Checking with Facebook Places before voting

Hi,

So I wrote a new facebook application that gives you credit for supporting my fathers congressional campaign. My father is running in Texas District 20 (the Alamo District), and I am writing this article as a specific guide to his supporters with iphones/ipads and facebook accounts. (If you do not have a facebook account… now is the time to signup!!)

But no matter where you are this election day, you should use Facebook Places to checkin at your polling station. Why? because anyone building a facebook political applications (like me) will be able to use your checkin to prove that you were at a voting station. This very simple piece of information, where, when and most importantly the -implication- that you actually did vote means that you are a player in what will soon become a very very active political space on facebook.

Remember, there will be a host of facebook applications that check for this data in the coming years. You can be an early adopter of this type of technology even before knowing what application you will be using. This is also good advise no matter who you support politically!!

For many of you, this could be the first time you have used facebook places to check-in anywhere. So I thought I would write you a little guide to checking in. This guide will assume that there is already a location available for you to check-in to, but if there is no such location available, you can follow my instructions to create a Facebook places location to make one for yourself.

First you need to load your Facebook application. These instructions are identical for the iphone and ipad, and should be similar on the Android. If you have not installed the application yet, you need to search for “facebook” in the app store application and download it. Then you should see an application icon like this one on your iphone:

Click the facebook application
Click the facebook application

Next you need to checkin. The simplest way to do this is to click the little geo-tag icon to the right of the text field:

This is where you typically start
This is where you typically start

After you click there you choose which location you want to check-in too. In this example I am checking in to campaign headquarters. If there is a not already a facebook location for your polling station, you should add one.

Choose a place to check-in to
Choose a place to check-in to

Obviously your polling place will not be called “Trotter for Congress Headquarters”. It will be something like “the Smith elementary school”. It does not really matter to much where exactly that you check in to… the application will specifically store your latitude and longitude. Any half-way intelligent facebook application will be able to tell that you were at a voting station, even if you actually check-in at the Burger King across the street. Still better to check in at your actual polling station, even if it means creating a new location in Facebook Places.

Then you will be presented with the check-in interface, which looks like this:

Check in to a given place
Check in to a given place

You can put anything you want in the “What are you doing?” field (including nothing at all). However, while an application can understand the implications of your latitude and longitude, your facebook friends might not. You might give a little context to your check-in by saying “Here to vote” or “Dropping my mom off to vote” or whatever. My facebook social election game, does not attempt to figure out if you actually voted, you can score in the game if you just show up at a polling station on election day. It does not matter if you are under-age, or not voting, or vote for the other guy… I cannot say for sure, but I think other vote-oriented facebook applications that exist to serve a particular political candidate will probably follow suit. Otherwise, someone will try to claim that the application “rewards” voting a particular way, and is somehow illegal/unethical.

However, I imagine that you will also see a large number of facebook applications that are not associated with a particular candidate that will ask about exactly how you voted. These style of applications will turn Facebook places into a kind of real-time location-aware exit polling engine… lots of potential uses for that type of application.

But none of these apps can operate without data. In this election (2010) this will be new, and we will struggle to get the word out… but in 2012 and beyond.. this will be more than normal.

Enjoy!

-FT

Facebook Places powers the first social election game

Today, Farrin Anne ‘Crane’ Gustafson, the manager of the social media strategy for the Clayton Trotter (my father) congressional campaign became the first person in history to use Facebook Places to check-in to a new kind of application: a social election game. She earned the “At the Voting” badge by checking-in using Facebook Places as she early voted today on the first social election game that I have been frantically coding for the last few weeks. The game concept is simple: it rewards real-world political activity with points and badges. There have been a lot of discussion about how Foursquare et al. might be used politically. This is especially true of Gowalla, which has been targeting politicians.  There are also people who have talked of using a facebook game to energize supporters. But as far as I know, my application is unprecedented for the following reasons:

