Every year, I travel a few hundred thousand miles through Europe, Asia, and the Middle East. I've observed that the cultural context of each society has a major impact on behavior.
Gathering with locals in Lyon, France to have a simple meal of bread, cheese, and vin de'table is very different from gathering with locals in Plymouth, New Hampshire to have a Subway sandwich. Not better or worse, just different.
Courtship rituals the Spanish Steps in Rome, Italy are very different than in a pub in Newcastle, England.
I recently read The Culture Code by Clotaire Rapaille, a cultural anthropologist who has developed a method for describing the reasons people around the world live and behave as they do. The book helped me understand some of the variation I've seen around the world.
For example, when purchasing a car, Americans seek a car that will express their identity. Germans will seek a car that optimizes engineering. American children will build a fantasy castle from Lego. German children will use Lego blueprints to build an exact scale model.
The chapters on relationships were fascinating. The descriptions are stereotypes, but interesting nonetheless. Culturally, Americans have unrealistic expectations of perfection in relationships (our 50% divorce rate is good evidence of this). English men spend a great deal of time with their mates at the pub and build a complex set of relationships outside the home that leads English women to fight for the attention of their men. Wander around Quayside in Newcastle on a Saturday night and you'll see the way that young women dress to attract the attention of their men. The Japanese view marriage as a practical partnership, often arranged by their parents. This does not imply marital bliss but the 2% divorce rate suggests it aligns with expectations.
Other chapters in the book explore Health, Youth, Home, Food, Work, Money, Shopping, and the way other cultures perceive America.
Although the idea of reducing complex cultural histories to a few key words (Culture Codes) is overly simplistic, several ideas ring as true
* Americans treat food as fuel rather than a high quality pleasurable experience to be savored
* Americans view buying over the internet as a focused task, while shopping at a mall is a social event
* Americans crave change, so making perfect products of high quality that last a long time does not align with our desire to have constantly improved products that work well enough for a short time and can then be replaced.
After reading the book, I have a new framework for approaching food, business meetings, and travel throughout the world.
Worth reading.
Kamis, 20 November 2008
Rabu, 19 November 2008
Harmonized Standards for the Genome and Family History
As one of the first humans to have my genome sequenced, I'm passionate about the standards used to record genomic and family history data. The initial national effort just completed the public comment phase and is not yet approved by the HITSP panel, but we hope to gain panel approval in December and present this work to the AHIC Successor on January 8, 2009 for acceptance by Secretary Leavitt before he leaves office. Here's a summary of the work thus far
IS08 Personalized Healthcare is the overall interoperability specification for exchanging genomic information and family history. It references several other HITSP components:
C32 HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component is the lifetime medical record summary.
C80 Clinical Document and Message Terminology Component includes the vocabularies used to precisely describe the genome and family history.
C83 CDA and CCD Content Modules Component is a detailed overview of family history pedigrees and genetic test results in the lifetime medical record.
C90 Clinical Genomic Decision Support Component is used to communicate genetic and family history information from healthcare IT applications to clinical decision support systems which provide an assessment of risks of diseases.
During our discussion of genomic and family history data, we focused on privacy, since keeping this information confidential per the wishes of the patient is paramount.
Concerns we discussed include:
a) Based on Provider’s different needs, would there have to be an “all or nothing” option for the family member’s access authorization?
b) Who makes the decision about which information is relevant?
c) If the family member is not capable of authorization or has passed away, is legal representation required?
d) What guidance does a Provider use to evaluate the access authorization?
We selected two HITSP Privacy and Security Components to meet these needs.
TP20 HITSP Access Control Transaction Package ensures only authorized people can view the data.
TP30 HITSP Manage Consent Directives Transaction Package provides an electronic record of patient privacy preferences and consents.
I look forward to engaging my own family in the use of these standards. My parents have agreed to share our histories and genomes as an example to accelerate adoption of these standards. More to come soon!
