Random Thoughts from a Restless Mind

“The most terrifying fact about the universe is not that it is hostile, but that it is indifferent.” –Stanley Kubrick

Man is the only species, on Earth at least, that seeks meaning in life. Once food, clothing, and shelter are secured, Man then turns his attention both inward and outward, in the quest for for some understanding of why we exist, a quest to make our existence meaningful. Alone among all creatures, we do not subsist (I eat, therefor I am) so much as insist (I think, therefore I am).

The great Religions of the Near East and Near West define a meaningful life in terms of fealty to a deity and His edicts. Further East and meaning is acquired by coming ever closer to enlightenment. New World religions such as those of the indigenous people of North America assign meaning to the achievement of harmony among all life forms. But what of the emerging worlds in which the great Religions hold little sway? Death is immutable, and it is death against which all meaning is measured. What came before can be ever and always dismissed as abstract, but what comes after is inextricably tied to what constitutes a meaningful life today.

Again, Kubrick: “If we can accept the challenges of life within the boundaries of death–however mutable man may be able to make them–our existence as a species can have genuine meaning and fulfillment.” How is this necessarily so? Why would it be so? Is it because Man as a species can and does sit down to think? If the universe is indeed indifferent and it is Man who introduces meaning, may it not be that our universe is man-made? Whether through acts of omission or commission, consequences intended or unintended, it’s hard to escape this conclusion.

Herein lies the essential challenge of seeking meaning in life: meaningful for whom? Adherents to the great Religions are set here. Meaning is parsed by some higher being. For the rest of us an epic societal tug-of-war exists externally. The furthest to one side posits that meaning ends at the tip of a nose, while the other extreme holds that it knows better and will tell you what you should find meaningful. The truth, at least the actionable truth, lies as always somewhere in between.

Once more, to Kubrick: “However vast the darkness, we must supply our own light.” Herein, I believe, lies the lesson. Meaning, writ small or large, can only truly be created within. The light of meaning is self-generated, but like all light it can be shared. Must be shared. It is in sharing whatever light we might have or create, however dim we might find it, that makes a meaningful life. What light we create is what separates us from all other life, for Man is alone in his ability to shine that light for others, then see and act upon that which is illuminated.

In the end, the Universe may very well be indifferent, but we need not be. Meaning, in life, may be as simple as the absence of indifference to others.

“The most terrifying fact about the universe is not that it is hostile, but that it is indifferent.” –Stanley Kubrick

Man is the only species, on Earth at least, that seeks meaning in life. Once food, clothing, and shelter are secured, Man then turns his attention both inward and outward, in the quest for some understanding of why we exist, a quest to make our existence meaningful. Alone among all creatures, we do not subsist (I eat, therefor I am) so much as insist (I think, therefore I am).

The great Religions of the Near East and Near West define a meaningful life in terms of fealty to a deity and His edicts. Further East and meaning is acquired by coming ever closer to enlightenment. New World religions assign meaning to the achievement of harmony among all life forms. But what of the emerging worlds in which the great Religions hold little sway?

Death itself is immutable, and it is death against which all meaning is measured. What came before can be ever and always dismissed as abstract, but what comes after is inextricably tied to what constitutes a meaningful life. Again, Kubrick: “If we can accept the challenges of life within the boundaries of death–however mutable man may be able to make them–our existence as a species can have genuine meaning and fulfillment.”

How is this necessarily so? Simply making the statement does not make this a reality, regardless of the fame or following of the author. Why would it be so? Is it because Man as a species can and does sit down to think? If the universe is indeed indifferent and it is Man who introduces meaning, must it not be that our effective universe is man-made? Whether through acts of omission or commission, consequences intended or unintended, it’s hard to escape this conclusion. Herein lies the essential challenge of seeking meaning in life: meaningful for whom?

Adherents to the great Religions are set here. Meaning is parsed by some higher being. For the rest of us an epic societal tug-of-war exists externally. The furthest to one side posits that meaning ends at the tip of a nose, while the other extreme holds that it knows better and will tell you what you should find meaningful; this usually means you doing something for someone else at the behest of the “know-betters”. The truth, at least the actionable truth, lies as always somewhere in between.

Once more, to Kubrick: “However vast the darkness, we must supply our own light.” Herein, I believe, lies the lesson. Meaning, writ small or large, can only be created within. The light of meaning is self-generated, but like all light it can be shared. Must be shared. It is in sharing whatever light we might have or create, however dim we might find it, that makes a meaningful life. What light we create is what separates us from all other life, for Man is alone in his ability to shine that light for others, then see and act upon that which is illuminated.

In the end, the Universe may very well be indifferent, but we need not be. Meaning, in life, may be as simple as the absence of indifference to the Universe.

Skyvision Centers has a subsidiary company called the Skyvision Business Lab. We do business process research for pharmaceutical companies, medical device companies, and other medical businesses in the eye care arena. One of the companies we have worked for is a very cool company that produces animated educational videos for  ophthalmologists and optometrists. I had an interesting experience while talking to their chief technology officer. It was interesting because the conversation proved our basic reason for existence at the Business Lab, that it is impossible for any company to develop, sell, and install any kind of product in our world without understanding the ins and outs of every day activities in an eye care practice.

