Virtually Priceless Thoughts

Reflections on Health, Informatics, and Research

Archive for the ‘Thinking’ tag

Design Thinking

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Jess McMullin has a good slide deck where he describes (slide 9) five levels of Design Maturity. (1)

Those levels are (paraphrased):

  1. Default – Status quo determines design.
  2. Style – Changes to look and feel
  3. Function – Design improves use
  4. Problem Solving – Seeks current problems and changes
  5. Framing – Redefinition of the problem itself.

This is a good list to remember in healthcare.

The potential for improvement (and some types of risk) increase as you move from default to framing. Also, it is harder for users to conceptualize the changes as you move through. It’s easy for people to visualize “we are going to put this paper form on the computer”. It’s harder for them to consistently visualize “where we’re going you won’t need to document”, or large lists of requirements… As you move along the levels of design you need to rely on more iterative and visual tools to support shared and common understandings of the changes that are being considered.

1. I found a similarity to a list of maturity for Business Analysts that was on Better Projects. If you are a BA or work with BA, think about where you fit in this list of maturity for the various kinds of activities / projects you work on.

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December 31st, 2010 at 7:51 am

My Learning Objectives 2010

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Thank you everyone for your feedback to my previous post on learning in 2010 – both in the comments and by email (some of you were shy and preferred to give me great feedback directly).

The day after I posted the previous post, Zen Habits posted a little piece on Focus and Passion, which was timely. I agree, somewhat, with what the post is saying, but not entirely. I agree that passion and excitement is key. Also that being great is important. BUT, I think you can become great at something by bringing together a few diverse skills to create that unique specialization rather than focusing on something singularly until you are great at that (although that can work as well). With the idea of tying pieces together uniquely…

…On to my personal learning objectives for this year. MyLearningPlan.png

I have broken down my five personal objectives into three groups:


  • Become more clear on types of team function / team leadership – particularly looking at successful and creative teams. Put learning into practice at work.
  • Explore the Evidence-based Anecdote (my term) in leadership. This objective relates to use of story-telling in leadership and change. Put learning into practice in grant writing / presentations.
  • Look into other experiences on adapting agile software development methods into research teams and clinical practice. I think there is something here… not sure where / when to apply this, yet.

Health Informatics Standards: (1)

  • Review Core documentation on openEHR and archetypes, with a focus on content related to chronic disease data modelling.

Board Games / Game Playing:

  • Review game mechanics / how to build board games.
  • This one is partly for fun (and to get me ready for my son in a few more years) but also to explore why we play games for fun and how can we imbue some of that fun into learning, work and research methods. Not only will I spend some time playing with game pieces, but I will look into mechanics and why they work to see if they can be included in some of our work / design processes in the future.

My learning plan will be to dedicate a month to each topic. I will take the “free” months to learn about fatherhood or to either delve more deeply into one of these topics above or to add an additional topic, based on what I have learned or what I have lived.

I will build out more specific reading / activities for each month and share what I have learned through some blog posts.

If anyone is interested in joining me for any one of these activities, please let me know. It would be fun to have a learning group.

January is team leadership month!

1. I have other projects this year that will pull me into SNOMED CT more deeply, if not, I would have put that on my list.

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January 8th, 2010 at 9:25 am

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What should I learn next?

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I usually take time each holiday season to think about what to learn over the next year.

This year, I have decided to ask, publicly, for advice on what to learn.

I have always had personal learning activities related to work that keep stretching me. My learning program is meant to be fun and – at the same time – useful. It provides some additional direction into areas that I would want to extend myself to know about or apply. It complements my “required reading” for the various projects, papers, and books I am working on as part of my normal work.

When I was an animator, my personal projects would stretch me in areas I had not animated before, for example. Since medical school, my personal learning program has included: learning about leadership and leaders, adult learning techniques, public speaking and presentation skills, user interface patterns, management techniques, and even how comic books work(1).

There are many areas that I could pursue that I am interested in. Some include (in no order):dreamstime_3016268-1.png

  • Visual Thinking / Visual Modelling Research in Healthcare
  • Prototyping and GUI Design Methods / Best Practices / Tools
  • Learn a modern programming language
  • Do a deep dive into to some Health Information Standards / Models
  • Focus more on various management and leadership methods

I thought it might be interesting to pose the question to those that know me and see where you think I should spend my learning time. You can recommend topics, specific books, resources, courses, or conferences.

I’d love suggestions that start with something like “It would be amazing if you…” or “Imagine having more…” or “You are good at X, and Y would really will take you to the next level”. You could even add a few extra bits like “It would be fun because…” and “You’d find it useful because…” You can make suggestions based on past experience (“If only Morgan was better at X”) or future trends (“Personalized Health 3.0 is the next big thing”).

