Building Unity Farm - Creating a Brand

As we move from the farm building stage to the farm operations stage, Kathy and I are turning our attention to the basics of running our farming business.   We've filed articles of incorporation (Unity Farm LLC), created a formal land management plan for review by the town of Sherborn, built basic processes for recording income/expenses, documented options for selling our products and formulated a multi-year strategic plan leading to full recognition as an agricultural enterprise.

Creating a brand is an important step for us as we begin to build awareness of our apples, honey, mushrooms, alpaca fiber, handmade soap, and blueberries.  This morning I heard the 1970's New Seekers song "I'd Like to Teach the World to Sing" and it comes very close to the Unity Farm vision (replace Turtle Doves with Guinea Fowl)

"I’d like to build the world a home
And furnish it with love
Grow apple trees and honey bees
And snow white turtle doves"

Since that song is so closely associated with soft drink sales, we'll need another approach.

At the entrance to Unity Farm, a large specimen-quality sugar maple greets visitors to the property.   We've used its silhouette, shown above, to create  a logo and label for the farm.

For individual products, we'll use silhouettes of  apples, bees, Shitake mushrooms, alpaca, etc providing us name recognition and a standard labeling platform for everything we sell.

We have a Facebook page and we'll create appropriate twitter, pinterest, and other social media sites.

We've already collected this season's alpaca fiber and are spinning it into wool.   We're harvesting our first honey over the next few weeks.   We'll have our first berries in August and apples in October.   Our quantities of everything this first year will be very limited.   Likely our first real sales and the possibility of a "mushroom CSA", selling guaranteed shares of Shitake mushrooms, will be in 2014.

In the meantime, we're continuing farm development.  We'll finish the hoop house (a kind of plastic sheeted green house) in July and have another mile of forest trails completed by the end of Summer.    We're also picking peas and strawberries from a nearby farm, making our own jam as we await the maturity of our own berries and other produce.

I'm off to Kyoto this weekend, so my next post will be dispatch from Japan, where I'm keynoting the IEEE conference this year.

Affiliation Planning

Many healthcare organizations  are discovering that accountable care reimbursed via global captitated risk contracts requires more primary care physicians and a more tightly coupled delivery network including suburban hospitals, home care, and long term care.   Affiliations, mergers, and acquisitions are accelerating to meet these needs.

From an IT perspective how are to respond to this organizational change with agility and efficacy?

We could rip and replace everything everywhere and mandate a single vendor solution for every workflow at every new location.

That would create standardization, but it would also consume more capital than we have at time when Meaningful Use Stage 2, ICD10, and compliance requirements have already committed all available IT resources.

A balanced approach is to enumerate the workflows we need to support and then build upon existing applications and infrastructure to automate priority processes that improve quality, safety, and efficiency.

In the past, we've used web-based viewers,  health information exchange, registries/repositories, master patient indexes, and secure email to link together organizations and coordinate care.

Can we share every data element for every purpose in every circumstance?   No.   Can we rapidly achieve "good enough" at low cost.   Yes.

Our solutions to date have been project based - implementing those point solutions that best fulfill a specific affiliation.   The pace of change is so intense that we need a more scalable solution - templates for new affiliations, mergers, and acquisitions.

What services do we offer?  What services do our new partners want?  What do we centralize?  What do we federate?  What do we change and importantly what do we not change?

Over the next few months, we'll do the following

1.  Ask IT infrastructure and application managers to list the services they have been tasked to provide in the past when new affiliations have been formed

2.  Ask existing affiliates and new affiliates about their experience during the partnership process.    Inventory their existing applications and their plans for upgrading/changing them.

3.  With a sense of supply (the services we offer) and demand (the services desired), we can create templates for affiliations, mergers, and acquisitions - a kind of Chinese menu that will enable us to rapidly develop FTE, capital and operating budget requests when new partnerships are planned.

Sometimes I'm asked to budget for projects that are not yet formalized, often with ill defined scope.    If I could present a set of templates to the Board and Senior management noting that partnerships fall into three categories - small, medium and large, each with an estimated price tag, I could craft a yearly operating plan and capital budget that includes x smalls, y mediums, and z larges, ensuring promises made are backed by the people, funding, and attention necessary to support timely delivery.

