Tuesday, November 18, 2008

An Era of Change

An Era of Change

This week's NYT Sunday Magazine has an article by Ron Suskind entitled "Change: How Eras End and Begin." In it, he describes a seminal scene in David Axelrod's office as Barack and Michelle Obama confer with eight others about whether or not Barack should pursue the presidency. Michelle says, "You need to ask yourself, Why do you want to do this?"

Barack says, "This I know: When I raise my hand and take that oath of office, I think the world will look at us differently. And millions of kids across this country will look at themselves differently."

Here's the amazing thing about that statement: we don't have to wait for the raising of Obama's hand some weeks from now for the world and our children to see these United States in a new light; that transformation happened on election night after We the People raised our hands by voting for him. Everything I've learned about our President Elect since his campaign began tells me that he would agree and would say it differently today.

Tuesday, November 04, 2008

Yes We Did!

Yes We Did!

This is a time to look forward, to move to a new place for our nation in this world. We have an incredible amount of healing to do - healing our economy, our relationships with other nations and peoples, of the sould of this amazing country.

As tough of a race as it has been, the work is just ahead of us. I am humbled to think that today we did what could not be done - one person at a time.

I made calls for Obama yesterday in Santa Monica, taking a few hours off from my business trip here to play a bit part in this massive effort. I spoke with many first-time voters in Colorado and North Carolina - some who had questions about exactly what to do on election day and many in North Carolina who had taken advantage of early voting to make their voice heard. One woman, was voting for the first time at the age of 49. It was the first election where she felt that her vote really mattered. She was right; as of this writing (12:28am ET), the winner of the state's 15 electoral votes is still undeclared - less than 14,000 votes of the more than 4 million cast separate the two candidates.

Many I spoke with were ready to stand in line for as long as it took to proudly - proudly - cast their ballot for Barack Obama. Some were tired of hearing from strangers interrupting their day with another call; but more were encouraging - thanking me for putting time in to make a difference. This is why I think today's results will turn into significant action: People - we the people - are ready to go to work to support our new president and make change a reality.

I will never forget this night.

Now let's get to work...

Friday, October 24, 2008

Happy Birthday to Me

Happy (Belated) Birthday to Me

Charlene Kingston, an old friend from college days in Ohio reconnected with me via Facebook and Twitter. She sent me a very thoughtful note for my 44th on the 21st that seemed worthy of a post:

The process of living daily life has a changing pace. The rhythms of working life and family provide a baseline of activity that influences our perception of the passing of time. Short-term projects, seasonal activities, and rituals make increasing demands on our schedules temporarily and then fade away. We adjust to the changes, bracing for greater demands, and relaxing when the demands subside. We may have a sense of the fullness of our calendars, but it can be tough to really assess how richly we are living each moment.

Birthdays are a great milestone to measure life. Like a punctuation mark, they break the routine flow of our days. And like reaching the top of a Ferris wheel, they give us a pause, a chance to catch our breath and to see our lives laid out like the geography below us.

For your birthday, I wish for you the clarity of a mountain top, the joys of being surrounded by the people you love, and the contentment that comes from your heart in knowing you are living your life with integrity and deep personal meaning.
Thanks, Charlene... It is good to take a breath at the top of the wheel, take stock, and be thankful.

Monday, October 13, 2008

Venus in Repose

Venus in Repose

Earlier this evening, Kym, Taylor and I said a long, tearful goodbye to a member of our family – our 1-1/2-year-old miniature schnauzer named Venus. She didn’t die; we gave her to a wonderful couple who we know will take very good care of her. Venus is, without question, the best dog I’ve ever known – not that I’ve been close to many. But experienced dog people have remarked about what a smart, well-behaved and good natured dog she is. Whether or not she is the best dog ever, I can’t say, but she is the best dog we could have ever hoped to own – if only for a season.

You might be wondering why in the world, if she’s such a wonderful animal, we would ever get rid of Venus. I’m wondering that a bit myself as there’s not exactly a black-and-white reason for our decision. It was ultimately Kym’s decision and one I felt was important to respect and agree with. If I try and pin it down to one unifying reason as to why we gave Venus away, I’d say it is this: we really fell in love with her.

That probably doesn’t sound like much of an answer at all, so I suppose I’ll start from the beginning. Maybe it will make more sense in context.