Of course, I always find it extremely interesting when I’m right!

It was a tiny little point, really, but how could you know something as small and seemingly insignificant as our discovery unless you had spent time on the “frontline” of medical practice? The chief technology officer for the video company was frustrated because doctors and their staff were not using this really cool product that they had purchased. Furthermore, because they weren’t using it, they were failing to buy downstream products from the video company. As it turns out the salespeople for this company were telling the doctors that this particular product should be “turned on” by the staff at the front desk of the office. This is exactly the wrong place because the front staff personnel simply have neither the time, nor the understanding, nor any incentive whatsoever to do this. The product actually works beautifully if it is “turned on” by the back-office staff. Bingo! Problem solved.

So what does this have to do with Electronic Medical Records (EMR), and for heaven’s sake what does this have to do with underpants? It’s simple, really. When was the last time you bought a totally new type of underpants, underpants that you had never seen before, and underpants that you had certainly never worn before, without trying them on? Furthermore, what’s the likelihood that you would allow someone else to design, fit, and choose a style  of underpants for you if that someone has not only never met you but has never even seen a picture of you?!  That’s the image I get every time I read an article about EMR.

In theory the concept of an electronic medical record that would allow permanent storage of every bit of medical information, with the ability to share that information between and among doctors and hospitals involved in the patient’s care, is so logical and obvious that debating the point seems silly. If you have ever seen my handwriting, for example, you’d realize that the entire field of EMR was worth developing just to make doctors stop using pens and pencils! Trust me on this… the doctor hasn’t yet been trained who is also a specialist in penmanship.

I actually trained at  two of the pioneering hospitals in the use of electronic medical records, and indeed in the use of computers in medicine in general. Dr. Larry Weed and Dr. Dennis Plante at the University of Vermont were pioneers in the concept of using computing power to make more accurate medical diagnoses. Both the University of Vermont Medical Center and the Maine Medical Center were among the very first institutions to develop and implement digital medical records for the storage and use of clinical data like lab reports and radiology reports. In theory both of these areas make sense, but in practice the storage and display of clinical data is all that’s actually helpful in day-to-day practice.

If this is the case, if the acquisition, storage, and retrieval of critical data is helpful, the next logical step must be to do the same thing with the information obtained in doctor’s offices, right? Well, in theory this makes a ton of sense. The problem is that nearly none of the EMR systems now in place have been designed from the doctor/patient experience outward; they’ve all been designed from the outside in, kind of like someone imagining what kind of underpants you might need or might like to wear, and making a guess about what size would fit you. With a few exceptions, tiny companies that are likely to be steamrolled in the process, every single EMR on the market is the wrong fit for a doctor and a patient.

Why is this? How could this possibly be with all the lip service that is being paid to the doctor /patient relationship and the importance of getting better care to patients? It goes back to that same tiny little problem that the medical video company tripped over: it’s really hard to know how something should work unless you spend some time where the work is going to be done. Electronic medical records in today’s market are responsive to INSTITUTIONS, insurance companies and governments and large hospital systems. System before doctor, doctor before staff, staff before patient. Today’s EMR’s have been designed with two spoken goals in mind: saving money and reducing medical errors. Should be a slamdunk at that, right? But even here the systems bat only .500, producing reams of data that will eventually allow distant institutions to pare medical spending, but neither capturing nor analyzing the correct data to improve both medical outcomes and medical safety. Fail here, too, but that’s another story entirely.

So what’s the solution? Well for me the answer is really pretty easy and pretty obvious. Send the underwear designer into the dressing room! Program design, programs of any type, are one part “knowledge of need” and one part plumbing. How can you know what type of plumbing is necessary unless you go and look at the exact place where the plumbing is needed? How can you know what size and what shape and what style of underwear will fit unless you actually go and look at the person who will be wearing the underwear? It’s so simple and so obvious that it sometimes makes me want to scream. Put the program designers in the offices of doctors who are actually seeing patients. Set them side-by-each. Make them sit next to the patients and experience what it’s like to receive care.

THEN design the program.

I’m available.The  Skyvision Business Lab is available. I have a hunch that the solution will hinge on something as simple and fundamental as my example above — front desk versus back office.  It doesn’t necessarily have to be me, and doesn’t necessarily have to be us, but it absolutely is necessary for it to be doctors and practices like Skyvision Centers, places where doctors and nurses and staff members actually take care of patients. Places where patients go to stay healthy or return to health. Places where it’s patient before staff, staff before doctor, doctor before system.

For whatever it’s worth I’m 5’8″ tall, I weigh 150 pounds, and I’m relatively lean for an old guy. I guess it’s a little embarrassing to admit this… I still wear “TightyWhiteys”, but I’m open-minded. I’m willing to change.

Just take a look at me first before you choose my underpants for me.