IS08 Personalized Healthcare is the overall interoperability specification for exchanging genomic information and family history. It references several other HITSP components:
C32 HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component is the lifetime medical record summary.
C80 Clinical Document and Message Terminology Component includes the vocabularies used to precisely describe the genome and family history.
C83 CDA and CCD Content Modules Component is a detailed overview of family history pedigrees and genetic test results in the lifetime medical record.
C90 Clinical Genomic Decision Support Component is used to communicate genetic and family history information from healthcare IT applications to clinical decision support systems which provide an assessment of risks of diseases.
During our discussion of genomic and family history data, we focused on privacy, since keeping this information confidential per the wishes of the patient is paramount.
Concerns we discussed include:
a) Based on Provider’s different needs, would there have to be an “all or nothing” option for the family member’s access authorization?
b) Who makes the decision about which information is relevant?
c) If the family member is not capable of authorization or has passed away, is legal representation required?
d) What guidance does a Provider use to evaluate the access authorization?
We selected two HITSP Privacy and Security Components to meet these needs.
TP20 HITSP Access Control Transaction Package ensures only authorized people can view the data.
TP30 HITSP Manage Consent Directives Transaction Package provides an electronic record of patient privacy preferences and consents.
I look forward to engaging my own family in the use of these standards. My parents have agreed to share our histories and genomes as an example to accelerate adoption of these standards. More to come soon!
Selasa, 18 November 2008
A Milestone for Personal Health Records
On November 12, Acting CMS administrator Kerry Weems and HHS Secretary Michael Leavitt made an announcement that has not been widely covered in the press, yet has deep significance.
The Center for Medicare and Medicaid Services (CMS) has embraced personal health records and will enable Medicare members in Arizona and Utah to access their own data from CMS databases via Google Health , NoMoreClipBoard , HealthTrio , and PassportMD . CMS pushes the data to the beneficiary's personal health record account upon the request of the beneficiary, rather than giving PHR vendors direct access to CMS databases.
Having worked with CMS for many years on transactions for treament/payment/operations and having worked with the CMS contracted Research Data Assistance Center (ResDac) for research datasets, I can say that CMS is very conservative about sharing its data and embracing new technologies.
The fact that CMS has linked the Medicare database to Google Health and other PHRs implies that CMS has embraced Healthcare 2.0 approaches to infrastructure and has validated the importance of personal health records. It also signifies that CMS has accepted secure transmission of healthcare data over the internet using HTTPS as secure enough. In the past, it's been challenging to transmit data from/to CMS via the public internet.
CMS, the funder of more than half of the healthcare in the US, generally drives adoption and change through reimbursement policy. In this case, by offering patients access to their own claims data, CMS will create patient expectations that will motivate the private payer community to do the same.
Linking Medicare over the internet to PHRs may be one of Secretary Leavitt's greatest accomplishments. Let's hope the Arizona and Utah pilots are successful.
The Center for Medicare and Medicaid Services (CMS) has embraced personal health records and will enable Medicare members in Arizona and Utah to access their own data from CMS databases via Google Health , NoMoreClipBoard , HealthTrio , and PassportMD . CMS pushes the data to the beneficiary's personal health record account upon the request of the beneficiary, rather than giving PHR vendors direct access to CMS databases.
Having worked with CMS for many years on transactions for treament/payment/operations and having worked with the CMS contracted Research Data Assistance Center (ResDac) for research datasets, I can say that CMS is very conservative about sharing its data and embracing new technologies.
The fact that CMS has linked the Medicare database to Google Health and other PHRs implies that CMS has embraced Healthcare 2.0 approaches to infrastructure and has validated the importance of personal health records. It also signifies that CMS has accepted secure transmission of healthcare data over the internet using HTTPS as secure enough. In the past, it's been challenging to transmit data from/to CMS via the public internet.
CMS, the funder of more than half of the healthcare in the US, generally drives adoption and change through reimbursement policy. In this case, by offering patients access to their own claims data, CMS will create patient expectations that will motivate the private payer community to do the same.
