PDCA in a Zen Perspective

The gamekeeper of the never (events) land

My job is maintaining the most negative database in New Zealand storing what (sometimes almost) went wrong and what did not (occasionally positively) go as patients expected in healthcare, to learn from them and improve quality and safety of care.

In recent dialog with other HL7 New Zealand executives, I called myself the gamekeeper of the never (events) land. The quarries under my administration are captured in tertiary care facilities and kept for shooting out systemic problems.

We would need to greatly extend the scope and range of this never (events) land as regional and national shared care initiatives are being rolled out. But there is a catch.

When patients, family members and other people within the community are taking more active roles in healthcare, it would be unlikely that they are naturally more motivated than health professionals to share unwanted results.

Thus we have got to build user friendly information systems and the culture of non-blaming discourse for collecting bad lucks to turn them into good practices which would be utilised by everyone in the community.

This is a quite a challenge.

All peoples of the world

We recognise that all peoples of the world have the right to live in peace, free from fear and want. - The Constitution of Japan - Preface

#SocialDeterminantsOfHealth #HealthEquity

One step at a time

Yes, I am back with so many things to share. But just one step at time as trees take years to grow tall.

Virtual Insanity

A few months ago, I was looking for some physical MIDI control device to use with iOS music creation/software synthesiser Apps on my iPad Mini. 

I had continued the search despite I wrote I had given up. Eventually I had end up with this iOS App, TB MIDI Stuff which does the quite opposite from what I had been looking for originally. It turns iPad/iPad Mini into a fully programmable versatile MIDI controller.

I have completed a couple of virtual controllers and my favourite is the one shown above. It is designed as a controller for Roland SYSTEM-1 Software Synthesiser. Of course, it can be controlled on a Mac's screen but mouse/track pad operations are not so intuitive as touch screen interface on iOS devices.

Here's the beauty of virtualisation. You still have some sense of touch without limitation of physical devices. Actually it really feel like operating on a physical gadget but the flexibility and potentials are  limitless.

I hope we could create similar experiences in Electronic Health Records.

Liberty, Equality, Fraternity

According to Cambridge Dictionaries Online

Liberty: the ​freedom to ​live as you ​wish or go where you ​want

Equality: the ​right of different ​groups of ​people to have a ​similar ​social ​position and ​receive the same ​treatment

Fraternity: a ​feeling of ​friendship and ​support

I think that they are values we all can share.

Let's get physical (or not)

Today's music production has become quite virtual. Not to speak of digitally sampled synthesisers and music workstations, there are virtual analog synthesisers, virtual acoustic instruments, virtual effecters and amplifiers and even virtual idol singers. However, sometimes we would miss physical touch.

My favourites have been Korg's nanoSERIES 2 trio, which look rather like some GUI objects just popped out of the computer screen than serious musical tools. They are handy and versatile with flexibility of choosing any combinations as you wish. The problem is that they are designed to function only one of them at a time when using with an iPad/iPad Mini.

I had looked around for the options which provide combined functionalities as a single device ideally with more decent feeling of playing musical instruments. There had been some attractive candidates but they all fell short in terms of portability.

Finally I found that most of the time a simple bus-powered USB hub does the job at least with two nanoSERIES 2 devices if you can tolerate the occasional "drawing too much power" error message and suspension. Also, inconvenience with only one or even no physical device does not do so much damage to the joy of being able to play iOS music apps anywhere.

Moderation is virtue.

To code, or not to code that is the question

Each time media start fussing over a black magic called "AI", it reminds me of how small number of people actually write some codes. So it is little known that what is great about AI is actually resides on a human art called coding rather than machinery of computers. It may be fortunate because it seems that I do not need to worry about witch-hunts within foreseeable future although I am sometimes called "wizard" from end users.

I really appreciate who code any kinds of AI programs even if they are actually a "counting horse" sort of circus acts. They at least need to have some insights into both of human psychology and computer logic which are completely different to each other. However, I do hate those who are selling false dreams or scaremongering to cheat money out of people's pockets.

Having said that, I am totally in favour of educating coding to everyone especially from very early stage of compulsory education although I know very well that coding is not for everyone but requires some distinct talent to be good at it.

Then everyone has some sense of what is coding is like and rough ideas about what is possible or easy and what is impossible or difficult with coding i.e. with computers. With more people receiving such education, I think the money for IT investment will be more effectively spent in more meaningful uses.

