment of zen – cactus images from Arizona

Here is the “burr in my sock” or “pebble in my shoe” that bad EHR design can become. In another context, this is can be beautiful.

Found this in my sock in the middle of my hike.

The only way to hike in Tucson in the fall is starting at 630am and being done before 9am.

CMIO’s take? Be present, get outside, take a breath.

The Narrows at Zion Canyon: a visual travelogue

In November of 2020, my son and I toured the Southwest US. One of our stops was at Zion Canyon National Park, where we were excited to experience the Narrows. It seemed a great way to escape the pandemic and get away. Spend a few minutes on the journey with us!

Driving, we arrived late in the day at Zion lodge, in darkness. We saw this improbable sight outside our cabin in the morning: canyon walls rising thousands of feet overhead, just outside our door.

We had rented dry suits from Zion Adventures, and laid out our clothing that evening for the hike ahead. In case you’re wondering about the hyperlinks, no this is not a paid post. Just a joyful recollection of an aging parent…

Double boot liners, grippy-soled rubberized river boots, an impervious suit with rubber-gasketed pants and sleeves, and a huge diagonal waterproof zipper across the chest. Hard to wrangle but exciting! We felt like spacemen. We wore several clothing layers underneath.

Normally the Narrows is a super-popular hike through the spring, summer and fall. We had thought that with the pandemic and with wintry November weather, we would have no trouble booking a shuttle ride from the Lodge in the park up to the entrance of the Narrows, 3 miles away. Suffice it to say, plan ahead. Fortunately, we found a last-minute shuttle option with seats remaining. Whew, disaster averted. Otherwise, the lodge had offered us “bikes to rent and ride up there, suits and all.” That would have been more adventure than I needed.

We walked the paved path for the 1st mile. Giddy and nervous, we passed a number of casual hikers who stared at our gear, our dry suits, our 6-foot wooden walking poles, our backpacks. Here, with the residual heat deep in the canyon, the last remnant of fall colors contrasted with the snowscapes outside the park.

And then: the pavement ends. Into the stream! I can feel the cold water sloshing around inside the boot. Hey! my feet stay dry! I don’t care about splashing because I’m sealed in up to my neck, and my backpack has a dry sack inside with food and water. The cyanobacteria poisoning warnings do not deter us. Upstream we went.

Did I mention the incredible geology? We feel puny in its presence.

I was surprised at the grip of these rubber soled river boots. Crunching upstream over large and small rocks was easier than expected. Where was all the slipperiness, the unstable rocks, the twisted ankles? The equipment smoothed that away. I grinned at my son; this was a blast. The water depth was up to a foot and the going was not hard. The current ran a couple of miles an hour.

As we saw fewer hikers, the enormity of the cavern became apparent. At one point, it appeared that the walls were maybe 3 football fields tall, 1000-feet-high sheer walls of stone. These walls plunged right down into the river with no shore or beach to speak of.

From there the river got deeper and faster. In about an hour and a half we arrived at the fork to observation point on the right, with photographers set up to catch the changing light in the canyon. Then we took the left fork to “Wall Street,” presumably named for the impressive sheer walls narrowing in.

At times, the water rises to the hips. Some hikers with only waterproof pants turn back. One couple raised their jackets, exposing bare midriffs to keep their clothes dry, and gamely walked through the first deep crossing. That must have been cold, with the water at 40 degrees. It is sunny, but also snowing.

At a rock outcropping, we paused for lunch. We find a few larger boulders, unpack and have our bagels. Suddenly ravenous, we savor the calories, noticing snowflakes drifting down 1000 feet into the canyon. The light is peculiar: in shadow, with sunlight bathing the Canyon just around the curve, blue sky overhead. It looks like indoor light because of all the bounce and reflection.

This is our turn around point. We rest, recharge, hear the stream burble, feel the snowflakes, our hunger sated, snug in our dry suits, we smell the fall giving way to winter.

It feels – cold, but I’m sweating from effort. The canyon appears unforgiving, but we have supplies and equipment up to the task. Flash floods and cyanobacteria poisoning are a risk, but we have mitigated them. Unlike more extreme adventure-seeking adrenaline junkies, this is the degree of risk and adventure I’m ready for.

It is time to head back. Downstream, like downhill, would be quicker. My main concern was balancing Seeing with Photography.