Please feel free to post a comment. I am really looking for ideas from you.

I will, in return, record my learnings here on the blog as I go.


— Morgan

PS – And YES! Before you say it, I will most definitely be spending time with my family this year and learning what I need about being a good father. This question is just focused on my own, quiet, learning time when everyone is sleeping.

PPS – Feel free to register under a fake name / email if you are not comfortable using a name I would recognize.

1. I highly recommend “Understanding Comics” by Scott McCLOUD as a place to start. I read it only last year.

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December 20th, 2009 at 7:32 am

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Compartamentalizing and Deep Thinking

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I recently set up another user account on my macbook. I thought it was an easy way to establish encryption for all the digital files associated with my research in order to inform Ethics that everything was indeed password protected and encrypted. Using FileVault for the home directory of this account ensures that everything in there has some level of encryption.

(I do need a better picture)
This has worked fairly well so far, and has allowed me to connect my dedicated recording devices only to that account so that the files are all stored in the encrypted home directory along with all my notes. I am using a combination of LiveScribe’s Pulse Pen and an iPod with recording microphone for capture, more on that combo in a later post.

The side benefit is that I do not have access to my email, calendar, task list, etc. I have tailored the environment for only the applications I need to do my analysis and so I can focus deeply. I have thought I have been quite good keeping focus and being productive and on task when i have work to do. This does take my focus to the next level. I didn’t realize quite how often my eyes look down at the little badges on my dock (when they are not at zero). Now, when I am focusing on my analysis work, there is nothing there to distract me in the dock, not even the mail icon (or accounts set up).


With fast user switching, it is easy enough to make a change and come back to the rest of my world, but it is just hard enough that I am not doing it unconsciously.

I wouldn’t recommend setting up separate accounts for every project, but for something as substantial as this research, it is proving to be a good choice.

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April 11th, 2009 at 8:31 am

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Out Lying – Reflections on Malcolm Gladwell’s New Book Outliers

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I’ve started reading Malcolm Gladwell’s latest book – Outliers. I’m only into chapter 3, but the “10,000 hour rule” keeps bumping around my head and has me thinking. Especially as I am spending the week at the Family Medicine Forum, brushing up knowledge.

“Outliers: The Story of Success” (Malcolm Gladwell)

Basically, it takes 10,000 hours to become an expert. Malcolm gives examples of hockey players and musicians practicing. Bill Gates programming, etc.

But, what counts in the 10,000 hours?

Bill Gates spent 100s if not 1000s of hours program a financial system – not a programming languages or an OS, but it seems to have counted. The Beatles played in Hamburg for thousands of hours, but how does that translate to the White Album?

In my recent career(s), I have two streams of work – my clinical and informatics work. How much are those intertwined into developing my own expertise?

By my calculations, I put in over 1,500 hours in obstetrical training. I don’t practice obstetrics anymore – does that still count?

I was an animator in the late 1980s and 1990s. What from there is transferable to my “expertise”? How about my biology degree?

A friend argued with me once that we mathematically cannot prove irrelevance. That is we cannot prove that one activity is not relevant to another. Is my understanding of wave theory relevant to my happy marriage?(1)

So what is relevant in those 10,000 hours? Is it game time, or just time on the ice? Is it physical action or visualization? Is it ward time or classroom time? I’m not sure.

Malcolm Gladwell hints that it is time dedicated to improving your skills. In that way reflection on action is key.

Maybe it is also how you define your expertise? Maybe Seth Godin has it right – try to be the best in the world. And the way to do that is to define our own world. Create your world and spend 10,000 hours becoming an expert in it.

My professional world consists of primary health care, clinical information systems, developing understanding of teams of engaged people wanting to make a difference, user-centred design goodness and of course lots of play intermingled. It’s a pretty good world and I’ve definitely enjoyed lying out here for a few thousand hours 🙂

1. Actually yes, as it turns out It has been – a few times just recently, in fact.

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November 29th, 2008 at 8:31 am

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Blog Action Day: Poverty

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October 15th is Blog Action Day and the topic is poverty, so I thought I would post on some activities we have been up to in regards to raising awareness of the need for better education in developing countries. Better education is a key enabler to improving people’s situations.

Two weeks ago we held our first “Engineering 4 Health Challenge” at UVic and it was a great success — the local high school students came together to think about and develop paper designs for health applications that would run on the OLPC. The ideas were fantastic, providing interesting ways to improve education on health.200810150602.jpg

It also allowed me, in my way, to support a colleague who spent 10 months last year in Tanzania treating and educating the population there on HIV and AIDS.

We will be continuing these Engineering 4 Health Challenges later this year with more local high school students and in early 2009 with University students. It is a great way to get people being creative about a real problem.

