Because of Winn Dixie (book review)

by Kate DiCamillo, via Wikipedia

I think it is crucial to read outside of one’s vocation.

Winn-Dixie is a supermarket chain where I grew up, in Tallahassee, Florida. Furthermore, Kate DiCamillo is a magical writer, whom my children and I discovered as they were growing up. I recently found audio books at our local library (Libby app, anyone?) and have been listening to a wide range of books on my commute to work.

Not only is the storytelling just brief, and perfect, but the audio narrator is entirely charming and transports me to my secondary school years and the heavy southern accents all around me at the time. The immediacy of the memory is almost as dramatic as those times when a particular aroma (?pecan pie?) ‘clicks’ in your mind’s eye back to a specific time and place…

In contrast to what I heard from day-to-day in town, I preferred to think that MY English was derived, on the other hand, NOT from my parent’s immigrant tongues, nor from my southern-drawling friends, but from Sesame Street, Electric Company and, of course, neutral-midwestern-toned Walter Cronkite:

“And, THAT’S the WAY it is, JAN-u-ary FIF-teen, NINE-teen-SIX-ty-EIGHT.”

Walter Cronkite, CBS evening news

CMIO’s take? Well, give this a listen, or indeed, read ANYTHING by Kate DiCamillo: The Miraculous Story of Edward Tulane, Tiger Rising, any of them. The sweet, optimistic years of childhood, the purity of mystery, the tentativeness of friendship and connection…Young Adult Fiction is where its at. And, Happy holidays, y’all!

Why I read and blog about Sci-Fi. Life 3.0, Superintelligence, and the Sirens of Titan

This is a fun read. My father never understood my passion for fantasy (The Hobbit, the Lord of the Rings) in middle school or sci-fi in high school (Ender’s Game, entire libraries of Asimov, Heinlein, PK Dick, and countless others). I’d try to explain, (not nearly as cogently as this journalist) that science fiction was imagining about our future, and that so many predictions from sci-fi authors have come true.

I’m currently reading Life 3.0 and SuperIntelligence for an upcoming book club, and also stumbled across The Sirens of Titan by Kurt Vonnegut, from 1959! Vonnegut is prescient; he predicts future concerns of machine intelligence, indeed artificial general intelligence, the concept (and worry) that, once created, a superintelligent being will be difficult or impossible to control and may find its human creators tiresome and unnecessary.

Hmm. The same theory is proposed, 60 years later by the authors of Life 3.0 and Superintelligence, but with more evidence and detail.

CMIO’s take? Where is the sci-fi about the future of Electronic Health Records? Ready to write one?

CHIME’s CMIO Leadership Academy in Ojai. Listen and learn.

http://chimecentral.org/mediaposts/cmio-leadership-academy-2019-images

Thanks to George Reynolds and those organizing CHIME’s recent Leadership Academy for existing and upcoming CMIO’s. I enjoyed teaching this year with other co-faculty like Brian Patty, Natalie Pageler, Cindy Kuelbs, George, Howard Landa, Keith Fraidenburg and David Butler.

The topics we covered in our Academy over 2 days included such CMIO best hits such as:

  • The Role of HIT in Today’s Provider Environment
  • Setting Vision and Strategy
  • Making Change Happen
  • Creating Buy-In
  • Demonstrating Business Value
  • Budgets and Business Plans
  • Creating Effective Teams
  • Instilling Customer Service as a Value
  • Organizational Culture
  • Building Networks and Community
  • Achieving Life/Work Balance

Thanks to my awesome and inspiring faculty colleagues; I learned a ton as a N00bie faculty member, and got lots of new books to read, for example Brian Patty’s “What Customers Crave.”

CMIO’s take: See one, do one, teach one is the norm during internship and residency training. Sometimes Teach One ends up being the best learning of all. And, join us next year at CMIO Leadership Academy.

New PIGlet? Or, interested in medical informatics? How to start…

Piglet: ie a New PIG (physician informatics group member)

Are you a PIGlet? Someone interested in the field of medical informatics? One of our newest informaticists coined the term PIGlet (Physician Informatics Group member). Cute. Increasingly I’m meeting with medical students, medical residents and now physicians as well as allied health persons (nurses, physical therapists) interested in the field, and unsure how to get started. Well…

Fallacy: informatics is about designing computer screens and talking with vendors about features and screen design.