I will post my templates once they are developed.

If any of my readers have developed such templates, I welcome the opportunity to review them.

Connecting the Meditech Hospitals in Massachusetts

Yesterday I joined several Massachusetts CIOs at a Meditech healthcare information exchange kickoff meeting.  

Here are the slides we used.

Meditech has chosen to do the right thing - support the Direct protocol without requiring a vendor specific HISP, an interoperability "subscription" or transaction fees.    Nationwide, any of Meditech's Meaningful Use Stage 2 certified platforms - Magic 5.66, Client/Server 5.66, or  6.07  can support the Direct implementation guide (SMTP/SMIME) and the SOAP/XDR addendum.

The Massachusetts HIE, the Mass HIWay, has been live since October 2012 and now transports thousands of transactions per day among providers, payers, patients, and government.  Our goal in 2013 is to add more organizations and more use cases.    Meditech provides about 70% of the hospital information systems in the Commonwealth, so it is critically important that Meditech integrates well into the state's cloud-based HISP.

Over the next few months, a diverse array of hospitals will work closely with Meditech and state government to implement production HIE transactions.

Earlier adopters will include Jordan Hospital, Holyoke Hospital, Winchester Hospital, Berkshire Health Systems, Harrington Hospital, and Exeter Health (New Hampshire)

Use cases include transition of care summary exchange, public health reporting. lab results reporting, admission notification, and ED arrival notification.

Once these pilots are complete, we'll spread Meditech connectivity through the Commonwealth.

With other EHR vendors, which are requiring vendor specific HISPs, we're still working through the trust issues (authentication is easy, authorization is harder) that enable HISP to HISP communications among those clinicians who have agreed to all our privacy policies.    Once this work is done the number of clinicians with HIE connectivity will accelerate as network effects incentivize data exchange for care coordination, care management, and population health.

Poem - Do Not Resuscitate

Do Not Resuscitate



I can say

your father is dying.

I can say

wishing will not make it so,

belief doesn't change a thing.



I can say

love does not conquer all,

miracles are pretty stories told in church,

the movies you saw as a child are lies,

blind hope is not a recipe for success,

underdogs usually lose,

death is not the worst thing, it is just

the last thing.

But for you

Building Unity Farm - Emergency Preparedness

In the month of June, we've had 10 inches of rain at Unity Farm (to view our weather station data click here).

Although our paddocks, pastures, and trails are normally dry, we've accumulated water in ways that impacts our ability to care for the animals.  The picture above shows one of our paddocks after a deluge of rain.   A manure pile that is under water is a bad thing.

What did we do?   I purchased a 1/2 horsepower submersible sump pump  and attached 1 1/4 inch sump pump hose to maximize outgoing water flow - a garden hose would have been too limiting.     Sump pump hose is sold in 25 foot segments because sump pumps are designed to go from basements to outdoors over a short distance.   In our case, we needed to pump 40,000 gallons of water into  a dense forest that would easily absorb the flow and return it to our water table.   I used 1 1/4 barbed couplings and hose clamps to link together 150 feet of sump pump hose.  

I built a cage of 23 gauge hardware cloth and submerged the pump inside the cage to ensure floating debris did not clog the pump.

The end result was a water flow of about 4000 gallons an hour from paddock to forest.   After 12 hours of pumping, the paddock was transformed from a lake to puddle.  

After mastering this technique, we're now ready for any flood related emergency.

Too much water is one challenge, but what about too little?   We have a well that consistently produces 8 gallons per minute of clear, chemically perfect water.  However, the well depends upon electricity.    If we lose power due to a storm, we have 50 gallons stored in the basement which will serve the needs of the household.   But, what about the animals?

To ensure we can keep all the animals of Unity Farm hydrated, warm, and safe, the farm has a 20 kilowatt generator and four propane tanks.   The entire barn, heating system, food storage, water supply, and internet connection can run off grid for a few weeks.   The pump system I described above is powered from the chicken coop, which is also backed up by the generator.

