The Man With 3300 Patents

Fun read in Smithsonian Magazine about Dr. Yoshiro Nakamatsu, a.k.a. "Sir Dr. Nakamats", who claims to have more than 3300 patents including the original floppy disk.

By Frotz at en.wikipedia [CC-BY-SA-3.0
(http://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons

He's clearly a wacko but also has some interesting things to say about successful innovation.

Money quote:

That early floppy, he says, is perhaps the purest embodiment of Ikispiration, the Dr. NakaMats system of creativity. Ikispiration has three essential elements: suji (“theory”), pika (“inspiration”) and iki (“practicality”). “To be a successful invention, all three are needed,” says Dr. NakaMats. “Many inventors have pika, but not the iki to realize their dreams.”

This actually makes a great deal of sense to me: a balance between what is known and practical taken someplace new thru inspiration.

Then there is this hilarious comment on having children (he has three):

“A child can be invented four ways,” he grumbles. “Smart seed, smart field. Smart seed, stupid field. Stupid seed, smart field. Stupid seed, stupid field.”

And how did his kids turn out?

“All stupid due to stupid field.”

So much for Mrs. NakaMats.

And so much for nature vs. nurture.

Online Access to Clinicians: Impact on Utilization

By Brian Kerrigan (Own work) [CC-BY-SA-3.0
(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

This recent article in JAMA reports on the results of a retrospective study of how online access to clinicians affects use of services.

The results are unexpected and contrary to conventional wisdom: patients with online access used substantially more services across the board including office visits, after hours advice, ED and inpatient admissions.

The study conducted by Kaiser Permanente, while subject to some limitations, is reasonably well constructed and looked at 24 months of utilization by established patients. Presumably the platform was Epic Systems patient portal MyChart.

This study throws some cold water on the current hopes that virtualization of the healthcare system will lead to decreased utilization. The thinking goes that if it is easier for patients and caregivers to connect, then simple matters will be handled "online" while those with chronic diseases will be more closely monitored and more likely to get help early when it is often easier to intervene before things escalate.

This study calls this into question.

Of course there are several potential flaws in the study - these are well described in the article. Clearly more studies are needed to validate or refute these findings.

The other, and ultimately most important question, is the overall long-term impact on clinical and financial OUTCOMES. It may be that online access leads to increased utlization that is both appropriate and ultimately more clinically effective.

If not, then we may have to rethink the use and value of online access.

The Clash of Domains

Paul Graham has an interesting post on coming up with good ideas for startups (and quickly weeding out the bad ones).

This part was particularly intriguing:

The clash of domains is a particularly fruitful source of ideas. If you know a lot about programming and you start learning about some other field, you'll probably see problems that software could solve. In fact, you're doubly likely to find good problems in another domain: (a) the inhabitants of that domain are not as likely as software people to have already solved their problems with software, and (b) since you come into the new domain totally ignorant, you don't even know what the status quo is to take it for granted.

Having spent a good part of my professional life working at the boundaries of different domains I have often found this to be both true and generalizable beyond software.

Obviously there can be a great benefits to being an "expert" with deep knowledge, but this can also blind one to new insights or perspectives. In addition, when you can bring knowledge from one area to another, this can create new insights and approaches. It can also provide a personal competitive advantage.

I've learned a lot about management from working in my vegetable garden. There is a time to plant and a time to harvest.  Spending a lot of time preparing the soil improves yield ("plant a 5 cent seed in a $1 hole). Pruning back will lead to better, more lush growth later.

In an age of increasing specialization, contrarians who pursue a wide variety of interests will sometimes produce the greatest breakthroughs.

Camels, Elephants & Cows, Oh My.

Are everywhere in Jaipur. For show and for work. Camel carts are common.

Met this guy at a roadside cafe:




Manish and Charuta ride an Elephant up to the Amber Fort:




Cows really are sacred in India - and for good reason. They graze and produce milk that sustains many a child and family. They are everywhere and roam freely, mixing in the streets with people and vehicles. It was not at all unusual to see a cow strolling down the main street as cars and taxis weave around. On more than one occasion I saw a few sitting in the median of a busy 6 lane highway calmly chewing their cud.

This one is was standing in the street just outside the very holy Brahma temple in Puskar:

Tears of Sadness. Tears of Joy.

One afternoon we load up in our trusty van and our insane, enraged driver takes us on another gut wrenching, harrowing drive. This time we are making the journey south across Rajasthan from Jaipur to Puskar Lake. The decision to go to Puskar, like most of our decisions on this trip is last minute and semi-random. Like me, my travel companions prefer to keep plans loose and seek opportunities for serendipity.

This one will turn out to be something truly magical! But, I'll get to that part soon enough.

The ride to Puskar fits a pattern that I'm becoming used to. Crazy driver? Check. Insane traffic? Check. Roads randomly punctuated by all manner of rest stops and small, dusty, dirty villages? Check. Phish tunes playing in my earplugs? Check. Great conversations and laughter with my travel companions. Double check.