Fallacy: informatics is about going into a dark room, creating a fantastic tool and launching it into the public and collecting all the acclaim from co-workers who instantly understand why you are requiring more clicks and typing to complete your amazing new software package.

Fallacy: informatics is about being smarter than everyone else and just KNOWING that your solution you cooked up in your head is going to work for everyone IF ONLY THEY DID THINGS THE RIGHT WAY, like you.

Instead: informatics is about creating a vision of what healthcare COULD BE, empowered with knowledge. This is a team sport. It is about collaboration: collecting everyone’s best ideas, developing consensus, trying a bunch of things in small batches, seeing what works, and then making a big bet, measuring outcomes, and diving back in for the next cycle of improvement. Done well, Informatics is Design Thinking and Teamwork, and the “information technology” is just how it is implemented. This is completely the opposite of what many think informatics is.

They’re … wrong.

Here are some ideas for getting started. A fair number of these are associated with a TED talk or other online video summaries.

  1. Read about informatics (but ONLY after reading about leadership and organizational change)
    1. Lorenzi, Riley, Managing Technological Change
    2. Journal of the American Medical Informatics Association
    3. The Design of Everyday Things (Norman), others
    4. Nudge (Thaler)
    5. The Glass Cage (Carr)
  2. Books to read (leadership, culture change, a book club if you’re lucky)
    1. Leading Change (Kotter)
    2. Good to Great (Collins), and others
    3. Death by Meeting (Lencioni)
    4. Delivering Happiness (Hsieh)
    5. Tribal Leadership (Logan)
  3. Books on self improvement
    1. Getting Things Done (Allen)
    2. Deep Work (Newport)
    3. The ONE Thing (Keller)
    4. Atomic Habits (Clear)
    5. The Practicing Mind (Sterner)

There are blogs:

Above all, be curious, be useful, pace yourself, take care of yourself so that when opportunities arise, you can occasionally sprint into action. Create learning habits to stay abreast of changes that affect your clinical practice and that of your colleagues. Read broadly about other industries unrelated to your own, and how problems are solved elsewhere.

CMIO’s take? Informatics has become a crucial part of medical training. The most commonly used (and often hated) tool for physicians today is the EHR; more common than the Yankauer, the retractor, the scalpel, the stethoscope, even. Why not develop exceptional skills with this tool? Until it matures into a self-aware entity (! a later post), it is on US to shape it into a useful tool.

Getting to Yes (Book review)

OK, nobody has time to read an actual book, so here is William Ury speaking at Creative Mornings about his book. Do you have 30 minutes to be a better person? Ever seen the arm-wrestle exercise? Watch the video.

I’ve read his book several times now. At least put it on your bookshelf. My take-aways for me and my colleagues and my work. We discussed this in our Large PIG book club recently.

  • Separate people from the problem. Personality is NOT at issue. Avoid blame on either side
  • Focus on interests, not positions. Be curious. See (and demonstrate your understanding of) the other party’s position clearly
  • Learn to manage emotions. Allow expression of strong emotions. Else, may block clear thinking
  • Express appreciation. Reflective listening (data, ideas, feelings, values). Seek others’ perspective.
  • Put a positive spin on your message. Avoid blame.
  • Escape the cycle of action and reaction. Instead, explore interests, invent options for mutual gain, leverage differences, brainstorm jointly as “wizards” (lower level persons who are permitted to work on ideas without leadership pressure)
  • Prepare your BATNA (Best Alternative To Negotiated Agreement) What will you do if you don’t agree?
  • Seek a third party who is trusted by both sides
  • Be SOFT on the people (care about the person), HARD on the problem (principled thinking)

I’ve read authors with similar points:
-Steven Covey: Listen first to understand, THEN speak to be understood
-Crucial Conversations: Make it safe to converse, Control your own stories, Contribute to shared pool of meaning, Ask other’s interpretations, Be tentative in your theories, Seek win-win opportunities.