  1. The application is the first to allow its users to specifically earn badges for checking-in at polling stations during voting. This is much different then using the application to mark political rallies etc etc. Obviously, you do not have to vote to get the badge, you do not even need to be of voting age, or registered to vote in the state. All you have to do add the application on facebook, check-in at a polling station during voting (even after hours) and you get credit for the badge. Of course -most- of the people who do this will be registered voters who want to essentially participate in -perfect- exit polling.
  2. The application is built directly into facebook. That means that a users “check-ins” are something they can share directly with their facebook friends. There is no longer any need for a third-party application, or the need to limit the reach of the application to the very very few users of the geo-game like foursquare. This is an app for everyone on the largest single social network.
  3. You can check your friends in when you vote, and that counts too. So one iphone+facebook application can support several different users.
  4. The game does not just support check-ins. You can sign up for vote reminders, get credit for volunteering, and most importantly, use the application to provide a structured endorsement on your wall.
  5. Because it is powered by the facebook social network, you get full credit when your friends score. When your friends show up at the polling station or sign up for a vote reminder, you get credit too. You “win” by cooperating to get the candidate elected. Because there is a powerful proxy for detecting real votes (polling station check-ins), it will be easy to tell who the “vote influencers” were.
  6. The design of the application allows for a deep integration with the ability for the crowd to communicate back to the candidate. If my father is elected, he will be able to use the application to mine the facebook social grid and engage with his constituents in a fundamentally new way.

I believe that all of these elements together (and not just GEO apps or just political games) are the foundations for a new class of facebook game: For now I am calling them social election games. I believe they are the future of politics.

Up until now political power in the United States came from essentially two places: sources of money and sources of fanatical single-issue voters. Democrats cater to different type of unions. Republicans appeal to evangelical Christians. Democrats appeal to environmentalists. Republicans appeal to big business. Each small group would either deliver either a small cache of extremely loyal voters, or expensive advertising, or both. People who were able to directly influence candidates and politicians were either donors, or the leaders of these extreme groups. In short, the people with political influence in this country have become those with agendas that are generally out of sync with anything remotely mainstream. I made it clear, in my endorsement of my father, that I do not agree with all of his extreme views. I support him primarily because I know he will be more careful with defense spending than his opponent has been, and that is a very important issue to me.

I feel out of sync with my fathers extremely conservative positions and I feel (slightly more) out of sync with his opponents extremely liberal policies. They have done well as candidates because they have appealed to the extremes. I know of no reasonable person who agrees with either candidate on all of their political stances. (I am aware, and intend, the implication that if I know you and you agree with my dad 100% that I think you are unreasonable; and that my father, in the sense that he obviously agrees with himself entirely,  is also unreasonable. Given the Tea party energy, me saying that my father is unreasonably conservative, will do nothing but help him. I endorsed my father because he was -more- reasonable than his opponent, not because he was reasonable. Frankly, who thinks of their own parent as ‘reasonable’ in any case… I mean really…)

American politics as a whole suffers from the Myth of Polarization. We have turned politics into a kind of entertainment, something like pro-wrestling. Listen to any televised political commentator and tell me they do not sound like they are going to break out at any moment with “aaaarrree you ready to ruuuuuuuumble?” and then present the surprise cage fight…

Why do we have this kind of environment? Because that kind of low-brow drama gets people to vote. But what if we had a different way to get people to vote?  What if we could have simple, polite conversations with our friends about who the next sheriff or Congressman should be? I think if those conversations were easy, if they were simple and if voting itself were a fun process, then we might see a trend back to center. A trend away from blood-sport politics. In this world, the wielders of influence would not be the arch-bishop, but the local priest, with 300 facebook friends who actually trusted him as a human being. Instead of caring about who the chief of police voted for, you would care about which candidate the policeman who lives down the street from you (with 354 facebook friends) endorsed. Instead of caring about who the national teachers unions endorsed for president, you would care more about your kids third-grade teacher (54 followers on Twitter). Instead of caring about some insane radio talk show host, you might care about the opinion of an intelligent college kid from South Dakota with a podcast followed by 300 people.