Kym had owned a rescue Chiquaqua-mix named Bambi when she was 5 years old.
The dog became sick after couple of months and needed to be put to sleep. I owned one briefly when I was about 12 or 13 – a sheltie named Robbie. I begged my parents for a dog, having no idea what it meant to take care of anything, let alone myself. My sister begged too and eventually they relented. Robbie was pretty hyper, nearly full grown, but still very much a puppy. He hadn’t been housetrained yet and we certainly weren’t disciplined enough to train him ourselves. My parents had made it clear that he was to be Melissa’s and my responsibility, not theirs. When it became obvious that we had neither the inclination nor the temperament to care for a high-maintenance dog like Robbie, my folks stayed true to their word and found a new home for him. Within days he was housetrained and, as far as I know, lived a happy life.

So it’s pretty safe to say that we’re not dog people. It’s not that I don’t like dogs. I actually like them a lot – especially the ones I’m not allergic to – but I understand that they have real needs that shouldn’t be neglected. I take that seriously enough to know that I wouldn’t want me for an owner if I were a dog. I’m too busy, travel too much and just don’t place enough of a priority on caring for a domestic animal to be a dog owner.

When Taylor turned five or so, he started asking for a brother or sister. We watched him with other children – babies especially – and saw how loving, gentle and attentive he was. T would make a great big brother but we knew a little sib wasn’t in the works.

So we talked about getting a dog. Actually, Kym talked about it and I demurred. Taylor was in no way ready for a dog. All the care responsibilities would fall on us and I was not going to devote the time required. Both Kym and Taylor were persistent and assured me that I wouldn’t be a primary caretaker. Whether that would turn out to be true or not, I argued that we are not dog people and we have no true appreciation of what it means to care for a dog.

I held out for as long as I could, wanting to wait forever – or at least until Taylor was eight and more capable of caring for a pet. But I knew that resistance was futile and I finally relented.

Kym had done her homework (as she does with most everything) and figured out that the best breed for us would be a miniature schnauzer. A small dog (about 12 pounds fully grown) but not a wimpy dog – one that would be a good and devoted companion and not destroy the house or the yard. She found a wonderful breeder in northern Maryland who bred and showed only miniature schnauzers. We put down a deposit and promised T a puppy for his next birthday.

Venus was born on March 10, 2007, just seven days shy of T’s sixth birthday. A purebred with a fine pedigree, we picked her up when she was 14 weeks old – already housetrained and ready to be loved. Within days, we knew she was a good fit. As advertised, she was smart, playful, and sweet. She barked only rarely – really only once a month or so and always for a reason – usually squirrels. All she ever wanted from us was to be nearby. She was always at our feet – ready to lick our hands or pick up a morsel that fell off the kitchen counter. Her pepper gray and white coat was soft as cashmere – especially in the summer when she lost her coarser winter coat. We kept her groomed short, which showed off her lean but muscular figure. She reminded us of one of those Mighty Dog dogs in the commercials when she leapt up the porch stairs from the yard.

As predicted, while Taylor clearly enjoyed Venus (mostly when it was past his bedtime and he was looking for an excuse to delay the inevitable), he didn’t take on ownership responsibilities. He’d feed her occasionally, but it was really up to Kym (and on occasion, me) to walk her and make sure she got what she needed. Kym was also completely responsible for the major stuff and I, on the contrary to my initial thoughts, had very little to do with caring for Venus. I did, however, pick up the tab while Kym did all the legwork.

Not that picking up the tab was a small deal. Our $1200 investment in her as a dog was only the beginning of the expenses. Dog insurance, wellness care (an excellent investment it turned out as she got pancreatitis when she was about six months old), invisible fence, spaying, food, medicine, kenneling when we went on vacation… it all added up pretty quickly. Vastly cheaper than a second child, mind you, but certainly not pocket change.

Still, we could afford it and Venus gave us no grief whatsoever, only love. She had a short spell of needing to chew and managed to get hold of a couple of power cords, but that phase quickly passed (maybe the power cords had something to do with it). After that, she was a perfect gentlewoman.

Kym and I both agreed Venus would not have run of the house so she was confined to the kitchen, foyer and Kym's office. Over time I successfully lobbied for her to be allowed in the family room – on our leather couch when we watched TV – as long as she stayed on a little bed we got for her. All she wanted was to be near us.

So far, this isn’t sounding anything like a tragic story and it’s really not. Over time, a couple of things happened that gave us pause. First, Venus got a number of tick bites from the woods behind our house. Lyme Disease is endemic here – as it is most everywhere nowadays. The bites would become infected and require a couple of visits to the vet. After a while it became clear that if we stayed where we live now, this would become a routine issue. The first time one of our frequent tick checks on Taylor proved fruitful – the little bugger on his chest was the size of a small freckle – our concern escalated.

