Month: July 2016

Version 3 of , my 3D-printed robot that fits in my pocket, is now a year old. Checkout our interview below!

In other words, I’ve been thinking about version 4 Mr. RIMP for a year! Long term I’d like Mr. R to satisfy the following requirements.

• Nicer.
• Funnier.
• Smarter.

Ha! Seriously…

• Capable of entertaining interactive behaviors (speech, animation, etc.)
• Easy to create using commonly available Maker tools and components (cheap electromechanical parts, 3D printing, soldering, etc.)
• Customizable at 3D-printed enclosure, hardware, and software behavior levels.
• Leverage some sort of wearable/IoT connectivity (interactivity, provisioning, etc.)
• Have some relevance to my interest in healthcare workflow technology (hence the next section of finite state machines in Python)

This blog post is really intended as just a place for me to archive some links relevant to the above requirements. (I find that I almost never go back to consult bookmarks. However I frequently go back to blog posts. And I like the idea someone else might stumble on this and then who knows what might happen!)

• fysom 2.1.2 pYthOn Finite State Machine
• A lightweight, object-oriented state machine implementation in Python
• A Finite State Machine in Python
• Summary of FSM implementations in Python
• Charming Python: Using state machines

On Periscope!

I have a particular interest in the relationship between stories and workflow. On one hand I’m ABD (All But Dissertation, that story here…) in computational linguistics (the science behind the engineering of natural language processing). On the other hand, I’ve spent my professional career focusing on various aspects of workflow technology in healthcare. Often, when dealing with nontechnical users, I substitute the word “story” for the word “workflow.” Workflow sounds scary (or at least boring). Story sounds friendly (or at least interesting). If I were to coin a phrase, Story Informatics comes to mind!

My post > Patient Narrative & Healthcare Workflow: Story Informatics!

— Charles Webster MD ⎌ ()

Many of my projects during my graduate degree in computational linguistics involved analyzing various kinds of narratives: Pilot’s conversing with co-pilots, physicians thinking out loud during problem solving, depressed patients ruminating about life, to name just a few areas. The workflows patients experience give rise to natural language descriptions, from patients, of their experiences interacting with those workflows. Wouldn’t it be cool is there was some way to convert those natural language descriptions into models of workflow? In fact, research leads toward this goal.

• Natural Language in Business Process Models: Theoretical Foundations, Techniques, and Applications
• Process Model Generation from Natural Language Text
• Business Process Management Applications Based on Semantic Process Models
• Applications of Standardized Business Process Models Using Natural Language Processing (NLP) Techniques
• A Tool for Natural Language Oriented Business Process Modeling

We don’t have to wait to use patient narrative to create workflow systems. Right now analysts create journey maps from customer descriptions of their experiences. My favorite phrase here is “empathic workflow.” As in design thinking, where empathy of users is so important, empathy is also so important when designing workflows with workflow technology.

. great post, reminded of slide re empathic workflow

— Charles Webster MD ⎌ ()

I am looking forward to today’s (every Friday at noon EST!) #HITsm tweetchat Using patient narrative to explore gaps in health data interoperability. Although, of course, I always substitute “workflow” for “data” (try it!): Using patient narrative to explore gaps in health workflow interoperability (AKA pragmatic interoperability).

On Periscope!

I was actually present, in a down-the-hall-occasional-beer-together sort of way, at the beginning baby steps of deep learning, a branch of machine learning, a branch of artificial intelligence (one of my graduate degrees). I was taking a graduate course in connectionist models and neural networks at CMU. Some students worked on neural networks with hidden layers. Several worked on recurrent neural networks, networks in which the output of the network feeds back into the network. And some of this work laid the foundations for today’s deep learning success.

Hidden layers are necessary to learn certain abstract concepts (such as Exclusive-OR). Recurrence is necessary to learn certain patterns of behavior over time (such as sentence structure, or, I speculate, workflows!). I even built neural network models of mental illness for one of my research projects. (Computer Modeling of Adaptive Depression and Asymmetric Hemispheric Processing, 1996) Some aspects of neural network optimization (that’s what learning is, in this model) resemble techniques I learned about in my industrial engineering courses.