Autumn Leaves

Spending in Auckland almost all the time since I came to New Zealand, it is a hard question to me if I miss sceneries in Japan. I am missing out beautiful sceneries of New Zealand in the first place!

However, one thing for sure I am missing is the vividness of Japanese scarlet maples in late autumn. I realised it when I was asked the question from one of my colleagues recently.

In spring, we can enjoy beautiful cherry blossoms in One Tree Hill, however, in this time of the year, Waitakere Ranges would not become aflame with autumn colours.

Nevertheless, I am enjoying the late autumn in Auckland since I recently moved to the office in Auckland City Hospital and walking in Auckland Domain was added to my daily routines.

Health Hackathon at the University of Auckland

I forgot when and from whom I heard it, but the phrase has been etched in my memory: "If there had been no such thing as deadline, the human would have not accomplished anything." More famously, the importance of an encounter in limited timeframe is stressed in the spirit of traditional Japanese tea ceremony as "Every meeting is just one occasion in the lifetime."

Today I attended just a small portion of the Health Hackathon: Solving Self-Care event being held at Tamaki Campus, the University of Auckland from Frinday to Sunday this weekend. I think it is a showpiece of what people can achieve if they concentrate their efforts in well-defined scope and timeframe.

I joined the team named "Hunger Reminder" which was working in the following proposition: Giving people the ability to recognise and be aware of hunger signs and support them in their ability to make better eating decisions. The primary target of this approach is to support people with Inflammatory Bowel Diseases (IBDs) to better manage their condition. It has potential to extend also to managing Diabetes, Obesity, Other inflammatory conditions, Eating disorders (such as Anorexia)

Our discussions utilise a variety of online free tools like Canvanizer Business Model Brainstorming tool, Draw.io Cloud Diagram Drawing tool and Concept.ly Application Prototyping tool. These tools greatly helped us share thoughts and formulate and visualise our ideas in tackling and solving the problems we were taking on.

Then what if similar tools are provided and available for healthcare namely self-care settings? As healthcare is about identifying and solving problems, actually we are want for health-focused equivalents of those tools. Then the age-old question, again. Why health IT cannot do what IT is doing for another industries or businesses?

However, so far in Health Hackathon, at least we are succeeding in rapid cycle prototyping in health IT. The question is how we keep and build our momentum. Maybe we should do this kind of event regularly to cultivate and disseminate the lessons we are learning.

HL7 January 2015 WGM San Antonio

It is a bit funny that it was my very first time to attend a HL7 conference or meeting held in the USA in my almost seventeen years career as a health IT specialist, throughout which I had been involved in the international health IT standardisation organisation via its affiliates in Japan and in New Zealand.

Previously, I had attended two International HL7 Interoperability Conferences (IHICs) in Acapulco, Mexico (2004) and in Auckland, New Zealand (2007). Even talking about Working Group Meetings (WGMs), I had attended those in Kyoto, Japan (2009) and in Sydney, Australia (2011). So I was not one of new faces at all, rather an old head with more than a decade of attendance records.

I think this shows the crucial importance of holding HL7 meetings and conferences outside of the USA regularly. The HL7 New Zealand (HL7 NZ) has a policy of sending one delegate to each WGM. Thus this time I was a proxy to the HL7 NZ Chair, David Hay, but in the occasion like the one in Sydney, we could send all the board members to the event. Such opportunities would help both the HL7 International and the affiliates in and around hosting countries share problems and exchange ideas for potential solutions.

My tweets and others' with the hashtag #HL7WGM pretty much covered the discussions happened in the WGM and you can dig in the wiki pages of Working Groups for further details so I would not repeat them here. I would like to conclude by introducing a music clip (although without no connections to the event except I knew about the band/tune in the return flight) which I think would summarise the meeting well. Enjoy!

Demystifying Zen

"Did Zen ideas create the kamikaze?" I was astonished when I saw the title. It was an article Ven Yushi Shimada, a friend of mine and a Zen monk introduced in his Japanese twitter account.

It argues that (Japanese philosophers' interpretations of) Zen's pursuit for "nothingness" made psychological pathway into dedication to the nation in devoting to the suicide attack.

My master wrote that enlightenment in Zen can be achievable in devotion to one's vocation as well as in practicing Zazen (sitting Zen) meditation. However, it is far more constructive context than above.

You may question reading "My master wrote" as Zen is famous for not relying on written words in conveying teachings.

In my humble opinion, the "no written words" rule should be understood this way. If you and your partner think exactly the same thing in exactly the same way and you both say a word, what would happen? Would you need to write down the word?