This kind of travel wears you down quickly and between that and the jet lag - my body still has no idea what time zone I'm in - I grow tired and and a bit cranky. I think, this sure is a long way to go just to see some lake and an old temple. Not for the first time, or the last, I will be proven wrong.

Manish and Charuta explain to me that Pushkar Lake and the Brahmin Temple located there is one of the most holy Hindu sites in the world. They make casual remarks, "Maybe we should get married there. You can be the witness, ha ha." I know they plan to go to Las Vegas for a quick legal marriage in a few weeks followed by a celebration in India so I brush this off as fun fantasy by two happy lovers.

As we enter the town, it becomes clear that this is not just another day in this holy place. We are arriving near sunset on Kartik Poornima, the most holy day of the year!  The place is alive in a way that can't be described. There is something deep and spiritual here.




I am not a religious man. I'm a rationalist first and foremost. But I freely admit that the universe greatly exceeds our puny capacity to understand. I consider myself "mildly agnostic" believing humility is the best position to adopt. And yet, something special is going on in this place.

We reach the temple site which sits near the lake just as the sun is setting. There is a gathering place outside the temple with stairs that descend to the water. The crowd is buzzing, chanting and performing religious rites led by a small army of Hindu priests. The mystery and mystic feeling swells.




Manish and Charuta prepare to participate and encourage me to do so as well. I've tried to make it a practice to join in religious ceremonies that involve friends and family with an open heart (if not an exactly open mind) . The Jewish holidays and bar mitzvahs. Catholic mass. I've even attended Friday prayers at a mosque in a small town in Turkey. I am happy to participate.

We start as a small group with two Hindu priests but almost immediately they separate me from my friends. One priest goes with them while the other leads me down the ancient marble steps to the lake. The priest is friendly and his English is good enough that I can follow most of what he is telling me. He explains each step in the ritual and then leads me through the prayers. He marks my forehead in red and applies grains of rice. He ties a string around my wrist, "to bring you good luck as long as you wear." We chant and manipulate the ritual objects - a flower, a coconut, some water from the lake. I'm interested but in my normal detached observer way.

He begins to lead me through a series of prayers based on my answers to questions about my parents, my wife and my children.

Then something extraordinary happens. He asks me if I have lost someone close to me. I immediately flash to my beloved brother-in-law Jeff who died of cancer at a young age leaving my sister Ann a widow to raise her two beautiful girls alone. Something deep inside me cracks open. I can barely get the words out. "Yes", I say, "my brother-in-law Jeff". He responds, "Then we will pray for him and his soul will ascend to heaven immediately".

He begins to chant and I struggle to respond. Tears begin to flow. I have cried about Jeff a number of times thru the years. He has been gone a long time but the wound is always fresh. I've told Beth that I don't think I will ever get over it. Here, in this place I grieve again, feeling the pain deeply but also a bit of release. I don't really believe in Heaven or Hell but somehow, here I want to believe. My brother says Jeff is in Heaven sailing his boat on a beautiful sea. Tonight I can picture that clearly.

The ritual ends by anointing myself with water from the lake and casting the flower petals into the water. I gather myself and my emotions, make a small donation to support the priest and the local charity that feeds the village, and then wander off to find my friends.

I see them performing a ritual together led by first priest we met. I start to descend the stairs but another priest stops me and says I must not approach them, "They are performing a special ceremony". It is then that I realize that they are, in fact being married at this very moment and I am a witness.

Again I am overwhelmed and tears begin to flow again. But this time they are tears of joy. I think of my own wife Beth and the deep, rich history we share after almost 30 years together. I am filled with happiness and love for my friends. Even from this distance I can see the love in their eyes as they gaze at each other and perform the rituals.

As they ascend the stairs there is joy around them.... and now, a mischievous look in their eyes.




"Guess what we just did?", they almost giggle.

"You just got married!"

"How did you know?"

"How could I NOT know!"

I tell them how honored I am to have been a witness to all of this.

And I tell them about my tears.

First tears of sadness, then tears of joy.

Shopping

My wife will never believe this but I went shopping with Manish and Charuta for 4 solid hours and had good time!

Basically you sit and drink tea or coffee and they bring all kinds of things for you to look at. You pick out what you like and then bargain hard.



When you get hungry, they bring you hot food.


These were so good, we went back the next day and got some more to take on the road with us!



Thank goodness Charuta was there to help me pick it lots of beautiful things for all the beautiful women in my life (and to negotiate - she's tough!!)

Blending In

I like to blend in with the locals when I can. In this part of the world I can pass pretty easily. More often than not, locals would first speak to me in Hindi. Manish and Charuta would crack up when ever a local would approach us and speak to me rather than them.

A little sun, the right clothes, a string on my wrist and as along as I keep my mouth shut I'm all set:

Mustache Contest

Met this guy on the road from Delhi to Jaipur.




I think we all know who won this contest.

India is Intense

The moment I step off the plane it hits me. I've been fortunate to do a bit of travel including some exotic locations: Kenya, Tanzania, Turkey, Israel. This is different than anything I have experienced before. Immediately there is an intensity of sounds, sights, smells and activity.