Linking Medicare over the internet to PHRs may be one of Secretary Leavitt's greatest accomplishments. Let's hope the Arizona and Utah pilots are successful.
Senin, 17 November 2008
The Economy and Academia
Last week, I wrote about the impact of the economy on my healthcare IT spending at Harvard Medical School and Beth Israel Deaconess Medical Center. Since that blog entry, Universities throughout the country have outlined their strategies for reduced capital and operating spending. The common features of these plans include hiring freezes, operational reductions, construction delays to avoid additional debt, and contingency planning for further reductions in the next fiscal year. However, all institutions have committed to maintain their current levels of financial aid, recognizing that the demand for aid in an economic downturn will increase.
Here are a few of the letters sent out by Deans and Presidents:
Bowdoin
Includes a hiring slowdown, linking faculty recruitment to new endowment contributions, holding departmental budgets flat, delaying construction and reducing discretionary spending
Tufts
Includes an optimistic view of operational budgets but suggests a delay in some construction projects
Cornell
Includes a Hiring Pause,a Construction pause, and an operational review to identify cost savings opportunities
Stanford
Includes a reduction in operational budget, planning for a three percent cut, a five percent cut and a seven percent cut, and a review of all construction project.
Dartmouth
Includes a Hiring Freeze, 5% budget cuts, planning for a five percent cut, a ten percent cut and a fifteen percent cut, and delaying construction
Harvard's letter is below. My commitment is to maintain highly reliable, secure, and efficient applications and infrastructure, ensuring that all maintenance and appropriate replacement is done despite the economic climate. I will adjust project scope and timing so that my staff can continue to thrive in a resource constrained environment.
-----
To Harvard Faculty, Students, and Staff:
I write today about the global economic crisis and its implications for us at Harvard.
We all know of the extraordinary turbulence still roiling the world's financial markets and the broader economy. The downturn is widely seen as the most serious in decades, and each day's headlines remind us that heightened volatility and persisting uncertainty have become our new economic reality.
For all the challenges such circumstances present, we are fortunate to be part of an institution remarkable for its resilience. Over centuries, Harvard has weathered many storms and sustained its strength through difficult times. We have done so by staying true to our academic values and our long-term ambitions, by carefully stewarding our resources and thoughtfully adapting to change. We will do so again.
But we must recognize that Harvard is not invulnerable to the seismic financial shocks in the larger world. Our own economic landscape has been significantly altered. We will need to plan and act in ways that reflect that reality, to assure that we continue to advance our priorities for teaching, research, and service.
Our principal sources of revenue are all likely to be affected by these new economic forces. Consider, first, the endowment. As a result of strong returns and the generosity of our alumni and friends, endowment income has come to fund more than a third of the University's annual operating budget. Our investments have often outperformed familiar market indexes, thanks to skillful management and broad diversification across asset classes. But given the breadth and the depth of the present downturn, even well-diversified portfolios are experiencing major losses. Moody's, a leading financial research and ratings service, recently projected a 30 percent decline in the value of college and university endowments in the current fiscal year. While we can hope that markets will improve, we need to be prepared to absorb unprecedented endowment losses and plan for a period of greater financial constraint.
The economic downturn also puts pressure on other revenues that fuel our annual budgets. Donors and foundations will be harder pressed to support our activities. Federal grants and contracts for sponsored research will be subject to the intensified stress on the federal budget. Tuition remains an important source of revenue, but in times like these we want to keep increases moderate, mindful that many students and families are facing economic strain.
Over the past several weeks I have been meeting individually and collectively with the deans of the faculties, as well as the Corporation, to share ideas on how we can best respond to this changed economic environment. We need to sustain our high academic ambitions at the same time that we bring greater financial discipline to all our activities. We have to think not just about what more we might wish to do, but what we might do at a different pace or do without. Tradeoffs and hard choices that can be avoided in times of plenty cannot be averted now. And, given the ongoing volatility and uncertainty, we need to plan and budget with a range of contingencies in view, including scenarios for reducing our spending both this year and next.
