Health = Being + Doing + Environment

A framework for exploring health

Health is a function of Being, Doing and Environment. I want to encompass the many ways we might define health, what we do about it and the activities that address health. The larger environment in which we live is also important. These interact and further shape each other.

Health

Health is a way of being and an attitude as well as a result of the actions we take or don't take and the environment in which we live.

To say "I am healthy" is itself complex. Does it mean I feel well? That I have no limitations on my activity? That I am free of disease or disability? Or that I have accommodated and compensated for my various diseases and disabilities?

Health is both broad and specific with a wide range of determinants of health. Here are a couple of examples work on this: Healthy People 2020 and Schroeder: We Can Do Better, Improving the Health of the American People, NEJM 2007.

Being

Who and what we are at this moment and the personal history that got us here.

• Personal values and goals - what health is to us, what's important to us, what we want to experience, what we want to leave as our legacy.
• Spirit - the innermost aspects of our being
• Mind - our state of mind, attitude, outlook, intellectual capabilities, interests, desires, mental health.
• Body - our physical body, it's current condition and history, our genetic inheritance, our various diseases and disabilities.

Doing

What we're doing now, our actions with ourselves, with others and in the larger world.

• Plans - in the boundary between Being and Doing, our plans are how we go from our intentions to action, although not everything we do is planned.
• Actions - what we're actually doing, with or without planning. The "behaviors" that are high on the list of health determinants and those that have no known effect on our health. 

Included in here are the things we do to manage our health, from immunizations to exercise, from medication that changes our biochemistry to meditation that changes our mind, from surgery to assistive devices.

Our actions affect others as well as ourselves. They also shape the larger environment, our own and others.

Environment

We live in an environment. The boundary between self and other is very fluid. We're completely interdependent with our environment. It's the context in which our actions take place. We can't take one breath without it. When we take advantage of it, the environment can make it easy to do the right thing, keep us safe and healthy, with no extra effort. On the flip side, the environment can be a real killer, from toxins that poison us to cultural norms that encourage risky behavior.

• Physical Environment - from our housing and food, from our zip code to climate zone - the place where we live, work and play - and the physical forces that surround us. 
• Social Environment - our family, friends and neighbors. We can't life without other people, from our conception and birth through the whole of our life. The social forces that we interact with our powerful in shaping our behavior and our health. 
• Access to Resources and Services - access is a combination of what's available and at what cost... including healthcare, education, employment.
• Public Policy and Public Health - what we collectively decide to do as a society
• Extrasomatic Intelligence - a fancy way to say that using our environment well can make us vastly smarter, from the written word to the most advanced analytics.

There's a lot being written about geography and health. Here's a start (Health Affairs Blog, August 6, 2015).

A work in progress

This is all a developing set of thoughts. I've had feedback about the diagram at the beginning of this post. More is welcome. I've received suggestions about the content. I'm not sure that Environment is the right label for the third section. Perhaps Connecting or Interacting or some other word that speaks to the interplay with the world around us.

Feel free to comment here or on Twitter or LinkedIn. Thanks.

Introduction to Agile Alchemy - a trial run

My friend, fellow meditator and Agile software wizard, Stephen Starkey, and I are piloting a training program that combines meditation and Agile to help people be more present, better connected to the people and task at hand, and as a result, brilliant and productive.

This first run will be a series of five Thursday evenings, April 14 through May 12, 2016. We'll meet in the West Loop at the Chicago Shambhala Center.

This is a “beta” program. We are teaching something fresh, extending and combining elements we know well in a new way. We are looking for a small group of pioneers to join us in this exploration.

Introduction to Agile Alchemy

Agile Alchemy is for anyone who must collaborate with others to be successful. We take the world, full of chaos and change, and build on the natural strength and flexibility of mind, to fully engage with the present situation. Then we leverage that brilliance. We use the wisdom of the ages and modern times to work with complex situations with precision and grace.