In this hopeful/hypothetical world, real-world trust relationships, enabled by virtual social networks, will become the new political currency. I want people like my father and his opponent to care much more about someone who has 1000 followers on facebook or twitter, and has shown that 730 of those followers take their endorsement seriously, than the person who can pay for a political ad for them for $100k.

The whole point of social media is that it is -not- a broadcast medium. It is an engagement medium. No matter who wins the election in the San Antonio ‘Alamo’ district in 2010, this application is a template for something much much bigger. The irony is that now that I have proven that it is possible, others will try to mine this for a profit. I will have none of that. After the election, I plan to Open Source the code. I plan to start a project to enable a whole slew of social election applications for different groups and for different interests. This open source project, (which is looking for a project manager) will keep the goal of bringing reasonableness back to politics as a central design goal.

P.S. Polls indicate that the election between my Clayton Trotter (my father) and Charlie Gonzalez will be very very close. I honestly think this application might tip the scales in my fathers favor.  How cool is that?

(Update 11-22-2010) P.P.S Sadly, my father lost to Congressman Gonzalez… oh well..

Happily it does look like this game might be on to something. It was featured on some of the top tech blogs:

http://www.insidefacebook.com/2010/10/24/social-voting/
http://gigaom.com/2010/10/22/if-voting-is-a-social-game-will-it-make-democracy-better/

Pretty cool!!

How to add a new place to Facebook places

Soon, I will be making an announcement about some work that I have been doing with the Facebook places API.

For now, I want to give a little tutorial on how to create a new place, in Facebook places, using your iphone Facebook app.

First, you have to download the facebook application from iTunes, or get someone to help you do this. This tutorial assumes that you have the facebook application already installed… if you really need help with this, go to the Mac store and talk to someone there… should be pretty simple…

The first step is pretty important:

Go to where you want to create the place!

So click on the facebook application to start…

Click the facebook application
Click the facebook application

This will pull up the home screen…

This is where you typically start
This is where you typically start

You can also get to the checkin menu from the main facebook menu in two steps:

This is the main menu, places is right in the middle
This is the main menu, places is right in the middle

After clicking there you will see the main Facebook places interface where you can see your friends recent checkins..

This is the central places interface on the iphone, but it is not the checkin interface
This is the central places interface on the iphone, but it is not the checkin interface

Now you should have gotten to the check-ins interface… one way or another…

The check-in interface looks like this!!

This is the checkins interface, you are almost to the point where you can create a new place
This is the checkins interface, you are almost to the point where you can create a new place

So now you could choose a place where you would want to checkin… but that is not what this tutorial is about. You want to create a *new* place that will show up on this list and allow other people to check-in. To do that you need to hit the little red button at the top right of the screen, which should bring you to the “new place” interface:

Make sure that the little blue dot is exactly where on the map that it should be!!

The iphone facebook app Add a Place interface
The iphone facebook app Add a Place interface

Now you will be able to check-in to your new place…

The iphone check-in interface
The iphone check-in interface

Now you should go ahead and check-in to your new location. By doing this you will start to “legitimize” the place in Facebooks eyes. You also need to get your friends to start using the place when they check-in.

I hope this helps someone. I could not find a current how-to on making a new place in Facebook places. It is pretty simple. If you ‘own’ a place (like a business or non-profit) then you should also read about the process to claim a facebook place.

HTH,

-FT

MirrorMed, Medical Manager and mm2mm

So originally MirrorMed was a fork of ClearHealth. It was done to satisfy my need to get certain features done… but now ClearHealth has moved far past it… the usefulness of the “fork” part of this has diminished to nothing.

Still there were a few useful things in MirrorMed that have not been replicated in ClearHealth or anywhere else that I know of.

The most useful of these was a tool that I built called mm2mm

mm2mm is a Medical Manager to MirrorMed integration engine. Basically it a php parser for the medical manager data files that allows you to seamlessly move to MySQL. I have used this tool more than any other part of MirrorMed, and so I am now releasing it Open Source (AGPL 3) and completely costless. You can download it from the MirrorMed sourceforge site.