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October 15th, 2008 at 5:04 am

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Space for Holding More than one Thought

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So not directly informatics related, but a few conversations and articles have come across my path that seemed worth sharing on the importance of taking time.

The Slow Leadership blog recently posted When Procrastination Works Better Than Action. While I don’t necessarily agree with using the word “procrastination” to describe thoughtful pauses, I do agree with the importance of thoughtful pauses.

People do feel rushed to provide an answer. Immediately. As a physician, I am trained to have the answers before the end of a visit – even if the answer isn’t readily apparent.

In Praise of Openmindedness discusses the idea of taking time to make sure you do not always follow your knee jerk reaction. The pressures of not having enough time makes the knee jerk reaction all too easy, and that might just mean you miss something grand.

And Roger Martin makes this the tenant of his book:

“The Opposable Mind: How Successful Leaders Win Through Integrative Thinking” (Roger L. Martin)

Holding onto opposite or contrary thoughts and taking a bit of time to explore each option to see what the impact might be comes natural to some. Cultivating this skill is a key to good leadership, according to the book. That action requires time as well.

Stephen Covey, puts it like this:


Between stimulus and response, there is space.

In that space lies our freedom and power to choose our response.

In our response lies our growth and our freedom.

I quite like that one.

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June 26th, 2008 at 5:40 am

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Story Telling and Healthcare IT

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I have been diving more into visual thinking and visual story telling.PeopleOutlines1b.graffle_ Canvas 2.jpg

I have often used stories in design and evaluation of clinical information systems – I call them storyboards or clinical cases. Clinical stories help to bridge the technical requirements and clinical needs. It also is an excuse to have some fun, add some color to dry requirements and come up with great names (how about Eara Weatherwax – look at the chart summary here – how can you NOT love a name like that?). They work to focus the clinical audience on a common picture, clear needs, and benefits. Clinicians are patient centric and we all have seen cases like the one’s presented. Cases can also highlight workflow and find gaps in design.

If the story is right.

And that is the tricky part — getting the right story (or stories) to highlight the needs without sounding like you have the worst possible patient in history. Doing that makes the story unbelievable. It has to be honest and completely apparent why a requirement needs to be met. It has to be pitched to the audience at the right complexity. If it is too simple, then the story doesn’t engage and it doesn’t test / stress a system. Too complex and you lose people.

So it is a balance and I have found a few things helpful to get that balance:

  1. Carefully adding clinical twists to stories is useful, but only to a degree. They need to fit the scenario. They need engage people in the story line and test the system. Avoid “now this time put in a diagnosis of X” type of scenarios.
  2. Making the stories longer is very helpful to enhancing understanding. It provides more context, gives the story duration, and stresses the system. Diagnose a patient with a cough in a visit and any EMR can document that. Now have the story continue with the patient going to get an X-ray and having to update the diagnosis to pneumonia. Shows the process and functionality in a whole different light.
  3. Sweat the details. Making sure the story is believable is important. Clinicians will be more engaged the more realistic the story is. I had one colleague dream about our “patients” from a testing session because they were vivid. If there are gaps, errors, it is really REALLY hard to get past them. In one example, I had gone to the point of making up a paper discharge summary of a fictitious patient who was discharged from a fictitious hospital. The page was to be used as back up material in a case. On the list of discharge medications I forgot to add a statin. The doctor who runs the lipid clinic could let that go. So details are important.
  4. Pick your values and tests carefully. If you want to show that a flag displays when a lab test is abnormal, don’t make it critical. Unless you intend to (in your story) act on that lab quickly. The doctors in testing will want to — that is what we’ve been trained to do. Better to show something that is slightly abnormal that doesn’t need to be acted on (e.g., a slightly low Hb) and try and impress me with a really high INR or really low potassium. I’ll respond clinically to the value, which isn’t necessarily what your want.

The clinical scenarios engage us in ways that tie us back to what we do as clinicians and that locks in more of our brain as we tie in clinical experience, link to previous cases, etc. This is similar to some of the work on visual thinking that activates more of the whole brain than just narrative.

We use teaching cases with students, but we tend not to use them as well for defining how our systems work.

We also need to look at how to better use clinical stories to teach leadership and the technical folk about the requirements. These require some simpler stories, perhaps, as they don’t need to learn all the details about how to work out pediatric dosing for an antibiotic. But they do need to understand the benefits of a system that supports me and calculates that dose quickly and safely. A system that prompts if there is a drug interaction / allergy. A system that allows me to attend to my patient while not having to think about every detail. Something that helps me treat Eara Weatherwax’s otitis media and makes sure she comes back for her immunizations when she’s feeling better.

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April 25th, 2008 at 7:32 am

Posted in Medicine

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