Agile Alchemy teaches:

• Meditation and contemplation practice as a basis for deeper awareness and opening to possibilities
• Tools for personal and organizational growth in areas such as:
• Process design and stewardship,
• Conflict resolution,
• Leadership, and
• Change management
• Simple and powerful techniques for creating and maintaining clarity, momentum, and adaptability.

This training program uses multiple perspectives:

• The brain and individuals’ ability to think creatively,
• Teams’ ability to deliver quality work, and
• Organizations’ ability to set and achieve their goals.

Program registration at Chicago Shambhala.

A New Logo for Strategic Health Network

What do you think?

HIMSS16 - Federal Initiatives

It's been a couple of weeks since HIMSS16, nonetheless, a few comments are still relevant.

HIMSS is an annual meeting of the tribe. We have matured as a community. There is a vast ecosystem of small, medium and large vendors. There is a broad Federal presence. There is a vibrant mix of start ups and long established players. There are many success stories from healthcare providers and also troubled implementations to learn from. This is a year of next steps.

It was a week of lively interaction, with 41,000+ of us in Las Vegas. There were over 200,000 tweets. What happened there was broadcast live across many channels. The continued growth of social media may have been the biggest news. #HIMSS16. The connections with peers that once required a live meeting now happen in virtual space every day.

Plenty of technology

It's time to declare victory on the technology side and move on to building the new world where clinical information is ubiquitous, available when and where needed, for an individual, for a population, for research, for managing processes, for continuous improvement, for a learning health system.

Swimming in the water, we may not have noticed the transition from the fresh water of the river to the salt water of the ocean. While it is both blue (open to possibilities) and red (full of the blood of battling interests), the more important point is that it is an ocean, very different from the rivers that feed it.

ONC Report to Congress, February 2016, Possession of
certified EHR among office-based physicians and hospitals

We are in a new world, created from decades of pilots, early adopters, mainstream adopters, overlapping technologies, the explosion of consumer technology, the investment of HITECH, the continued achievement of Moore's Law.

The rate limiting factors are our imagination, our creativity in adapting to the new capabilities, our willingness to progress in times of uncertainty - to manage change, to act and not wait for the next version (there will always be a next, newer, better version), our willingness to actively engage partners, our willingness to fully participate in new payment models.

Alignment across HHS, between ONC and CMS, and with the rest of us

The opening keynote was from HHS Secretary Burwell, with the value of EHRs in surfacing the drinking water issues in Flint Michigan. Flint is both an example of the success of health IT (that the records were available and searchable), and the potential to do so much more (real time public health surveillance).

The conversation between Karen DeSalvo, the National Coordinator for Health IT (ONC), and Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), set the tone for where we are and what's to come: health IT is an enabler for healthcare reform.

This year's discussion continues the collaboration from HIMSS15.

Infrastructure

• Increased use of consistent standards across HHS initiatives
• Certified Health IT as a base requirement for participation in HHS initiatives

Interoperability 

• No one wants to be labeled a data blocker. After a year of heightened visibility, EHRs vendors have embraced various collaboratives to improve the exchange of information. Moving from press releases to working information exchange is going to take time and continued attention.

• HHS Interoperability Announcement (February 29, 2016)
• ONC Interoperability Pledge with vendor list (February 29, 2016)
• Senate Hearing on Information Blocking (July 23, 2015)
• ONC Report to Congress on Information Blocking (April 2015)

• An additional round of HITECH funding is now available to State Medicaid programs to better connect non-Meaningful Use providers (post-acute and long-term care, behavioral health, pharmacies, support services, etc) with Meaningful Use providers (Eligible Hospitals and Eligible Professionals). 
• CMS Blog - Slavitt/DeSalvo (March 2, 2016)
• State Medicaid Directory Letter (February 29, 2016)

App Challenge

• FHIR continues to get attention as the standard API of choice.
• ONC is building on this with two competitions and a new grant opportunity 
• Consumer Health Data Aggregator Challenge (deadline May 30, 2016) 
• Provider User-Experience Challenge (deadline May 30, 2016)
• Discovery Infrastructure for Clinical Health IT Apps (deadline April 30, 2016)