There is the disappointing idea that the more photos one takes, the less the brain experiences. Or maybe not. Yes, there’s more to show off when you get home, but were you really present? Or did you just line up and frame the shot? But, if you don’t take photos, how interesting is your blog post later? #FirstWorldProbs.

I tried to do both. Who knows.

Downstream was a pleasant splash. Yes, it was 1.5 times easier and slightly faster. There was little resistance to swinging the shins through the water as it flowed with you.

There are great speedway-sized curves to this river, as the millennia of water microscopically carry away molecules of rock every day. The views are magnificent.

It is a hike that promotes mindfulness. Your focus is required for not-stumbling, for pushing upstream, for awakening your senses. The constant, echoed river babble precludes idle chatter.

It is: exploration, sightseeing, photography, companionship, escape, reflection, effort, appreciation for dry-suit and photographic technology, wonder, mindfulness, pure sensation, focus, curiosity, pride of offspring, joy. All at once. Each in turn.

We emerge from the river, dripping and yet perfectly dry. We make our shuttle home.

A perfect day.

My code: “You cannot overestimate the unimportance of practically everything.” (NYTimes)

Wait, what?

www.nytimes.com/2021/04/17/opinion/letters/personal-philosophy.html

Happy weekend! I just saw this on the NYTimes.

Read this sentence a couple of times. Then read the 100-word “life philosophy” letters to the editor. This one, from David Pastore, Mountainside, N.J.  …  Wow. 

CMIO’s take: Do you have a life philosophy to share? Please comment below.

Forest bathing: what is it good for?

Sometimes it is good to get away. Mind you, this photo is more than a year old (before pandemic), but it makes a few points…

Exercise

Remember to get some exercise. Just … not with 3 super-fit members of your family. Notice everyone having a good time running, except Dad with the barely suppressed grimace of pain and facial mask of determination.

Family

Remember, family members are supposed to support each other. And not run too fast for old people to keep up.

Forest

This is the beautiful Forest of Nisene Marks. I have to say, those articles about Forest Bathing? Yup, they’re right on. That time spent in the woods? When I wasn’t gasping for air, it was a spectacular place, a place to recharge.

Leisurely Jog

As always, I had agreed to go for a “leisurely jog” with the kids and with my baby sis. We would run up the path for maybe a mile or 2, then “It’ll be easy, coming back down! Come on! It’ll be fun!”

Grasping my iPhone with a death grip, I set off. Because, if you’re going to go for a run, your iPhone HAS to track your exercise, doesn’t it? As quippy daughter always says:

“Dad, it’s NOT about the steps. IT’S ABOUT THE LIFE.”

I disagree. If my exercise app doesn’t track it, what’s the point?

Nevertheless, we get to the top (barely). I sprint to the turnaround sign (because, Dads have to make a point). This causes nausea with imminent vagal response.

After some time spent with arms tripod-ed on the knees, gasping for air, concerned looks from the sister (the kids are immune to these cries for sympathy) and an extended period of hands-on-hips walking back down the trail, we commence our downward leg.

I was promised an easier time headed down. This was a complete fabrication.

It was several hours later (or so it seemed) we got back to the car.

CMIO’s take: I do have to admit, the smells, the sights, the laughter were a wonderful respite. Yes, we did bathe in the forest (with our clothes on). And it did refresh my spirit. How do YOU recharge?

My Failure Resume, redux

Well, it is time to update my resume. It has been a year, I have failed at more things. I’ve read more failure resumes, and I like some of the newer ideas, for example, listing your NON-skills. I’ve added mine.

One idea for brave souls willing to try, is to submit both your Regular CV / resume AND your Failure resume to your next job interview. Here are 1 page versions of mine (REGULAR resume – 1 page / FAILURE resume – 1 page).

And, wouldn’t you know, the most popular post on this blog, after 3 years of weekly writing on aspirational topics in informatics?

My original Failure Resume. Go figure.