Reflections on HINZ 2014

The annual convention of the Health Informatics New Zealand, HINZ 2014 Conference and Exhibition was held on 10-12 November at SKYCITY Auckland.

It was a massive experience for me and honestly I am still in recovering mode. So much people to meet, so much discussions to join and so much information to absorb.

It started with the mobile health and FHIR seminar by HL7 New Zealand in which I was a part of the organising team but it really had heated up the scene. The rest of the conference was also dominated by the mood of something big were just started everywhere.

No one made the question which was heard until the last year: "How can New Zealand Health IT lead the pack again?" Here we are, back in full steam.

Spring has come

At last the spring weather has come to New Zealand and it is the season for cherry blossoms here. The cherry blossoms here have their own paces and they are not so synchronised like their counterparts in Japan.

Actually large majorities of the cherry trees in Japan are cloned sisters. So they bloom at the same time in one region and the "blooming front" sweeps throughout the archipelago like a wave of cheers by a capacity crowd in a football stadium.

The spectators also go wild in the season in Japan. As the climax is short-lived, the battles to "occupy" better places for cherry blossom viewing parties are really fierce. Because even slight changes of the weather may slow or accelerate blooming, the party organisers have to watch out for weather forecasts to determine the timing of the event.

However, I prefer the way cherries bloom in New Zealand. As each tree has its own time to bloom we can enjoy cherry blossoms for a prolonged period even in one region. Also there are not intense competitions to secure a good view of them. I also like the contrast of the blue sky and the green lawn as the background of pink blossoms.

Apart from the contrast of colours, so was in Japan before cloned cherries dominated there, I think.

The moon over the rainbow

Hawaiians said, "No rain, no rainbows."

After another busy day, seeing the moon over a gorgeous rainbow was just awesome.

Through coloured spectacles

The lenses in the photo above have nearly 90% transparency and give you a high contrast view especially in dawn, sunset and rainy conditions. However, you will definitely feel strange when you wear them as you will lose sense of colours. Your view will go monotonous just with shades of yellow.

It is very interesting as they are only cutting 10% of visible lights and actually boosting your sense of contrast but you can no longer distinguish between colours.

Even more interestingly, although similar things happen when you are focusing on a particular aspect on your observation or experience, you won't notice the difference unlike the effect of yellow sunglasses.

A human is so prone to biases, isn't it?

Decision 2014

I have been always keen to vote since back in where I originally came from, but I have found New Zealand elections are much more exciting.

Everyone was talking about politics during the weeks preceding the election day, with many openly arguing which candidate and party should get their votes or should not. Some of them even tried to persuade others to follow the suit.

The result this time was the reflection of New Zealand currently doing well overall compared with other parts of the world. Definitely reemerged fears of wars and violences seem to have made Kiwis prefer stability and continuity.

It is a difficult time for lefties as the world less seems to a place of corporation, but rather of competition. However, by cleverly sharing information and knowledge utilising abundant computing power and ubiquitous network, corporation will eventually beat competition in terms of efficiency and effectiveness, not only in equality and diversity.

I think that finding the way to achieve it is the challenge for the Labour Party for the next three years.

Supermoon

Enlightenment is like the moon reflected on the water. The moon does not get wet, nor is the water broken. Although its light is wide and great, the moon is reflected even in a puddle an inch wide. The whole moon and the entire sky are reflected in dewdrops on the grass, or even in one drop of water.

From "Genjō Kōan" by Dōgen - Translated by Robert Baker Aitken and Kazuaki Tanahashi for the San Francisco Zen Center

After a long hard day

My job at the hospital is mostly made up with "business as usual" things but sometimes it includes a real "go-live" event. Yesterday was such a special occasion.

Fortunately everything goes well except a couple of "Houston, we've had a problem" moments which had eventually been sorted out.

Today was a kind of follow-up and we do had a tricky problem which required some guessing game but had not taken so much time to reach the solution.

After working quite long hours in two days, I found I really love this job. A successful go-live can be that much sweet!

No mater where you originally came from, we fight together for you

This post's title is from the lyrics of a song in Māori language (Te Reo) by Stan Walker, "Aotearoa", celebrating the New Zealand indigenous language week (Te Wiki o Te Reo Māori) 2014 which was last week.

"Ahakoa nō hea mai koe, ka whawhai tonu mātou mōu"

My heart goes to all those who are hoping to contribute to, but struggling to settle in this beautiful country, Aotearoa, New Zealand.