CMIO’s take? This is a foundational book for Informatics and leadership in general. Find time to learn these lessons. Find the win-win.

Book review: Turtles All the Way Down

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Five stars.

John Green channels teenage angst like no one, and he parlays them, unaccountably, into riveting novels of pathos and the teen journey. He broke my heart with The Fault in Our Stars, and he did it agai with Turtles. The title of course comes from the story that some old woman was arguing in favor of the Flat Earth theory with a modern scientist who was of course discussing that the Earth is a sphere. The woman then patiently explains, when the scientist asks, that the Flat Earth is, of course, sitting on the back of an enormous turtle. Ah ha! thinks the scientist, who asks, “Well, what is the turtle sitting on, then?” And the immortal response: “Well, it’s turtles ALL THE WAY DOWN.” Duh.

Green parlays that saying into the mental health cycle of the protagonist, whose Obsessive Compulsive Disorder (OCD) pervades the narrative and prevents our heroine from achieving so many great things. Throw in a murder mystery, and you THERE, you’ve lost another full day of your vacation marinating in someone’s fever dreams.

CMIO’s take? I always feel rewarded, when I come out the other side of a novel, feeling like I just lived someone else’s life for a day or so, my adrenal glands all squeezed out, my emotions having been through the wringer, and somehow, my own head a bit clearer for it, and my own problems just a little bit less pressing.

Book review: Flow (second time review)

Here we are (again)! How can I review this? An incredible landmark of a book, it has sat on my bookshelf for more than a decade, and then on my ‘actively reading coffee table’ for another few years. Despite its mention in almost every important other book I have read, and my repeated abortive attempts to push through, I found this book alternatively revelatory and then densely incomprehensible. I frequently dove in, underlined many passages, got stuck, and put this book down for prolonged periods. 

Finally I convinced my book club friends to tackle this, set a discussion date (Jan 2019), and that was my trick to completing the massive read.

What I’ll take away is the idea of linking happiness NOT to acquisition and idle pleasure, but to difficult challenges that are just outside my comfort zone and skill set, where with maximal concentration, I can succeed. 

Fortunately for me, I have had many times in my life when I have achieved such Flow, and now I have a framework for thinking about it and setting up my day, my home, my work life to achieve this as often as possible for myself and for colleagues. 

Incidentally, I have recently completed the massive tome ‘Alexander Hamilton‘ by Chernow, another incredible read (I was drawn in by, of course the immensely popular musical), and I am led to reflect that Hamilton must, in his voluminous lifetime of groundbreaking writings, must have set up conditions to achieve Flow for quite extensive parts of his life, despite tremendous tragedy, political rancor and his final demise at the business end of a duelist’s pistol. For example, he would read all day, head to bed, then wake up the next morning and just write, with no interruptions, for hours. As a result, his subconscious worked on problems overnight. Often his manuscripts had NO corrections, as he would scribble furiously a final draft, fully formed. This was how he tackled many of the Federalist papers, papers that are studies in minute detail by constitutional scholars to this day. 

My favorite Flow pointers:

  • Attention is how you create your experience and consciousness, and psychic entropy is the opposite: the chaos that detracts from focus and intentional effort. 
  • Flow requires: clear goals and feedback; concentration on the task; a sense of control; loss of self consciousness; transformation of time. 
  • Flow occurs when the top of your skills barely match the presented challenge. Otherwise you get boredom or anxiety. 
  • Source of dissatisfaction at work: lack of variety and challenge; conflicts with other people/boss; too much pressure, too little time. All CAN BE under our control. 
  • Autotelic self: easily translates external threats into enjoyable challenges and maintains inner harmony, transforming potential entropy into creating flow. 

CMIO’s take? I defer to these great words by Chuang Tzu: ‘When I come to a complicated place, I size up the difficulties, tell myself to watch out and be careful, keep my eyes on what I’m doing, work very slowly, and move my knife with the greatest of subtlety, until–flop! the whole thing comes apart like a clod of earth crumbling to the ground. I stand there holding the knife and look all around me, completely satisfied and reluctant to move on, and then I wipe off the knife and put it away.”