I love some of the writing out there on Failure Resumes:

  • Stanford Engineering: “come to terms with the mistakes … made along the way and … extract important lessons”
  • Forbes: Of 10 job applications, received 0 responses to traditional resume, but 8 responses for a traditional resume PLUS a failure resume.
  • Inc.com: why to encourage your employees to make a failure resume.
  • Even Einstein struggled: a scientific paper on how describing Einstein’s struggles to science students increased students’ hopefulness and engagement with science class.
  • ScienceAlert.com: A CV of failures is an entertaining and instructive read

CMIO’s take? I’ll be teaching an Informatics Leadership course soon, and will expect all our participants to write a one-page Failure Resume. Join us!

Doomscrolling. Are you guilty of it? (nytimes)

image from the NYtimes article

https://www.wired.com/story/stop-doomscrolling

Here is a new term for you: Doomscrolling. I am guilty of this, until I become aware of it and have to wrench myself away. It is a like car-crash in slow motion and you want to know how this horror story ends.

CMIO’s take? STOP. Turn it off, go live your life, and talk about
THREE good things.

Pandemic skills: Giving feedback successfully: I Like … I wish … What if … ?

Theater and acting: a life skill [icon from thenounproject.com]

During this pandemic, many of us have been stuck in front of our screens, like talking heads (Max Headroom, anyone?). If “sitting is the new smoking” (or perhaps not), then I’ve been “smoking” a lot.

Virtual meetings are draining, and I’m on them up to 8 hours a day, even busier now with all the EHR modifications, keeping up with policy changes, what Covid-testing is available, how we admit, treat, discharge, follow, track patients.

At the ends of long hours, long days, long weeks, our nerves are frayed.

I’ve observed that interactions between people have everything to do with the interpersonal skills of the individuals. Sometimes the conversation does NOT go well. Whether it is by email (worst for crucial conversations), by phone (slightly less bad), by online video meeting (slightly less bad) or in person (best, when possible), it is certainly worsened by the pandemic situation.

I’ve been taking a Story Skills Workshop (by Seth Godin and Bernadette Jiwa) that recently concluded. I have to say that I’ve learned quite a lot, and not what I was expecting to learn. I highly, highly recommend it. Seth and Bernadette offer a series of online lessons, released over time. There are about 6 expert coaches, and the instruction is to sign up for an interest group or ‘accountability group’. You’re given a story structure (the 5 C’s: Context, Catalyst, Complication, Change, Consequence) and then specific lessons to write and polish specific elements of your own story in this framework. The cool part is the instruction to ‘first write your own story, and then go comment on at least 5 others.’

  • I learned that it is possible, in an online-only course, to develop a sense of community and collegiality in a short 30 days.
  • I learned that it is crucial to be gentle in first contact with others online. For example, when giving feedback on others’ stories, DO NOT start right in with ‘why don’t you add more Emotion to that moment in your story?’ You’ll learn (as did I) that conversation either stops or becomes defensive. Remember that online conversations carry ZERO nonverbal: no Kind tone of voice, no Friendly posture. All you see are the words, and it is automatic to imagine them coming from a frowning critic with crossed arms, shaking his brutish head. [Pause for self-reflection amongst my blog-readers, as well as from myself…]
  • Instead, try something my theater-trained son taught me:

‘I like… I wish… What if …’

My highly emotionally intelligent son
  • Framing any response this way allows your recipient to hear something positive, then a neutrally posed concern, followed by a tentative suggestion. Having been on both sides of such a well-formed critique, I can say: it is EASY to write, doesn’t take longer, and on the receiving end FEELS COMPLETELY DIFFERENT. It FEELS like a close friend, reaching a hand over to pull you up to a higher step.
  • FOR EXAMPLE: Take one of my story-critiques of a co-participant in the story workshop, not done well on my part: “Why don’t you add more emotion to your story? It reads like a timeline, but nothing about what you felt, or how that impacted you.” I thought I was clever, to point out one of the main points of that week’s lesson. What I received was… no response. Hmm.
  • Rephrasing the reply using this framework, when I replied to a different participant’s story, sounded like this: “Hi, Joe! I liked your story, especially the unexpected part about running away from home at 16. I wish I could be there at that moment when you made the decision, everything boiling-over, and then a crucial moment. What if you paused in your story and told us what you were thinking and feeling right then? I would be riveted.” Guess what? We had a great online conversation after that, and he re-wrote his story, and I WAS RIVETED. Win-win.

CMIO’s take? Story telling: cool. Gentle, effective feedback: cooler. Don’t we all need to get better at this?

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