For those who are interested in Medical Manager, you might enjoy reading the history of Medical Manager, which I maintain. Recently someone reminded me that there have now been convictions in the Medical Manager dealership scandal.

Medical Manager was my family business for many years. My Aunt and Uncle still work tirelessly to support clients and my grandfather, now deceased, helped them start the business. The Medical Manager dealership scandal, where Medical Manager ousted small dealerships and apparently accepted bribes to buyout the larger dealerships originally taught me that nothing but Open Source was viable in healthcare informatics.

The release of mm2mm has brought me full circle with Medical Manager. It makes it trivial to use a FOSS EHR like ClearHealth, OpenEMR, OpenVistA or Astronaut VistA on top of an instance of Medical Manager but most of the people who have used mm2mm as beta testers were interested in creating a web-archive of the medical manager database or in entirely migrating away from Medical Manager.

Medical Manager was a great product, but years of neglect and proprietary thinking have doomed it. It might be possible to save if it was released as Open Source now, but it is probably too late.

Oh well…

-FT

betting on quantified self

So I lost the Health Developer challenge to ringful. But they had a pretty good app, so there is no shame in that.

More importantly, I think I really made people think.

Steven Downs of project health design, said this about toeleven.org:

However, instead of using Google Health or HealthVault as a platform, Fred used Twitter. Fred had the notion that people already use Twitter to track what is happening with their lives, so why not track what is happening to their health? That builds upon another key finding from Project HealthDesign: help people track their health information by incorporating the process into their existing daily routine, not adding something new

So basically, while they did not chose me to win the contest, they got the point I was making. If I had time to add some graphical goodness to the app, then I think I might have been able to make a better stab at being more competitive from a user experience standpoint, and I think I might have done better. There is always the next contest.

Still I have made strong headway with the notion that the quantified self movement, is merging with the PHR movement. The quantified self guys are pushing this logging to Twitter thing pretty hard. And toeleven.org is one idea about how to fully move Twitter into the PHR space. We will see how that community reacts to these ideas.

I think it is inevitable that the notions of the “life stream” as per facebook and twitter and the notions of traditional PHR will begin to merge. It is not a question of whether?, but rather when?, and how?

toeleven.org is an Open Source app looking for a project manager.. contact me if you are interested in owning the project…

-FT

My Health2.0 submission goes to eleven

I decided to enter the Health 2.0 Developer Challenge.

My submission is toeleven.org

My goal was to find a way meet one of the challenges using some kind of integration with our new Audio PHR system Your Doctors Advice. (At the time of the writing its in a closed beta… you can sign in, but cannot use it yet) This has been the project that I have been working on for almost a year, with Cautious Patient.  but I let time get away from me, and I could not find a way to get anything interesting done in time, that applied to any of the Challenge categories. Next year we will consider writing our own challenge.

But I discovered that a part-time project that I have been working on for the last month or so actually applied to a contest to re-implement some of the original Project HealthDesign applications. One of those applications was, specifically, an application designed to track Observations of Daily Living (ODLs) for people with chronic pain. I have friends and family with chronic pain, and I actually wrote this application to help one of them keep a pain/food journal more easily.

The contest had two requirements: re-implement one of the original designs from one of the videos, and use a “commercially available PHR service that can securely store the data”.  What is a PHR? It is a personal (or “personally controlled”) health record. What the contest makers meant was to try and get new functionality available in Google Health, or HealthVault or Dossia or the like.

Well Google Health has been, until very recently been incapable of storing ODLs because it insists on the limited data that a CCR can encompass. Even with the new update, Google Health has limited abilities to store arbitrary data. Im not sure if I can easily include pictures of food in a Google Health app (this might have changed recently). HealthVault has famously supported the recordings of arbitrary data, but is so capable in this regard that there is little need to force the data into any standard at all.  If I want to participate in either approach, I have to go through very extensive integration and approval process. Neither platform is truly open. Perhaps that makes them “safer” for patients, but perhaps that just makes them walled gardens with useless inscrutable iphone-app-store-like approval process that stifles true innovation… you know… one or the other….

