The White Wizard is Walking

I received my Walking Jacket at the reception desk of my Italian hotel. I’d just paid an exorbitant amount of tax in exchange for receive my jacket from the Italian Postal Service for my trusty, favourite jacket to be turned into a disruptive artwork by @ReginaHolliday. I first wore it to the Medical Informatics Europe Conference in Pisa in August 2012 and then to the ISO TC 215 meeting in Vienna the following September.

I’d heard about Regina and her family’s story some time before, my awareness raised purely through the twitter community, and then finding images of her 73 cents mural. I finally met her at HIC12, the Australian health informatics conference in Sydney in early August.

Regina was a keynote speaker and during her HIC address, many in the audience were clearly moved. It is the only presentation that I have seen in the health IT environment that received a standing ovation – powerful stuff. It polarised people. Most loved it and felt inspired; some thought it inappropriate in a healthIT conference – go figure!

Regina and I talked one night at dinner. She offered to paint me a jacket. I felt a bit like a fraud – I have no special patient data faux pas story to tell. My involvement in health IT stems from having a long-term engagement with the health system from the tender age of 5; about how that influencing my decision to become a doctor; and my subsequent, almost accidental, slip sideways into health informatics. Nowadays my work focus is firmly on getting health data right, working collaboratively with international clinicians to agree on common definitions about how to represent clinical content in electronic health records.

fulljacketAnd yet here is my jacket – a favourite that I bought way back in 2000 for my first foray out of clinical practice and into the corporate world – my first step into health informatics. I hadn’t worn it for a while and Regina’s painting has given it a new lease of life. It now has its own story – having travelled to the US to be painted, on to Europe to be worn for the first time in Italy and Vienna, and now back home to Australia.

Regina hasn’t explained the image to me. I’ve asked … and waited. She promised to blog about it, but I think I’ll be waiting a while. In her gallery of jackets that tell personal stories, mine is number 176.

So let me share what I think it portrays…

I was hit by a car when I was five years old. As a result I started my first day of school on crutches and in plaster from my waist to my right ankle – that young girl on crutches and wearing a caliper is me. Mini-me!

That accident resulted in some permanent problems and I ended up experiencing a series of operations during my childhood and early teenage years. Way too much time was spent in hospital than was healthy, but I still remember telling my orthopaedic surgeon that I wanted to be a Nurse. I remember him saying ‘Rubbish. You shouldn’t do that much walking. You should be a Doctor, instead”! Maybe it planted a seed. I don’t remember it influencing my decision to enter medicine, but that is where I found myself. I’m not sure that as a young intern and resident years we walked less than the nurses – my memory is we never stopped running!

I practiced medicine for over 15 years, gradually side-stepping into health informatics as I joined my husband in developing, marketing, selling, supporting one of the first prescribing systems in Australia. He was the geek GP, passionate to combine his love of clinical practice with technology. I merely agreed to support him in his venture, having absolutely no idea what I was getting myself into.

That kickstarted the health informatics chapter of my life – 17 years duration to date – which has propelled my husband and myself jointly into the world of business, from cottage industry to large corporate consulting firms, and travel to some extraordinary places.

topjacketThe adult woman in Regina’s image is also me – as the ‘omowizard’. This has become my online persona, largely now related to Twitter and blogging. ‘omowizard’ originated from a love of Tolkien and seeking a Hotmail account back in 2000. Gandalf was taken, as was the ‘white wizard’. So given my laundry responsibilities for my young family at the time, I became whiter than white – the Omo wizard. For those unaware, Omo is a brand of clothes washing powder that at the time claimed to wash clothes ‘whiter than white’! I never dreamed anyone else would ever have to know or understand that, not even when I experimented on Twitter for the first time as @omowizard. Now it is probably too late to change 🙂

In the painting I am standing in isolation on a very tall, narrow, bleak pillar. I’m not quite sure what that is representing. Some have suggested a reference to Sauron’s tower in Lord of the Rings, but maybe that’s too fanciful! I certainly don’t have any magic powers. My youngest child informed me recently that I have a strong maternal death stare as a superpower, but I don’t think that counts. Maybe it represents the approach that we have been using to standardise the clinical content for health records. It is known as openEHR and although I have been heavily involved in developing the clinical modelling side of it – building archetypes and training others. It has stood in isolation for many years and outside of the mainstream approaches to health IT, but in recent years has become recognised and is gaining increasing recognition as a significant contributor towards the goal of semantic interoperability. Only Regina knows the answer to this one!

bottomjacketThe ribbons or strands entwining around the tower are really interesting to me. The main one rippling across the tower reads: “A house divided against itself cannot stand”. This appears to be a direct reference to Jesus’ words in Matthew 12:25 – “He knew what they were thinking and told them, “Every kingdom divided against itself is destroyed, and every city or household divided against itself will not stand.” (NIV 2012). Abraham Lincoln used the phrase in a speech to Republican candidates at the Republican State Convention on June 16, 1858 relating to the danger of slavery-based disunion. Apparently it is still used sometimes in political speeches, calling for unity and working together for a common goal.