As we plan, we must also affirm our strong commitment to financial aid for our students. In Harvard College, that will mean carrying forward our recent years' initiatives to make a Harvard education affordable for outstanding students from low- and middle-income families. As before, families with incomes below $60,000 will pay nothing to send a child to Harvard College, and families with incomes up to $180,000 and typical assets can expect to pay no more than approximately 10 percent of income. Across our graduate and professional schools, we will maintain financial aid budgets at least at their current levels -- and ensure that our students still have access to needed loans, even though many banks are making them less readily available.
We have long been dedicated to research and the discovery of new knowledge across a wide range of fields of scientific and humanistic inquiry. In recent years we have made significant investments toward breaking down intellectual barriers across disciplines and across Schools to generate new knowledge and to develop new courses and educational opportunities for our students. These commitments must continue to guide us as we make decisions and choices in a significantly more constrained fiscal environment.
Harvard values its reputation as a stable and supportive employer, and we view our workforce as a critical part of all we do. We recognize as well the responsibility that comes with being one of the largest employers in the commonwealth of Massachusetts. At the same time, changing financial realities will require us to look carefully at compensation costs, which account for nearly half the University's budget.
We are assessing all aspects of our ambitious capital planning program, including the phasing and development of our campus in Allston.
We are working with administrative and financial deans from across the University to develop new approaches for generating both savings and new revenue sources, building on the ideas and best practices of each of the Schools.
Harvard is a famously decentralized place, and one size will not fit all. Each School will face its own particular challenges. But we must at the same time join together to address these new circumstances with creativity and a spirit of common enterprise.
Today, perhaps as never before, we need to work collectively to develop approaches and efficiencies that will allow every part of Harvard to thrive in the years to come. Together, we must continue to advance the priorities that define us.
For all that has changed in recent weeks, we remain devoted to attracting the very best students, faculty, and staff to Harvard. We will undertake the daily work of education and scholarship with the same intensity and imagination. We will set our academic sights just as high, and we will ensure that the ambitions and vibrancy of our community and the strength of its commitment to the pursuit of truth remain unsurpassed.
Drew Faust
Here are a few of the letters sent out by Deans and Presidents:
Bowdoin
Includes a hiring slowdown, linking faculty recruitment to new endowment contributions, holding departmental budgets flat, delaying construction and reducing discretionary spending
Tufts
Includes an optimistic view of operational budgets but suggests a delay in some construction projects
Cornell
Includes a Hiring Pause,a Construction pause, and an operational review to identify cost savings opportunities
Stanford
Includes a reduction in operational budget, planning for a three percent cut, a five percent cut and a seven percent cut, and a review of all construction project.
Dartmouth
Includes a Hiring Freeze, 5% budget cuts, planning for a five percent cut, a ten percent cut and a fifteen percent cut, and delaying construction
Harvard's letter is below. My commitment is to maintain highly reliable, secure, and efficient applications and infrastructure, ensuring that all maintenance and appropriate replacement is done despite the economic climate. I will adjust project scope and timing so that my staff can continue to thrive in a resource constrained environment.
-----
To Harvard Faculty, Students, and Staff:
I write today about the global economic crisis and its implications for us at Harvard.
We all know of the extraordinary turbulence still roiling the world's financial markets and the broader economy. The downturn is widely seen as the most serious in decades, and each day's headlines remind us that heightened volatility and persisting uncertainty have become our new economic reality.
For all the challenges such circumstances present, we are fortunate to be part of an institution remarkable for its resilience. Over centuries, Harvard has weathered many storms and sustained its strength through difficult times. We have done so by staying true to our academic values and our long-term ambitions, by carefully stewarding our resources and thoughtfully adapting to change. We will do so again.