I much prefer Twitter and Facebook as application platforms, who have far more open application approval processes. These platforms have realized that their success is tied to the openness of their networks. They are acting much more like “Internets with new protocols”.

But Twitter is not appropriate for health data… because it is essentially a public broadcast medium? Right? That is the way it is typically used, and it is certainly a broadcast technology. But it is not necessarily “public” broadcasting. You can change any twitter account into a protected account, that will ensure that only people you want to see it can see it. So Twitter is “commercially available” that can “securely store the data”, but is it a PHR? I think it is if you use it like one. In fact, it is probably one of the most popular platforms for logging health, wellness and fitness information on the planet.

I think an application that relies on Google Health or HealthVault faces an uphill battle, because that is not where people are tracking ODLs. People actually use Twitter and Facebook to track what is happening in their lives. They use it to record their mood changes, their stress levels and details about how their bowels are moving. Most importantly for my purposes people are already using Twitter as a food diary.  If you want to save time you can just take pictures of your food and use that instead of trying to write down anything. If you are interested in finding out what food might cause pain you are more interested in ingredients than calories, and so food diaries that focus on accurately tracking calorie intake are overkill.

So I wanted a way to simply and easily track ODLs of pain, using Twitter, right beside the already smooth process of tracking food intake.

But I wanted to do this in a way that would be easy to data mine, so that I could take the food data, or pictures, and overlay that in a data-mining friendly way with the pain data. Obviously, I needed a good syntax for recording the pain information, and so I did some research on micro-blogging ODL syntax options. I ultimately settled on the grafitter syntax, because its site was actually up and doing cool data mining stuff. But I did not want my friend to need to actually learn any kind of “twitter syntax” to log her pain. Instead I wanted her to have a simple web form that she could use on her smart phone, that would allow her to quickly and accurately describe her pain. Just like the video from Project Health Design on Helena.

So what is Helena doing? In the video, she is recording which medications she is on. But that is one of the few things that doctors have (or should have) accurate data on. Other than recording that medication data, she is simply creating a ODL system that is customized to her world, allowing her to track -when- she takes the medications, which in her world is just “the yellow pill” or “the big pill”. Moreover, she wants to log three specific things that seem to impact her pain: sleep, yoga and the local weather. But the Twitter ecosystem already takes care of all of that. There are devices that track sleep, that can log the sleep quality data to Twitter. Helena could use fitbit which could log her movement during yoga workouts to Twitter. She can even use Twitter to track the local weather.

Helena and my friend, both have the ability to log very different kinds of data to twitter that are difficult and or time-consuming to acquire in any other way. All they need is a method to create and record their own “Pain Tracking Interface” that could be used to describe what they were going through. One of the project health design teams described one such interface, as part of the many things that the teams released.

So I built a new Twitter application to do that. Its easier to understand if you see it in action once, so here it is:

You can try the application yourself at toeleven.org

So this is not only a method for creating a “Pain Tracking Interface” but for tracking anything you want to perform careful date-stamped quantitative analysis. There is little that you could not track using the system, and it will perfectly interface with any other Twitter data stream so that you can perform data analysis on yourself easily, using Grafitter, or something else just like it.

I want to be clear. I did not write this application to win the contest. I wrote this application to help my friend. It is far enough along that my friend can do what she needs to figure out her pain. This idea can easily go farther, but this is not my main priority. I am going to talk about where this should go, but do not assume that I am going to be the one to do this. Competition and collaboration welcome.

I am releasing all of the php sourcecode for toeleven.org as Open Source as soon as I have the cycles. I think the following work needs to be done on the system.