Ultimately I moved off into other academic directions, ending up with an MS in Intelligent Systems. But I’ve kept my eye on neural network research, especially as it emerged into commercial use. More recently I’ve seen reconvergence with my interest in healthcare workflow and workflow technologies. In particular, machine learning methods are increasingly used to recognize context and predict what users need or wish to do next. Think Google Now on Android. Machine learning systems, like other data pipeline-oriented systems, resemble, in some respects, workflow management system architectures.

With that history in mind, I recently downloaded the free and open source TensorFlow (Flow!) deep learning software from Google. I’m going through the tutorials and seeing a lot of familiar ideas, except they are no longer half-baked, like they were back when I was a graduate student. I have not decided what data sets make sense for me to mess with (got one?) so I’ve been poking at the 2016 made available by (thank you very much). What would be interesting to recognize or predict? Who will be nominated? Whether they will make it into the top 100? Their likely eventual rank? What would be the inputs? Who nominated who? Characteristics of their followers and/or followers? The actual contents of the tweets? Love to hear some suggestions!

On to the HITsm tweetchat questions!

Topic 1: What jobs will be affected most by AI and Deep Learning in Healthcare? #HITsm

Immediately? Visual pattern and object recognition: dermatology, radiology

Topic 2: What types of initial diagnoses would be helpful to be made by AI algorithms #HITsm

Just like certain kinds of ECG diagnosis are almost baked into heart monitors, I think you’ll see cheap apps and hardware for skin and certain imaging tasks (ultrasound comes to mind, less risk of radiation).

Topic 3: What healthcare decisions would you be comfortable being made by AI, if a human reviewed, life or death abnormalities? #HITsm

You’ve heard of shared decision making? Between patient and clinician? Well, consider shared decision-making among patient, clinician, and intelligent systems. The classic model of shared decision making (back even before it was called that) was the Vulcan mind-meld between clinician knowledge and experience and patient values and goals (Healthcare Trade-offs, Shared Decision Making, Vulcan Mind-melds, and a Marriage Metaphor). Well, if clinical knowledge can be artificially machine learned from experience, we are now looking at a mind-meld among patient, clinician, and machine.

Figuring out and allocating competencies and responsibilities? That involves my favorite topic, workflow, as I’ve written about here.

Topic 4: If an AI could be trained to recognize body movements and facial cues, would you be willing to utilize automated visits with telemedicine followup? #HITsm

Patient monitoring is largest wearable/IoT growth area, and in principle includes gesture and facial expression recognition. Recognizing categories of human behavior can be more than just visual, it can include other sensor data as well. Increasingly, these wearable/IoT/machine learning systems will learn to recognize more-and-more abstract human states, such as emotions (affective computing) and goal, plan, and task/activity status: workflow! (Though some might say “life-flow”).

Topic 5: What type of pattern recognition could be used to enhance interoperability in healthcare? #HITsm

I frequently promote what I call pragmatic, or workflow, interoperability. Syntactic and semantic interoperability are about moving data and shared meaning. Pragmatic interoperability is about how actionable data is used. An important aspect of pragmatic workflow interoperability is goal and plan recognition. If I observe you doing something, and I recognize what you are trying to do, and I can help, that is a form of interpersonal interoperability. Something similar exists between any two coordinating entities, be they people, robots, or organizations. Deep learning can play an important role in recognizing goals and plans and then triggering helpful actions and workflows.

I’ll see you at the #HITsm tweetchat! [#HITsm chat 7.15.16] Deep learning in healthcare.

On Periscope!

I’ve not always been enamored of the annual #HIT100 nomination tweet fest. I came round when I realized how useful it can be increasing awareness of the importance of healthcare workflow and workflow technology. I literally looked through thousands of followees and followers for . I added my own hash tag, (more info here) to each tweet. This year I’ve enjoyed the #HIT100 process immensely.

I’d like specifically thank each of the following health IT twitterati.

(If you mentioned workflow in your nomination, but perhaps used an alternative spelling 🙂 let me know so I can add you to my treasured archive.)

Thank you Sean! I’ve enjoyed your blabs. Your combined interests of social work and workflow (“social workflow”) is an interesting addition to the health workflow IT conversation. I look forward to seeing it evolve further.

I nominate to the for , good convo's & ALL the blog posts

— Sean Erreger LCSW ()

Thank you Nick! Our conversation about healthcare workflow, natural language processing, and workflow technology, during your Internet radio talk show, was one of my early opportunities to raise healthcare workflow consciousness.