The lowest ribbon says simply, ‘openEHR’; the one immediately to its right, ‘HL7’; and just above it, ‘Standards and Interoperability’.

I had described the approach that we are taking with our openEHR clinical modelling to Regina as one in which we are engaging with clinicians and domain experts to verify that the computable definitions that we are building in openEHR systems are fit for purpose. It is a collaborative approach that is crowdsourcing clinical expertise using the Clinical Knowledge Manager tool. For many years there had been little engagement with the HL7 community as a whole, although recently there appear to have been a softening of the lines of political demarcation. Those not constrained by political blinkers can see there could be significant mutual benefit from openEHR content definitions being used within HL7 constructs. Who knows if this will eventuate? And then there are other opportunities such as the CIMI and FHIR projects… Collaborating is the key.

So I interpret the ribbons yielded by the omowizard as another way of Regina calling for collaboration and collective action in healthIT. It seems that she is portraying me as a coordinator of some of the standardisation occurring in healthIT around the archetype work – using the @omowizard’s twitter and blogging being one of the means to coordinate and share the passion, perhaps!

I love the painting but in trying to interpret it, it is not a comfortable image for me. I don’t like being the focus. I am certainly enjoying my small bit part in the openEHR clinical modelling and health IT standards world. I have come to openEHR when it was relatively immature. We are seeing it grow and become established, but it is definitely not my idea or vision. I’m just one of number who have had the exciting opportunity of being a facilitator for something that I believe will make a difference.

I hope that when I wear this jacket it will trigger some discussions that might further progress in sharing health information and impacting the provision of health care – that is reason enough to wear it.

Thankyou, Regina. My jacket is a piece of art that is beautiful to look at; It is a powerful statement when understood in context of its origins; and is potentially a disruptive force when considered as part of the larger international Walking Gallery movement. I look forward to more opportunities to wear it at home in Australia and in my travels.

Photographs: Art or Technology?l

This week we had a photography- friend arrive on a flying visit from overseas – 48 hours on the ground, including the seminar in which he was participating. We took him down the Great Ocean Road – a glorious coastal road – last time we drove it was in a rented Porsche, top down, for the full experience. But that was February – there was no desire to repeat it in July!

We left at 8am and arrived back at 10pm – it is a long drive… with some choice stops along the way for refreshments and to absorb the views.

Our friend had most of his camera kit with him – 2x semi-professional digital bodies and multiple lenses, including the extraordinary 14-24mm fish-eye. I had my, um, phone camera!

At the end of the day we were happy and exhausted. Our friend had over 750 shots, I had about 120 – mostly variations of Gibson’s steps, the 12 Apostles and Loch Ard Gorge in the late afternoon light.

We talked at length about the camera gear, tempting me to invest in some new technology. My last significant purchases were Nikon F801 and accessories back somewhere around 1990! Film! Yet it did give me some fun playing around with black and white developing for a short window. I haven’t used this camera for at least 10 years.

I’ve had a couple of the early digital cameras – mostly with very ho hum results in the early days.

In recent years I have been the proud owner of a very modest Panasonic Lumix point and shoot – 7MP, 10x optical zoom, super little Leica lens. It has been a brilliant camera to fling in my handbag on overseas business trips – always there to capture some little treasure to bring home as a memory of the trip.

I’d like to think that I approach my photography a little more seriously than just taking happy snaps, but I’m not too precious about it. My aesthetic has refined over time, and I particularly enjoy the experience when I venture out specifically with the aim of taking photos – it changes the way I view my world around me, and I really value that.

I was browsing through my photos this week, and uploaded of my travel-related photos to try out the photo section on Google+. My brief trip down memory lane of my travels in recent years was largely the result of my trusty Panasonic P&S. And while I didn’t have the range of lenses and manual settings, I have somehow managed to capture some very pleasing shots. I guess it comes down to understanding light and composition better now, after all this time.

While I have been briefly tempted this week to get back into ‘the gear’, the burden of lugging it all over the world and worrying about it being stolen etc seems too onerous – just not worth the effort.

I’ve decided I’m going to stick with something ‘middle of the road’, that gives me enough manual control to make my hobby satisfying, but is easily transportable and can be with me at all times – that fits better with my priorities.

So while all the photos above have been taken on a mobile phone, maybe I’ll look at updating my trusty Panasonic – it’s is looking pretty battle worn now, the body showing evidence of it’s adventures from many scratches and scrapes!

While the technology is necessary, for me it just a tool for me to exercise my art!

This slideshow requires JavaScript.