But we must recognize that Harvard is not invulnerable to the seismic financial shocks in the larger world. Our own economic landscape has been significantly altered. We will need to plan and act in ways that reflect that reality, to assure that we continue to advance our priorities for teaching, research, and service.
Our principal sources of revenue are all likely to be affected by these new economic forces. Consider, first, the endowment. As a result of strong returns and the generosity of our alumni and friends, endowment income has come to fund more than a third of the University's annual operating budget. Our investments have often outperformed familiar market indexes, thanks to skillful management and broad diversification across asset classes. But given the breadth and the depth of the present downturn, even well-diversified portfolios are experiencing major losses. Moody's, a leading financial research and ratings service, recently projected a 30 percent decline in the value of college and university endowments in the current fiscal year. While we can hope that markets will improve, we need to be prepared to absorb unprecedented endowment losses and plan for a period of greater financial constraint.
The economic downturn also puts pressure on other revenues that fuel our annual budgets. Donors and foundations will be harder pressed to support our activities. Federal grants and contracts for sponsored research will be subject to the intensified stress on the federal budget. Tuition remains an important source of revenue, but in times like these we want to keep increases moderate, mindful that many students and families are facing economic strain.
Over the past several weeks I have been meeting individually and collectively with the deans of the faculties, as well as the Corporation, to share ideas on how we can best respond to this changed economic environment. We need to sustain our high academic ambitions at the same time that we bring greater financial discipline to all our activities. We have to think not just about what more we might wish to do, but what we might do at a different pace or do without. Tradeoffs and hard choices that can be avoided in times of plenty cannot be averted now. And, given the ongoing volatility and uncertainty, we need to plan and budget with a range of contingencies in view, including scenarios for reducing our spending both this year and next.
As we plan, we must also affirm our strong commitment to financial aid for our students. In Harvard College, that will mean carrying forward our recent years' initiatives to make a Harvard education affordable for outstanding students from low- and middle-income families. As before, families with incomes below $60,000 will pay nothing to send a child to Harvard College, and families with incomes up to $180,000 and typical assets can expect to pay no more than approximately 10 percent of income. Across our graduate and professional schools, we will maintain financial aid budgets at least at their current levels -- and ensure that our students still have access to needed loans, even though many banks are making them less readily available.
We have long been dedicated to research and the discovery of new knowledge across a wide range of fields of scientific and humanistic inquiry. In recent years we have made significant investments toward breaking down intellectual barriers across disciplines and across Schools to generate new knowledge and to develop new courses and educational opportunities for our students. These commitments must continue to guide us as we make decisions and choices in a significantly more constrained fiscal environment.
Harvard values its reputation as a stable and supportive employer, and we view our workforce as a critical part of all we do. We recognize as well the responsibility that comes with being one of the largest employers in the commonwealth of Massachusetts. At the same time, changing financial realities will require us to look carefully at compensation costs, which account for nearly half the University's budget.
We are assessing all aspects of our ambitious capital planning program, including the phasing and development of our campus in Allston.
We are working with administrative and financial deans from across the University to develop new approaches for generating both savings and new revenue sources, building on the ideas and best practices of each of the Schools.
Harvard is a famously decentralized place, and one size will not fit all. Each School will face its own particular challenges. But we must at the same time join together to address these new circumstances with creativity and a spirit of common enterprise.
Today, perhaps as never before, we need to work collectively to develop approaches and efficiencies that will allow every part of Harvard to thrive in the years to come. Together, we must continue to advance the priorities that define us.
For all that has changed in recent weeks, we remain devoted to attracting the very best students, faculty, and staff to Harvard. We will undertake the daily work of education and scholarship with the same intensity and imagination. We will set our academic sights just as high, and we will ensure that the ambitions and vibrancy of our community and the strength of its commitment to the pursuit of truth remain unsurpassed.
Drew Faust
Jumat, 14 November 2008
Cool Technology of the Week
In my quest for creating a storage utility service for thousands of users, I've explored SAN, NAS, Content Addressable Storage, compression/de-duplication, and file virtualization.