  1. Create a replacement data analysis tool for grafitter, with more functionality, specific to ODLs
  2. Improve the iphone and android specific interfaces to the ODL forms
  3. Build in facebook integration for those that do not want to link twitter to facebook
  4. Create much better form-builders that make it more obvious how to build forms for different things, specially targeting HTML5 (I feel doing fancy work in the HTML4 world is a waste of time at this stage)
  5. Allow users to share their ODL forms that “standardized” ODL forms might become popular based on some kind of crowd-sourcing approach.
  6. The interface is a little sparse, could be improved alot with some good design work.

I also did not submit the application to win the contest, as much as to try and reframe the problem. I want to make a difference in the world of Personal Health Information, and I know I am not alone in this. But we need to stop trying to force people into behaviors that they will never commit to. The largest single “addressable” healthcare issue is compliance. If we all did what we should know that we are supposed to do, then many of the difficult healthcare problems, like Diabetes, Heart Disease and even HIV would become rare events, and manageable for our society.  I am overweight. So I have a compliance problem. I need to focus on losing the weight, which will protect my heart in the long run, rather than interfacing with some software that I have to comply with. Our goal with the Audio PHR, is to create an application that helps people do the right thing more than it creates new user burdens. I am not convinced that our PHR philosophies are simple enough. I am not convinced that toeleven.org or our Audio PHR is simple enough. But they are simpler. That is a step in the right direction.

Normally, I would also talk about how we need to be working together on open systems using open source software at this point. But Project Health Design and Robert Wood Johnson are absolutely the choir when it comes to that sermon. They understand the potential of Open Source. My goal with submitting this application is not to win, although that would be nice. My goal is to completely reframe the problem. I want them to see that their notion of PHR is trying to force people to move against the current. Facebook and Twitter applications, whatever else you want to say about them… are “with” the current. People are there, using those systems, that is where the action is. We need to bring the behavior changing healthcare innovations to the people, not the the people to the innovations. This is a big paradigm shift, but it is at the heart of Open Source. Essentially I am a developer on one of the Health Design projects, and I have made a pretty signifigant problem into what Torvalds calls a “shallow bug”. The bug is “How do we get people to signup to use this stuff?” I have solved half of that problem, people are already signed up to use Twitter, they just have to use Twitter in a new way… as a PHR.

Eric Raymond experienced this kind of paradigm-shift from a contribution with his fetchmail project. I have quoted this before and I will quote it again:

The real turning point in the project was when Harry Hochheiser sent me his scratch code for forwarding mail to the client machine’s SMTP port. I realized almost immediately that a reliable implementation of this feature would make all the other delivery modes next to obsolete.

For many weeks I had been tweaking fetchmail rather incrementally while feeling like the interface design was serviceable but grubby – inelegant and with too many exiguous options hanging out all over. The options to dump fetched mail to a mailbox file or standard output particularly bothered me, but I couldn’t figure out why.

What I saw when I thought about SMTP forwarding was that popclient had been trying to do too many things. It had been designed to be both a mail transport agent (MTA) and a local delivery agent (MDA). With SMTP forwarding, it could get out of the MDA business and be a pure MTA, handing off mail to other programs for local delivery just as sendmail does.

Why mess with all the complexity of configuring a mail delivery agent or setting up lock-and-append on a mailbox when port 25 is almost guaranteed to be there on any platform with TCP/IP support in the first place? Especially when this means retrieved mail is guaranteed to look like normal sender-initiated SMTP mail, which is really what we want anyway.

There are several lessons here. First, this SMTP-forwarding idea was the biggest single payoff I got from consciously trying to emulate Linus’ methods. A user gave me this terrific idea – all I had to do was understand the implications.

underline mine.