I nominate for as king and champion

— Nick van Terheyden ()

Thank you Colin! You have a generous spirit. You make every one of us, who have our own narrow individual obsession, feel like you are channeling us at conferences, in blog posts, during tweet chats, blabs, and periscopes.

I nominate to the list No stronger champion for workflow in healthcare than our friend Chuck!

— Colin Hung ()

Thank you Jim! Very cool to have met you, a radiologist, several years ago at the Healthcare Process Improvement Conference in Orlando. And also very cool how process improvement methods are finally coming together and merging with health IT and workflow tech!

I nominate to the list bc he understands it really is about the workflow

— Jim Rawson MD ()

Thank you Sarah! An Batman thanks you. (To the Workflow-mobile!)

I nominate to the for always shining the light where health IT workflow is involved. And for his great blabs!!!

— Sarah Bennight ()

. "Batman of workflow. Shine the light & he appears to rescue your wf"

To the Workflow-mobile!

— Charles Webster MD ⎌ ()

Thank you Dirk! And thank you for sharing what gets your goat during One-Minute Hatcam Interview!

I nominate to the for his promoting standards and leadership

— Dirk Stanley, MD MPH ()

. An honor! Loved your CMIO letter! Recall your One-Minute Interview at ? http://t.co/N4MFg4LFlc

— Charles Webster MD ⎌ ()

Thank you Joe! And thank you for letting me use your handsome mug on my Twitter avatar during AHIPinstitute!

I nominate to because he is making sure we all consider in our solutions!

— Joe Lavelle ()

. BTW props to 4 allowing me 2 use his likeness on my Twitter avatar!

— Charles Webster MD ⎌ ()

Thank you AdvancedMD! Thank you especially for noting the workflow+interoperability connection. Not only is interoperability necessary for great workflow, great workflow technology can help may true healthcare interoperability a reality.

We nominate to the for always having the end game in sight.

— AdvancedMD ()

Thank you Faisal! And thank you for following back when you were the 6th person I followed on Twitter!

Thanks Charles. Nominate that workflow watchdog we need to make sure runs smooth.

— Faisal Qureshi ()

My 1st Twitter follows:

— Charles Webster MD ⎌ ()

Thank you Matt! You had me at ‘workflow’!

I nominate for . Only need 1 word to capture Chuck: .

— Matt Fisher ()

Thank you Janet! And thank for attending so many of my Periscopes!!

I nominate to list for innovation and keeping real!

— JanetCabibbo ()

. on : Fireworks at Red White & Boom from our downtown apt! https://t.co/PudKiKjTaP

— JanetCabibbo ()

Thank you Peggy! We, JETS! The and I, hope to bump into you at some health IT event here in Columbus, Ohio, sometime!

I nominate to for helping me get up to speed on . Wonderful to have you in Cbus & the community!

— Peggy Kilty MA, RHIT ()

I nominate to b/c JETS! The told me too (well, actually I read his mind, since …)

— Charles Webster MD ⎌ ()

Thank you Linda! And for letting me interview you, at length, when you were #HIT1 (out of #HIT100).

TX! Remember > Video & Written Q&A w/First-Ranked Linda Stotsky?

— Charles Webster MD ⎌ ()

Thank you Manish! Love your healthcare workflow history and motivation, which I published on this blog: How Does Manish Sharma Know So Much About Healthcare Workflow Technology? His Answer!

I nominate to for being the WORKLOW thought leader in

— manish sharma ()

Thank you FormFast! I recall as if it was only yesterday, our co-hosted webinar, The Power of Process (almost 2000 views on Youtube!).

we nominate for for consistently sharing his expertise and insight to help promote the value of in

— FormFast ()

Thank you Vince! The first shall be last. You’re the first person I followed on Twitter. Thank you for being an excellent health IT & healthcare workflow discussant!

I nominate to for overcoming his shyness & educating us all about WORKFLOW!!

— Vince Kuraitis ()

On Periscope!

Believe it or not, “professionalism” has a lot of definitions. If you are inside a profession, such as medicine or law, then you likely have a lengthy and specific set of guidelines, or instructions, about how to maintain your professionalism. If you are a member of the public, dealing with professionals, you have a shorter, more informal, sense of what it means for them to act professionally. And if you are a sociologist, you have yet another (set of internally debated) definitions.