Then a couple of months ago, Venus broke through the Invisible Fence. Taylor was outside at the time – we heard his repeated screams. As I ran out of the house, I thought for sure Venus or someone else had been hit by a car. He was in a complete panic as he watched her run down the sidewalk and disappear.

Though she’s a tiny dog, even at a full sprint, I can’t outrun her when we go for our evening tears around the circle. If she ever wanted to get away from us, she could do it without so much as panting. Turns out that Venus’ jailbreak was purely a crime of passion; her boyfriend, Dusty, a golden lab puppy twice her size, was out for a walk in the neighborhood and she simply couldn’t help herself.

I think that was the trigger for what ultimately followed; Kym saw that, between the ticks and Venus’ ability to break the fence at will, we would need to stop relying on the fence and always walk her. And that process led to bigger questions: Were we really prepared to do this for the next 12 years? Could we provide Venus with the best possible life?

We love Venus, but we also saw that we didn’t give her all the attention she needed. Maybe that’s not right; we gave her all that she needed. We just didn’t give her what she really deserved. We didn’t play with her enough or let her have the run of the house or the yard. She simply deserved more than we were able to give her.

Kym, with her usual care and diligence, eventually found a couple, the grandparents of one of T’s classmates, who were ready for a new member of their family with whom they could share their palatial home in Frederick, MD, just 30 miles north of us. They had owned a miniature schnauzer in the past, were in semi-retirement, and had plenty of grandkids, land and love to share with our little girl.

A couple of visits with them gave us more than enough assurance that Venus would have everything a dog could want – not indulgent love, but the right kind of love and attention – and time.

Kym spent nearly the entire day today preparing for the delivery. She typed up checklists, Venus' daily routine, her wellness schedule – it was amazing to see it all in writing as she documented everything that went into caring for Venus beyond food, water and walks. Her new owners were rightfully impressed as Kym went through every detail. As we left, we asked them to call us first whenever they went out of town so we could take Venus for them. I’m already missing her, but am happy to know she is getting what she deserves.

Many tears were shed, mostly by Kym. She knew she was doing the right thing for Venus, even though it was breaking her heart. T didn’t cry until we got into the car and he finally realized what it meant (in his heart anyway – he has known intellectually what it meant for a few weeks). He was sad that he had lost a playmate – or at least a potential playmate since we often had to ask him to play with her as he rarely thought to do so on his own.

Tonight, Kym apologized for not listening to me in the first place – that I was right, we’re not dog people. But I was wrong. We are dog people. We just know that we shouldn’t own a dog. But we have loved one dog as much as any other dog person. I know because of the tears I am shedding now.

Saturday, September 06, 2008

Sleep on It

Yesterday, I had to install a security update on my work PC that required a reboot. I dutifully closed the 20 or so windows of stuff I had open, making sure I had saved each document. Later that day, I went to open a draft of a whitepaper on the use of electronic data sources for drug safety surveillance as a follow-on to BearingPoint's work on the eHealth Initiative Connecting Communities for Drug Safety Toolkit.

No document. No trace. Nada.

I can't recall the last time I've totally lost a document or file. I backup my hard drive, archive email and am pretty religious about hitting the save button (seems my spiritual calling has been downgraded from saving souls to saving documents, but that's another story). But the biggest change that's happened, frankly, is that Microsoft has gotten pretty good at making sure documents don't get lost when their applications crash. They crash pretty often still, but at least when they do, you can almost always pick up the pieces.

I had already put in several hours over three days into editing this paper and was probably less than an hour from finishing. With extreme diligence, I look through every option I could think of to find it. Hidden file searches, Google Desktop, looking to see if I had named it something else accidentally in the process of saving it. In the end, I figured that I had been saving the temporary internet file of the draft that had been sent to me via email. But when I opened it again from the email, another instance of the document - Whitepaper(2).doc - came up containing none of my changes.

The path address for that file was in the Temporary Internet File folder a couple of subfolders down. But when I looked in the TIF folder, there were no subfolders showing - even though I had made sure that all "hidden" files would show.

I gave up, resigned to the idea that I would spend a good part of the weekend rebuilding what I had already done.

My favorite time of the day is that place between when I wake up and when I get up. Things become clearer during that intersticial space between dreams and reality. It's when I'm best at figuring out puzzles whose solutions have eluded me - be they that one last line in the lyric of a song, a business issue or trying to remember where I left my sunglasses.

Today when I returned to my computer, I typed the file path into my Windows Explorer browser and the hidden files appeared one by one. There among the hundreds of temporary files was a beautiful sight - my lost file.

The weekend is saved - or at least it gave me enough time to treat myself to a little blogging...