I really think the toleven.org Twitter-centric design is fundamentally more effective than the whole Common Platform effort. While I think both the Common Framework, and its top competitor the Indivo X modular architecture, have some value, they are fundamentally fighting a losing fight, trying to turn the masses into using PHR systems to log data. Forcing each application developer to write code to a separate API which does exactly the same thing in a different way is a non-starter. The only time that happens is when developers have a big motivation. An API is only useful when it has users behind it, and lets be honest, HealthVault and Google Health do not have users. Neither do Indivo X (which is still alpha/beta) or any implementation of the Common Platform. The only PHR systems that actually have any users are the MyHealtheVet application from the VA and the Kaiser PHR. Both of those applications are gateways into deep connection into those respective integrated healthcare delivery systems, something Google Health and HealthVault are not (although they might be someday soon.)

My grandfather once advised me “Never play a man at his own game”. I have taken that to heart. I now live by a modified form of that advice:

If I am failing and cannot see why: change the game or change the rules.

That is why I work with Open Source. It allows me to change the rules. I want to thank Robert Wood Johnson for their commitment to Open Source. The information that their project released made the application that I built for my friend more capable. It allowed me to flesh out the design and prevented me from building a special purpose application. Thanks to Michael Botsko for making a good jQuery Form builder. People like him build tools that let people like me try and make a difference.

-FT

Why I am supporting my father for congress

My father, Clayton Trotter, is running for congress in San Antonio, T.X.

He has won the Republican Nomination against incumbent Democrat Gonzalez. He has the support of the local Tea Party.

My father is a true conservative both socially and fiscally. A federalist in the tradition of Ron Paul. My personal opinions often go against my father. Like the majority of Americans I tend to be financially conservative but socially liberal.

I doubt the rest of my immediate or extended family will be following my lead. They do not support my fathers complete conservative bent. They seemed shocked to learn that I would be supporting my father. I am also very close to many liberal friends who also might be baffled by my decision. How could I support my father when we diverge on so many issues?

The answer is simple. My father, whatever is political stance, is far more qualified to represent San Antonio and Texas in the United States Congress. It is not because he is a legal scholar of the first rank, though he is, and it not because of his conservative politics (which I can assure you are sincere.)

I am supporting him because he knows the price of war. My brother John Trotter, (Byron to his family) was killed in Iraq during Fallujah II while fighting in nearby Ramadi.

Losing him broke my heart. It broke my fathers heart. It devastated my family.

I will support my fathers campaign to run for congress because his broken heart qualifies him to decide whether the United States should go to war. His broken heart qualifies him to monitor and approve defense spending. My father is qualified to prevent a defense spending program that allowed defense contractors to make billions, even as national guardsman were self armoring vehicles in Iraq. I believe that he will read those bills a little more carefully, that he will pay closer attention when generals and admirals testify, and he will work harder than the thousands of congressmen who have no concept of the real consequences of even their smallest decisions. I know that he will do this in peacetime as well as during war, so that our soldiers, sailors, marines and airmen have what they need before they are sent to fight for us. I know that he will not tolerate the Washington bullshit that puts our service members at risk. I know that he will not put politics, even Republican politics, before the military. I know that he would happily give up his political career to save the life of even one soldier; someone-else’s Byron.

Our minor political differences pale in comparison to this single issue.

My father did not know it, but he prompted me to write this post by leaving the following message on my google voice account. He decided to visit my brothers grave at Arlington national cemetery today (the anniversary of 9/11) on his visit to Washington. While he was there he left this message for me. I am publishing this without his permission, because I want to give you insight into the man he truly is. I want you to see him as I see him, formidable, but also deeply vulnerable. His own words are the deepest endorsement I can make for him. I hope he does not mind too much.

Clayton Trotter 9-11 Call to Fred Trotter

Like all politicians, he needs contributions to win, please consider helping him.

Thanks,

-FT

Personal Science

Recently I have been approached by a clinic in Austin that operates under the assumption that there is a causal relationship between childhood vaccinations and autism.

This will not the first foray into the thick of bio-ethical debates. I have, in the past, advised both planned parenthood and catholic clinics on how to use open source healthcare software.

My policy for organizations like this is simple: I almost always help them. My software or software ideas can improve the experience of patients at any clinic, even if that clinic is taking a position on an ethical issue that I am unsure about or against. Most importantly there is nothing that I can do to change the position of the clinics in question, one way or another.