I’ll start with my elective course in medical sociology during medical school. It was taught by Odin Anderson, who has been called the father of medical sociology. To the sociological eye, professions serve to self-police (maintain standards) and maximize economic position.

Profession: group which controls entry into its own ranks to ensure its pay rates are kept high — Max Weber

— Charles Webster MD ⎌ ()

Many groups within society aspire to become professions. The medical and legal professions are considered the gold standards. Other groups, such as engineering and teaching, are partially professionalized. Most would agree that the social media “profession” has a long way to go before it becomes a true profession. Indeed, some would probably argue that social media work shouldn’t become too professional, as that might kill the goose that lays the golden egg, so to speak. An important element of social media is it’s impromptu and edgy nature. “Edginess” tends to disappear when rules and norms arrive. I suspect we’ll see a dynamic and evolving mix of the two extremes.

Professionalization: social process by which any trade or occupation transforms itself into a true profession

— Charles Webster MD ⎌ ()

In contrast to the sociological view, medicine describes professionalism quite differently.

“The professionalism charter defined three fundamental principles of professionalism:

• The primacy of patient welfare: This principle focuses on altruism, trust, and patient interest. The charter states: ‘Market forces, societal pressures, and administrative exigencies must not compromise this principle’.
• Patient autonomy. This principle incorporates honesty with patients and the need to educate and empower patients to make appropriate medical decisions.
• Social justice. This principle addresses physicians’ societal contract and distributive justice—that is, considering the available resources and the needs of all patients while taking care of an individual patient.”

By the way, the Jordan Cohen mentioned below was my advisor during medical school!

"Professionalism is an important component of medicine's contract w/society"

— Charles Webster MD ⎌ ()

Then there are more general treatments of professionalism.

Professionalism: Professional Work, Professional Practice & Learning

— Charles Webster MD ⎌ ()

Due to all these difference senses of what it means to be a profession, to act professionally, and with professionalism, I actually prefer old-fashioned words, such as manners or etiquette.

From :

“Etiquette refers to a code of behavior, a set of norms of correct conduct expected by a society, group, or social class. It is a generally expected social behavior. These rules of the code or the set of norms are usually unwritten, but aspect of these relay reflect an underlying moral code. Manners are unenforced standards of conduct or cultural norms that show that an individual is “refined” and “cultured” with a society or group. These norms codify human behavior, manners, just like morality, have no formal system for punishing transgressions other than social disapproval.”

Many books about etiquette and protocol are, essentially, filled with workflows, such as exactly how to greet someone, take leave, and make introductions. These workflows arise and evolve over time. They are phenotypes reflect practical environmental constraints, human purposes and goals, and personal moral codes and organizational values (the corresponding genotypes).

Now, how does all of this apply to professionalism in social media?

I’m sure you can think of examples in the #HITsm, #HCLDR, #HIT100 and related healthcare social media communities during which generally accepted rules and norms were followed scrupulously. And you can also think of episodes when rules and norms were not followed, and then there were direct and indirect expressions of social disapproval. I suspect these rules and norms have evolved immensely from the early days of social media, and will continue to do so.

On Periscope!

Believe it or not. That Hollywood Squares-esque social video platform, Blab, mostly populated by people talking about how great Blab is, is a really great way to demo health IT software! used the Blab Chrome extension…

The chrome plugin for screen sharing works great. Thanks for passing it along !

— Don Lee ()

…and gave about an hour demo of the ZenPRM collaboration and provider resource management system. Well, it would have been an hour, except I kept interrupting and asking questions. Which Don answered impeccably.

. Yes! Glad I got a screenshot of bing a SW demo! Looked great!

— Charles Webster MD ⎌ ()

Couple of things to note. The live blab looked way better than either the replay or the youtube version. In both of the latter, the screencast is squeezed into a corner quarter of the video. But in the original blab, it stretches gloriously and crisply across about the top three fifths of the screen. I’m sure best practices will emerge, but in this case what seemed to work was lowering the screen resolution and bumping up the font size on the sending end, and playing around with the browser size and aspect ratio on the receiving end.

I am already looking forward to many demos of healthcare workflow software!

On Periscope!