Thursday, September 04, 2008

NCPDP Modeling & Methodology Road Map

Yesterday, I sent this email to a bunch of folks working on creating a new road map for developing pharmacy and ePrescribing-related standards through NCPDP, the National Council for Prescription Drug Programs, a standards development organization. Too often, volunteers like these never get the credit or thanks they deserve for working on something so esoteric and abstract, but that is, nevertheless, absolutely critical in my view to transforming the current healthcare system into something that actually resembles a system. If you're one of those people working on similar thankless initiatives, thanks to you too... and please, please keep up the good work.

To the members of the NCPDP Modeling and Methodology Road Map Task Group –

I got a lump in my throat reading this document today. That’s a good thing.
It took me back to 2005 and the many conversations Jim McCain and I had about how important data modeling will be to the future of NCPDP and our ability to create standards that are more readily interoperable with other healthcare information exchange standards. There wasn’t much of an appetite for these ideas back then – mostly because people didn’t know what the heck we were talking about. But the leaders of NCPDP also understood that we were in danger of building standards that, while effective in meeting current needs, could someday become a “bridge to nowhere” if we didn’t look at how they could be more aligned with standards used in other environments. So the group received the Board’s blessing and got up and running.

I wish I could have been more involved in this most recent work, but from what I’ve just read, you did more than fine without me. Point by point, you’ve articulated a set of rock-solid arguments for why we need to move toward model-based standards and have developed a clear road map for accomplishing that goal. I’m truly in awe of the quality of this document’s contents and how well they articulate a detailed approach to achieving what was an inexact if not impassioned notion three years ago.

What we have now is a way and a plan; what we still require is a means and the will to execute on this plan. NCPDP will be more effective in creating future standards by adopting a model-based approach using open-source tools. But our success in achieving the ultimate goal of creating semantic interoperability within healthcare will be severely limited unless we get the rest of the healthcare standards development community to follow a shared path. That’s why I believe that it’s extremely important that we quickly vet this work and share it with other SDOs – perhaps through our ongoing SDO summit meetings.

Workgroup 15 – Sample Management and Activity Reporting Transactions for Safety – will be starting work on developing draft standards for drug sample data so samples can be managed through electronic prescribing systems and included in medication histories. It’s a fairly small and simple domain relative to others and it may be a good environment in which to work through the soup-to-nuts modeling process so that we can further refine it. We would need a modeler to join our task group, but would welcome the opportunity to demonstrate this capability.

If I go on much further, they’ll have to cue the orchestra to begin playing “America the Beautiful”, so I’ll just offer one more thought: The main reason I felt so compelled to blather on about your work is because I’ve experienced the gratitude of a patient whose life was saved or made better because of something I did back when I was involved in direct patient care. Sadly, people won’t be coming up to you in the street to give you hugs because of how you changed their lives. That’s too bad because this work will ultimately impact more people than any individual doctor, nurse or pharmacist ever could. I just wanted to let you know that someone sees it, understands its relevance, and wants to thank you deeply.

Thank you, thank you.


Tuesday, March 04, 2008

William F. Buckley, Jr. - 1925-2008

William F. Buckley, Jr. - 1925-2008

Newsweek's cover story on the death of the voice of right wing political commentary prompted me to read again a copy of a letter of thanks Mr. Buckley wrote to my grandmother, which I keep framed in my office. Though I may not have agreed with his political views and probably have more affinity to his son, Christopher Buckley (still waiting for the brilliant Little Green Men to come out as a film - too bad his father will no longer be around to play the main character), I can't help but appreciate his skill as a writer. But judge for yourself...

June 8, 1967

Mrs. Joseph A. Martin
Box 518
Big Stone Gap,

Dear Mrs. Martin:

Your gift has given us heart. It's too early, as yet, to know for sure whether we will make it, but if enough others respond as generously as you have done, the prospects are good. We can only hope.

And hope, also, that you have some idea how much you mean to us. Not only concretely - your contribution will mean the survival of the magazine if, as I say, there are others as generous as you - but also spiritually. We write sometimes into a void. We see, of course, the effect we have in some specific instances - an article read into the Congressional Record, a student debate based on some of the things we write, letters from practical politicians who are moved by some of the analyses we publish. But our donors are, for the most part, a silent lot, in the highest traditions of philanthropy. But when the magazine staggers under the load, you come in from the shadows, and help us up from our knees. Perhaps someone once behaved towards you in that way, in which case you will know the measure of our gratitude.

Yours faithfully,

Wm. F. Buckley, Jr.

It reminds me of Lincoln's letter to Mrs. Bixby, when he had to inform her of the loss of five of her sons to the war. Form letters just don't cut it...