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.

The (surprise) influence of social networking

I’ve just arrived back from Medinfo2010 in Cape Town and been intrigued to see the power of social networking in action.

Business networking did not exist in my world until I started work within a KPMG Consulting JV in the heady days of 2000, immediately before the dotcom crash. Rather naive and idealistic, straight out of my native General Practice, I watched one of the sales team actively seek out his contacts and regularly catch up for coffee or lunch. It puzzled me at the time as these contacts often had nothing to do with his day-to-day sales responsibilities, yet he nurtured these relationships carefully & deliberately, teaching me that most sales and related opportunities are formed on a basis of solid relationships and trust. Ironically, I’m not sure that I actually saw him make a sale for our software offering at the time, but later I observed that he moved on to his next role entirely because of his network of relationships.

In the past 2 years I have been involved in fostering clinician collaboration in the openEHR Clinical Knowledge Manager. As part of my personal research I made myself a previously non-existent Facebook account and started tweeting. It has been an interesting journey, particularly with Twitter, watching how unknown groups of individuals build together into a semblance of community based on similar interests. My area of interest has been around health IT in general – especially electronic health records, personal health records and quality of health data – and in particular sharing information about my day-to-day world of openEHR, archetypes and clinician engagement in electronic health records. Over time I worked out how to find the tweets that fitted my areas of interest, gradually refining and filtering them into a relevant information feed. These days I receive a great overview of happenings in the eHealth domain through the tweets of the 300-ish people I follow. If they start tweeting about what they ate for breakfast and such trivia, I have a very low tolerance for unfollowing them, unless they amuse me in other ways – I rather like the power of the ‘unfollow’!

The active component of Twitter has been interesting to explore. I have made contact with some very interesting and like-minded people from all over the world; most are US-based, with a number in Europe and South America, and surprisingly few locally here in Australia. I struggle to be pithy and witty, usually resorting usually to re-share eHealth-related articles and information that interest me. Over time, I have slowly built up a following who also seem interested in similar topics, much to my surprise.

In the past couple of years I have been privileged to travel to some European and Australian conferences and international ISO standards meetings. At each meeting I have met up with a few people tweeting from the meeting or found existing contacts on Twitter and continued communications between meetings – new friendships begun and existing friendships consolidated.

This recent meeting was a little different.

Firstly, fellow tweeps with whom I was building some friendship and trust actively introduced me to influential contacts of their own. The credibility of these introductions have opened doors that I could never have achieved on my own and may turn out to be significant opportunities in furthering my collaborative work with clinicians. I am trying to keep my excitement under some control until we can confirm that the promises made will actually be delivered;-) Too many times I’ve seen ambitious promises disappear into the ether, so… for now, we wait and dialogue. Keep you posted! In return I was able to introduce some of my contacts, so hopefully an overall win-win experience for all, twitter-driven.

Secondly, I had the surreal experience of people coming up and introducing themselves, not knowing my real name, but addressing my by my twitter ‘handle’ – I presume the recognition being the result of tweeting directly from the conference and my photo. My non-Twitter companions were rather surprised to hear me being addressed as ‘omowizard’ – it took a little time to explain!

I’ve participated in LinkedIn for years and it has been a very passive, unengaging experience – no connectivity apart from inviting others to link and being invited back. Facebook I keep predominantly limited to friends and family. Twitter however is an active and evolving community and it has provided new opportunities for meaningful connectedness to individuals who have common interests or drivers. It is a much more positive experience – I both share and receive – and the community as a whole becomes a richer resource.

How cool is that! It is fun, and I suspect I’m just a little addicted8-|