Last year, we replaced all the well equipment which had reached end of life.   In addition to water flows to the barns and paddocks, we do have drip irrigation keeping all our fruit trees and produce plantings moist.    Just as we're ready for floods, we're also ready for droughts.

Finally, we have a fully stocked root cellar with about a year of food kept at 60 degrees, so if there is a very significant man-made or natural disaster, we should be self sufficient.

Every day at Unity Farm is a learning experience.  Thus far, our emergencies have been few, but we're prepared for whatever may come.

The June HIT Standards Committee

The June HIT Standards Committee focused on novel transport standards for patient mediated exchange, an overview of patient/family engagement tools, updates on formulary downloads, use cases for image sharing, and lab ordering standards.

Dixie Baker and David McCallie presented the NWHIN Power Team review of the emerging transport standards for consumer exchanges that I believe will accelerate all types of interoperability in the next few years - the HL7 Fast Healthcare Interoperability Resources (FHIR, pronounced "Fire") initiative , the RESTful Health Exchange (RHEx) Project and the Blue Button Plus (BB+) Initiative.   It's clear to me that the combination of REST for transport, OpenID/OAuth2 for authentication/authorization, and FHIR for content will be a winner as we scale interoperability to the national level.

Next, Leslie Kelly Hall presented the efforts of the Consumer Technology Workgroup to prioritize patient and family engagement standards including structured data capture from forms/questionnaires and care plans.

Jamie Ferguson, with John Klimek from NCPDP, presented the preliminary recommendations of the Clinical Operations Workgroup for adoption of formulary standards.    We also discussed use cases for image exchange (provider to patient, provider to provider, provider to care team) and endorsed the S&I framework efforts on lab ordering standards.

Finally, Doug Fridsma and Set Pazinski provided an ONC update.

A very good meeting with exciting new standards evolving to support Meaningful Use Stage 3 and beyond

Making a Difference

Although I usually reserve Thursday for personal blogs, Father's Day was a time for reflection that enabled me to put aside the endless emails, operational tribulations, and budget season stresses to think about what really matters.

In my 51 years, 2013 marked the first time I've had no father with me on Father's Day.  For the first time, I've taken on the mantle of "alpha" father for the family.

I celebrated Father's day with my wife, daughter and her partner David, enjoying a Japanese lunch and helping them rewire the kitchen in their new apartment.   They rent one of 4 units in a 1910-era shingled house in Medford.   We braved the dungeon-like basement to find the old breaker box and located the power controls for the kitchen.    I taught them how a GFCI receptacle is wired, carefully isolating the Load and Line sides, the hot wire, the common wire, and the ground.    We then built new kitchen shelving for her pots and pans.    It was a perfect Father's Day, serving those around me and making my daughter's life easier.

I called my mother, as I have done every day since my father's death, to check on her progress.  She's gardening, taking daily walks, and keeping her brain busy with numerous cultural and social activities.

So, what part of this inspired me to think about what really matters?

Will my tombstone read

"He balanced his budget 20 years in a row"
"He addressed all regulatory requirements for over 2 decades"
"He completed all his annual operating plan goals and more"

Unlikely.

If in some small way, I empower my daughter to fledge from the nest, taking responsibility for running a household and finding her own way in the world, I will have created a legacy that could last for a century.

If in some small way, I enable my mother to maintain her wellness, learn new technologies, and experience a rich "act two" after my father's death, I will have made a real impact on her life.

Both are examples of making a difference.

As I look at my weekly calendar, about half my waking hours are spent on operations, a quarter on planning the future, and quarter in service to my family and community.

It's the last quarter, when I give my time, that has the greatest chance of impacting the long term future of those around me, accelerating the progress of the next generation, and catalyzing good outcomes in the world.

While balancing a budget is a must do, it's quickly forgotten.   You're only as good as your last budget cycle or your last successful project.

However, if your family, your colleagues, and your students feel inspired by something you've said, a situation you've created, or a barrier you've broken down, then you've created a memory that can last a lifetime.

So next time your equanimity is challenged by a person, situation, or event in your job, remember that such issues are transient.    Focus your emotional energy on that which really matters and you'll make a difference.   That's the pot of gold at the end of my rainbow (photo taken at Unity Farm a few hours ago)