Book review: Singularity Sky

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Four stars.

Stross’s Accelerando is perhaps my favorite book of his so far. I like his writing, the ideas that he sprinkles along the way.

In Singularity Sky, for example, that the economic takeover of a planet begins with a rainfall of portable telephones from the sky, and that those who pick them up are asked to “Entertain us! Tell us a story!” And the surprises continue to develop from there.

He throws in ideas like, nano-machines that can manufacture goods from a ‘storage locker’ of solid metal, on demand as molecules, textiles, objects, working machines are programmed and created upon request. What would that look like at personal scale? within a family? at city scale? nation scale? planetary scale? Is it the result of, or the cause of, revolution?

CMIO’s take: what are you reading? Reading is the ultimate form of empathy, which is the root of compassion, which is the root of communication, which is the root of community and teamwork. We can all read more.

Book review: Artemis

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Five stars.

Maybe the best sci-fi book of the year? Well, it is in the running. I’m sure it is difficult for an author to follow-up a first-novel blockbuster book with a successful second novel, but Andy has pulled it off. It is NOT the paradigm-shifting story of a marooned human on Mars, but a gritty, near-future story about a super-smart deliveryman (gal) who is sick of people telling her she’s “not living up to her potential.” And she is a smuggler: she smuggles goods in from Earth to the Moon colony called Artemis. But then her smuggling gets her involved in something a lot bigger than she intended.

Andy unwinds this tale with a huge dollop of delicious hard-science fully integrated into the storytelling and into the problem-solving. This key is the same key that unlocked The Martian for me and so many others. Feels like the 1970’s TV show “The A-team” except with hard science instead of those rapid-action cut scenes where they’re building something cool that will get them out of trouble by the end of the episode. That kind of feeling. Except better.

CMIO’s take? Science rocks. Artemis rocks. Two thumbs up.

The Glass Cage by Nicholas Carr (book review)

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One of our book club books, for the ‘clinical decision support’ team for the electronic health record at our institution. We have now read it in our Large PIG book club meeting (the Physician Informatics Group: we try hard not to take ourselves too seriously). Some of us were depressed after reading. The initial optimism of the ‘glass cockpit’, the fancy new computerized design of the complex Airbus aircraft, are instead proving to be a ‘glass cage’, which isolates us and anesthetizes us from the real world. The author provides riveting examples of glass cages: the Inuit who lose their cultural skills of navigating brutally inhospitable landscapes because of GPS and snowmobiles, also, the pilots who make error because of automation, leading to automation bias and automation complacency: thinking the computer must be right, and the computer will know, so I don’t have to. Further, our attention wanders as we cede responsibility for moment to moment control of the task. How do we fight such a trend and temptation, as designers?

Yet the author speaks about ‘adaptive automation’ where a computer could detect the cognitive load or stress in a human partner, and share the cognitive work appropriately. He speaks of Charles Lindbergh, describing his plane as an extension of himself, as a ‘we.’ Can we aspire to improving the design of our current electronic systems to such a partnership that avoids the anesthetic effect and instead becomes more than the sum of the partners? Chess is now played best by human-computer partners; could health care and other industries be the same? And what could that look like? The Glass Cage gives us an evidence-based view into that future (and hopeful) world.

UPDATE: We had a great discussion during our recent book club. As an indicator, several of my colleagues told me: “I don’t like this book.” Perfect! It made for a juicy, spirited conversation about the benefits and risks of automation and how the stories in the book did or did not apply to healthcare and what we were building. Maybe we can consider “adaptive automation” so that the computer scales up and down its assistance as the clinician comes under crisis so that the human can focus on problem solving and the computer can increasingly assist with routine tasks. And then, we need to take care that “automation complacency” does not increase. We already have heard of clinicians saying “Well, EHR did not pop up an alert for a drug interaction, so that means it must be safe to prescribe this new med for this patient.” Whoa, are we giving away the primacy of our own training and experience to an algorithm already?

CMIO’s take: keep reading, keep learning. It is only through extensive experience from reading and books that we can learn from others in healthcare, and from others in other industries divergent from our own. There are more smart people who DON’T work for you, than who do.