As you read this, I am away enjoying the mountains. As always, I take plenty of reading material on vacation because I can study with fewer distractions. While ruminating over what to take along, I realized how much reading blogs has become a part of my search for new ways of looking at problems, as a way of finding new ideas.
How are new ideas and approaches to solving problems born? No matter what field of endeavor one is in, this is an important question. Sometimes, it seems new ideas arise simply because it is inevitable, because it is simply time. At other times, genius seems to be the best answer. In the field of HIT, new designs for clinical care systems and semantic interoperability are the “big” problems awaiting solutions.
Semantic interoperability has never captured my imagination in the same way that software design has. Clinical care system design has become somewhat of an obsession for me, which regular readers might have picked up on. I see clinical software design as more of a search for the algorithms that undergird clinical care than as merely a step in product development. At its essence, clinical care is an attempt to relieve suffering and promote health, and over centuries of development, something wonderful has grown out of what probably began as shamanistic practices. The rise of biomedical sciences has made clinical care more exact, more effective, more complex and, judging by the rate of medical errors, perhaps more dangerous.
Somewhere in modern clinical practice are patterns and algorithms that can be studied, refined, and brought to bear to further combat disease and misery. I am looking for those patterns and algorithms along with a way to represent them and incorporate them into software systems. There is a direct line from patterns and algorithms to processes, workflows, and discrete math. I see them as expressions of the same underlying reality.
So, how does all of this fit with the title of the post? Well, there have been many times when I’ve run into a wall, and then happily stumbled across something that made the quest seem achievable again. The first, of course, was the workflow theory research of Will van Aalst and colleagues. It is impossible to give too much praise to what they have contributed to analyzing and understanding processes.
Closer to home, there is the indomitable Chuck Webster. Chuck has made workflow technology in clinical care the important topic it should be. Daily, it seems, he makes me pay attention to some previously overlooked aspect of clinical workflow or workflow research, which is both welcome and irritating (I already have enough reading to do).
Thomas Beale absolutely belongs in this group. Many hours have been spent pondering his writings. Some I print and reread periodically. As I said earlier, at present, I am not that interested in interoperability. However, I get the feeling from Beale’s writings that he sees an underlying reality as well. It would be nice if he would write a book I could take with me on next summer’s vacation.
Recently, I have begun reading Bobby Gladd’s KHIT.org blog. His posts (stories? vignettes?) are thoughtful and somehow put into perspective all the nonsense that happens in HIT –informative and thoroughly satisfying…
Each person described above offers some combination of insights, anecdotes, experiences, and information that force me to consider things in a different light. They discuss hard problems with an eye toward fixing them, not complaining that they exist. All are on the vacation reading list.
Not on the reading list, but just as much appreciated, are those who take the time to comment on EHR Science, and especially those who send notes about their work and experiences. It is reassuring to know so many are working on the big problems and are eager to share ideas. An idea whose time has come grows out of communities that are questioning, optimistic, and insistent. Luckily, communities dedicated to the big questions of HIT are thriving.
Vacation reading is a time for learning about at least one new thing. That honor goes to cognitive task analysis this year. Working Minds: A Practitioner’s Guide to Cognitive Task Analysis (MIT Press) reminds me of van der Aalst’s workflow management text. At under 300 pages, excluding references and notes, it is not too long-winded. I like books that get to the facts without too much extraneous discussion, and this book seems to be in that category.
For recreational reading, I’m taking along two Star Trek DS9 books, a novel (Time’s Enemy) and a collection of short stories (Prophecy and Change). Both are set during the series. After reading a few of the reboot novels, I longed for the old days when everyone was still on the station. The novel will keep me from reading all the short stories the first day or so. As backup, I have A Scandal in Bohemia to fall back on.
I read Advent of the Algorithm a while back. However, there is something about the way that Berlinski describes the formalization of fundamental aspects of mathematics that makes rereads a treat. Seeing how mathematics developed in response to specific problems and the personalities involved tempers the dryness found in many mathematical histories. The math chapters are short and easy to digest. The asides, of which there are many, I skip.
Finally, there is a book I received from Lawrence Weed by way of his son, Lincoln. Medicine in Denial, among other things, examines clinical decision-making. It looks at how information is applied to decision-making in different scenarios. I have only perused it lightly. And from those initial weeks, I can see that reading it will take some time. Likely, this will be summer-long reading and will make it into a post at some point.
For forever, I have spent the first summer vacation at the beach. I look forward to the cool mountain air, good reads and, hopefully, a few new ideas. See you in two weeks…