One area that has been a struggle is providing a cloud of mid-tier storage at price that the community is willing to pay.
This week, EMC introduced Atmos, a policy-based information management solution for building cloud storage infrastructures. Atmos is a multi-petabyte information management solution designed to optimize the delivery of unstructured information (files rather than databases) across large-scale, global storage environments. Cloud Optimized Storage (COS), EMC's name for this new class of storage, is massively scalable and initially designed for Web 2.0, telecommunications, and media companies with significant storage demands such as YouTube, Picassa, Flickr, and Akamai.
EMC calculates that for every $1.00 spent on storage, $6.00 is spent on backup and recovery over the life of the information. The Atmos approach is to use large arrays of inexpensive drives without RAID - data is simply replicated within the Atmos cabinet or in a different cabinet across the coutry. Eliminating RAID enhances performance and reduces complexity. EMC also realized that archiving/restoring a petabyte of data is extremely challenging, but replication works well as a backup strategy.
EMC Atmos is made up of management software that is packaged with a low-cost, high-density storage system that offers ease of implementation and service in an efficient footprint (comprised of X86 servers and high-capacity SATA drives).
Per EMC, the features of Atmos include:
* Massive scalability: EMC Atmos scales effortlessly to accommodate the ever-expanding need for storage.
* Policy-based information management: EMC Atmos improves operational efficiency by automatically distributing information based on business policy. The user-defined policies dictate how, when, and where the information resides.
* Object metadata: EMC Atmos uses metadata to refine the content distribution and retention policy, improve searches, or build custom queries for cloud-based services.
* All-in-one data services: EMC Atmos includes built-in storage and information management features that include replication, versioning, compression, de-duplication, and disk spin-down. These features are native to the platform.
* Choice of access mechanisms: EMC Atmos provides flexible Web service APIs (REST/SOAP) for Internet-based applications or legacy protocols (CIFS/NFS/IFS) for file-based systems. This enables integration with virtually any application.
* Automated system management: EMC Atmos provides auto-configuring, auto-managing, and auto-healing capabilities to reduce administration and downtime.
* Multi-tenancy: EMC Atmos can allow multiple applications to be served from the same infrastructure. Each application is securely partitioned and can never access another application's data. Multi-tenancy is ideal for service providers or large enterprises who wish to provide cloud services for many customers or departments.
* Unified namespace: EMC Atmos uses a single view of the information to provide universal access regardless of location, reducing complexity and improving productivity.
These features seem to be a good fit for the image storage requirements of a large academic medical center and the increasing need for storing genomics data for the research community.
A cloud of inexpensive, massively scalable storage. That's cool!
One area that has been a struggle is providing a cloud of mid-tier storage at price that the community is willing to pay.
This week, EMC introduced Atmos, a policy-based information management solution for building cloud storage infrastructures. Atmos is a multi-petabyte information management solution designed to optimize the delivery of unstructured information (files rather than databases) across large-scale, global storage environments. Cloud Optimized Storage (COS), EMC's name for this new class of storage, is massively scalable and initially designed for Web 2.0, telecommunications, and media companies with significant storage demands such as YouTube, Picassa, Flickr, and Akamai.
EMC calculates that for every $1.00 spent on storage, $6.00 is spent on backup and recovery over the life of the information. The Atmos approach is to use large arrays of inexpensive drives without RAID - data is simply replicated within the Atmos cabinet or in a different cabinet across the coutry. Eliminating RAID enhances performance and reduces complexity. EMC also realized that archiving/restoring a petabyte of data is extremely challenging, but replication works well as a backup strategy.
EMC Atmos is made up of management software that is packaged with a low-cost, high-density storage system that offers ease of implementation and service in an efficient footprint (comprised of X86 servers and high-capacity SATA drives).
Per EMC, the features of Atmos include:
* Massive scalability: EMC Atmos scales effortlessly to accommodate the ever-expanding need for storage.