I hope that in the end, open source software will help to resolve some of these ethical debates by providing a cheaper means to get better quality data. While my opinions cannot change policy better data can.

So will I help this clinic? Probably. Will I allow this clinic to advertise my help as any kind of endorsement? Definitely not. Which is basically the same position I take on any reasonably complex bioethical issue where I can see both sides of an issue. Of course many in my community would say that members of the anti-vaccine community do not deserve this kind of benefit of the doubt.

Before climate-gate I might have agreed. But now I am much more sympathetic to arguments that run contrary to modern scientific consensus. I fell very betrayed that centrally referenced climate data was fudged by respected scientist in order to support a very specific conclusion. Because of the pharmaceutical corporate interest I am afraid that vaccine safety data might have been similarly fudged.

It is my hope that providing a clinic with a dramatically different agenda than the main stream medical community with cheap and effective tools to do advanced data gathering and analysis that I might provide them with a kind of truth-over-pressure. If vaccines can cause autism, then they should be able to generate some reproducible data that shows that. If vaccines do not cause autism then by giving this clinic better data tools I hope that I might be able to create a kind ideological implosion within the organization. I hope that I am not enabling an organization that is torturing kids with invasive, traumatizing procedures for nothing. But unfortunately I am not in a position to make that determination.

I hope, truly, that I am right to take this approach. I hope that the assumption that transparent code plus transparent data can create pressure to find the truth for other difficult issues is right. It feels like, more and more like I am betting more than my career on this idea of open source software in healthcare… I am betting my conscience too.

I would like your comments about my approach generally and about this situation specifically.

VistA modernization must use MUMPS

Once more, the debate about “whether” to migrate VistA from MUMPS has come up again in main stream press.

This always makes me sad because it shows just how fundamentally ignorant people are of what VistA is.

So lets get something straight. If you are not using MUMPS, in some form or fashion, it is not VistA. It is a new software project. New Software projects to develop comprehensive EHR solutions, do not work. Ever. That is called “Big Bang Development” and it is utterly doomed to fail.

In order to create an EHR system you have to grow one. You start with a system that is not comprehensive, you use it anyway, and then it grows into something that is a comprehensive EHR system. You cannot take a comprehensive EHR and assume that you can re-write it, from scratch in another language and that it will work. That is just unfathomable.

This has been tried, several times, and consistently failed.

So the reason that it is not “an option” is that it will fail. Thinking about it as an option is simply madness.

It is very like saying, “We need the Linux Kernel to improve, so we will recode it in Java.. not enough people are trained in low-level C programming” The folly and hubris should seem clearer now perhaps?

You might try drastically reinventing what MUMPS is, like ClearHealth, but you cannot simply “get away from it”.

Another example might be “New York has proven that the street + subway system is effective, the city planners of Venice should adopt that in place of the canal system that they currently use. Obviously New York shows that these modern features are capable of moving far more people…” The reason Venice does not consider a subway system is that it -cannot- work. The city planners there know that, so they never try.

It is ironic that people who say “we should move away from MUMPS” consistently consider those of us who actually understand the architecture and design of the system, and insist that we continue with MUMPS as a kind of “particularly obstinate political faction”, from the link above:

“Is MUMPS the right entity? I think the obvious answer is ‘no,’” Meagher said. “It just happens to have a bunch of very committed people who want to stay in that environment.”

When an engineer says “I can think of no way to achieve near light speeds in our lifetime”, he is not taking an obstinate political position. It is not “pro-light-speed” vs “against-light-speed”. The engineer is taking a position based on what he understands to be achievable.

When I say “VistA must stay with MUMPS”, I do so based on the only relevant evidence’ efforts to move away from MUMPS have consistently, and expensively, failed. I do not like MUMPS at all, but I have a pretty solid understanding of software engineering and you simply do not simply migrate to a new language for a codebase as large as this.

-FT