* Policy-based information management: EMC Atmos improves operational efficiency by automatically distributing information based on business policy. The user-defined policies dictate how, when, and where the information resides.
* Object metadata: EMC Atmos uses metadata to refine the content distribution and retention policy, improve searches, or build custom queries for cloud-based services.
* All-in-one data services: EMC Atmos includes built-in storage and information management features that include replication, versioning, compression, de-duplication, and disk spin-down. These features are native to the platform.
* Choice of access mechanisms: EMC Atmos provides flexible Web service APIs (REST/SOAP) for Internet-based applications or legacy protocols (CIFS/NFS/IFS) for file-based systems. This enables integration with virtually any application.
* Automated system management: EMC Atmos provides auto-configuring, auto-managing, and auto-healing capabilities to reduce administration and downtime.
* Multi-tenancy: EMC Atmos can allow multiple applications to be served from the same infrastructure. Each application is securely partitioned and can never access another application's data. Multi-tenancy is ideal for service providers or large enterprises who wish to provide cloud services for many customers or departments.
* Unified namespace: EMC Atmos uses a single view of the information to provide universal access regardless of location, reducing complexity and improving productivity.
These features seem to be a good fit for the image storage requirements of a large academic medical center and the increasing need for storing genomics data for the research community.
A cloud of inexpensive, massively scalable storage. That's cool!
Kamis, 13 November 2008
A Home Root Cellar
I've written about my efforts to eat regionally and locally by growing my own food and supporting a local CSA.The challenge in New England is how to preserve food from November to May when the garden is bare (other than Kale, Chard, and Collards which grow well in cold frames).
During the month of October we pickled, canned, and froze our fruits and vegetables to prepare for the winter ahead.
We also created a root cellar in our basement to store turnips, potatoes, carrots, rutabegas and dozens of different types of squash. My favorite squash is Hubbard, which keeps for 6 months at 50-55 degrees. Hubbard squash used to be a very popular squash in the US, but today fewer people cook and the varieties available in supermarkets are limited.
Just about every home in New England has a basement. Most basements are too warm for winter food storage, but there are two techniques that work well. The first is easy - the bulkhead leading down to the cellar stays above freezing, so we loaded the steps down the basement with vegetables. The other is to create ventilation into a closed part of the basement.
Here's how it works.
Traditionally, the root cellar was an underground space built under or near the home, insulated by the ground and vented so cold air could flow in and warm air out in the fall. Then when winter temperatures arrived, the vents were closed, and the cellar stayed cold but not freezing. You can create an indoor version of the cellars that have long served homesteaders well by walling off a basement corner and adding the vents, allowing the temperature to remain near freezing through the winter months.
There are several good online resources describing how to build a root cellar
Mother Earth News
Earth House
Organic Gardening
Back to the Land
There are also several good books available for help in cellaring in the modern home or apartment.
Root Cellaring
Putting Food By
Over the next 6 months of cold weather, we'll see how long the root cellar lasts. I look forward to reliving the summer and fall harvest every time I cut open a squash or open a jar.
Rabu, 12 November 2008
The Final Report to AHIC
Today is the last meeting of the American Health Information Community, the country's "Board of Directors" for Healthcare IT, established by President Bush's Executive Order.
The agenda includes the transition of the AHIC working groups to the AHIC Successor, an overview of the progress we've made as a country on interoperability, and a summary of everything that CCHIT has accomplished to establish certification of EHRs, PHRs, and HIEs.
Here's a summary of my remarks on interoperability
The Health Information Technology Standards Panel (HITSP) has created a forum for stakeholders to talk about standards and resolve their differences. Over the past three years, the work HITSP has done on Problem lists, Medications, Notes, Allergies, Reports, Microbiology and Labs have brought together many stakeholders and resolved many differences. Whenever possible, we've reduced the choices for standards to one single, unambiguous implementation guide. Of course, not every debate is fully resolved, but as a country we're much closer to harmony today than 3 years ago.
600 different government/academic/payer/provider/vendor/consumer organizations, both large and small, have volunteered their time to work on these issues.
We've organized HITSP to ensure that standards are reused to the greatest extent possible. Our Domain Committees select the fewest number of standards possible and package them so that our Perspective committees can select from a small library of possibilities.
As of January 2009, HITSP will report to the AHIC Successor and will work on their prioritized Value Cases. What's a Value Case?
My simple definition is that a Value Case is a use case which takes into account
Strategic value to business users
Implementability
Transaction volume if adopted
Return on investment of automated transaction flows
Compliance requirements (such as HIPAA, Medicare Part D)
On November 10, the Value Case process began with a meeting of a working group to define the first Value Case priorities for Clinical Research/Clinical Trials, a special extra HITSP use case authorized by AHIC and the Successor. This Value Case is important for two reasons - it will serve as a model future Value Case development and thus will impact the way future healthcare IT priorities are developed by the AHIC Successor. The implementation of this Value Case will be funded by a combination of public and private sources, not just the Office of the National Coordinator. If stakeholders are willing to pay for standards harmonization in the future, it may provide a means to fund HITSP's function without depending entirely on government sources.
Secretary Leavitt deserves our thanks for being a tireless supporter of healthcare IT and standards harmonization. HITSP volunteers are working overtime to ensure we finish all our 2008 harmonization goals over the next few weeks so that Secretary Leavitt can accept this work as part of the national standards recognition process.
After January 20's change in adminisration, I look forward to leading HITSP in 2009 and working with the new secretary of HHS, whoever that may be.
The agenda includes the transition of the AHIC working groups to the AHIC Successor, an overview of the progress we've made as a country on interoperability, and a summary of everything that CCHIT has accomplished to establish certification of EHRs, PHRs, and HIEs.
Here's a summary of my remarks on interoperability
The Health Information Technology Standards Panel (HITSP) has created a forum for stakeholders to talk about standards and resolve their differences. Over the past three years, the work HITSP has done on Problem lists, Medications, Notes, Allergies, Reports, Microbiology and Labs have brought together many stakeholders and resolved many differences. Whenever possible, we've reduced the choices for standards to one single, unambiguous implementation guide. Of course, not every debate is fully resolved, but as a country we're much closer to harmony today than 3 years ago.
600 different government/academic/payer/provider/vendor/consumer organizations, both large and small, have volunteered their time to work on these issues.
We've organized HITSP to ensure that standards are reused to the greatest extent possible. Our Domain Committees select the fewest number of standards possible and package them so that our Perspective committees can select from a small library of possibilities.
As of January 2009, HITSP will report to the AHIC Successor and will work on their prioritized Value Cases. What's a Value Case?
My simple definition is that a Value Case is a use case which takes into account
Strategic value to business users
Implementability
Transaction volume if adopted
Return on investment of automated transaction flows
Compliance requirements (such as HIPAA, Medicare Part D)
On November 10, the Value Case process began with a meeting of a working group to define the first Value Case priorities for Clinical Research/Clinical Trials, a special extra HITSP use case authorized by AHIC and the Successor. This Value Case is important for two reasons - it will serve as a model future Value Case development and thus will impact the way future healthcare IT priorities are developed by the AHIC Successor. The implementation of this Value Case will be funded by a combination of public and private sources, not just the Office of the National Coordinator. If stakeholders are willing to pay for standards harmonization in the future, it may provide a means to fund HITSP's function without depending entirely on government sources.
Secretary Leavitt deserves our thanks for being a tireless supporter of healthcare IT and standards harmonization. HITSP volunteers are working overtime to ensure we finish all our 2008 harmonization goals over the next few weeks so that Secretary Leavitt can accept this work as part of the national standards recognition process.
After January 20's change in adminisration, I look forward to leading HITSP in 2009 and working with the new secretary of HHS, whoever that may be.
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