Intense. This is the word one often hears associated with travel in India. There is the scale of course, after all the place is huge and crowded. But there is more to it than size. It's as if the heat has boiled it down to an super concentrated mixture, undiluted, overwhelming and intoxicating. This theme of Intensity, which first hits me while standing at baggage claim will recur and be reinforced as we travel. Even now as I reflect, I can't think of a better word to summarize this vast and complex place.

The heat and spices of the food.

The overwhelming crowds and traffic.

The diversity of dress and culture and religion.

The dust, filth and crushing poverty contrasting with the natural beauty, wealth and opulence.

And the people. The rich variety of faces and skin tones. Wide smiles seem to come easily, even from the most disadvantaged. But there are also occasional scowls and sadness. The wealthy and some of the most wretched I have ever seen (and I've walked the back alleys of Istanbul and sat in a Masai dung hut) mix freely in the streets.

Yes, intense is the only word that will do.

The Puppet Show

One night we visited a replica of an authentic Rajistani village. Crafts, performances and food all designed to give you a sense of village life in this region.

This girl greeted us at the entrance and marked our foreheads with crimson and rice grains:




These two young girls danced and twirled while their mother and father played traditional instruments:



The best part however was the puppet show! This man played the tabla (Indian drums) and sang the narration:



Here is the "stage":




We laughed so hard at this crazy, energetic show that included a suggestive dancing girl, Michael Jackson (whose head comes off and flys off into space several times), a scary snake, and a horse and man doing things that are not suitable for me to describe in this family-oriented blog!

It was truly hilarious even though I couldn't understand a word of it!!

Then we sat down to a traditional meal





I'd go back just to see the puppets again...

The Ultimate Back Door Travel Experience

Beth and I subscribe to Rick Steves' back door travel philosophy. Basically this is about avoiding the typical tourist-trap, big bus, race through the sites travel experience. That's the "front door".

The "back door" is all about getting close to the ground, less rushed and more authentic. It's about trying to really understand and feel how the locals live. It's about staying at the 2 star B&B even when you can afford better, eating in a place full of locals that doesn't have a "Tourista Menu" (or any English on the menu), going through the museum in reverse order to avoid the big crowd. Most Importantly it is about taking advantage of any opportunity to hang out with locals. We consciously and deliberately collect friends from across the world with the hope that we might someday share a backdoor experience with them.

So when Manish told me that we were going to have Sunday lunch in Delhi with an old friend and his family I was pretty sure I was in for something special.

Ever the concerned, caring friend he asked, "Are you sure this is OK? If you want to do something else that's fine."

"No way!", I replied and proceeded to explain the back door philosophy.

I was not disappointed.

Sanjeev was a close childhood friend of Manish but they had lost touch for almost 30 years. Through the power of social networking, they recently reconnected and our visit to India provided the first opportunity to meet in person after all those years. Sanjeev's mother was important in Manish's early life and a close friend of his mother as well. So it was an extra bonus when he learned that she would be there as well.

We drove to a residential area of Delhi and joined Sanjeev, his wife, two children and his parents for a wonderful home cooked meal. It was the kind of backdoor experience I crave and it was, in a word, fantastic.

The pictures best tell the tale.




Manish & Sanjeev catch up on old times. "Remember how we used to play in the garden after school and eat fresh pears from the tree?"




The table is set. The food was all home made and really GOOD!




Grandfather takes a short break from watching the big cricket match (India vs. England!) to join us.




Old friends reunited.

India

I've been fascinated by India for a long time for reasons that I've never been quite able to understand myself.

Perhaps it is the rich and ancient culture, or the incredible diversity of people, or the rise of one of the worlds largest democracies after centuries of oppression.

Or maybe it's the food. After all, this love affair began with my first meal at a real Indian Restaurant almost 30 years ago!

Regardless of the reason, I have longed to spend time there and when work-related travel presented the opportunity to be close by I couldn't pass up the chance to visit. A short visit, a single appetizer as it were, but one that was sure to whet the appetite for a future feast.

Of course, the best meals are shared with others and the best travel is through the back door. Manish, my colleague and friend is a US citizen but native of India. When I asked if he would be willing to take me there once we had completed our work in Abu Dhabi he graciously and enthusiastically agreed. He then set about planning what turned out to be an unforgettable visit to two corners of the Golden Triangle of India: Delhi and Jaipur.

We met in Abu Dhabi where we had several days of work to do before heading out for our adventure together. Over breakfast the first morning in AD, Manish says he has something important to tell me. Something personal. Something that would affect our trip. He has a strange look on his face - a mix of excitement and apprehension.

He started off, "I've met someone. Her name is Charuta. Actually I've known her for almost 2 years but since we worked together we avoided mixing our personal and professional lives. But we realized that we truly liked each other. She is Indian too and we have so much in common. So we started dating and that, in turn led to us falling in love....and....we are getting married! Is it ok if she comes on the trip with us?"

I must have had a grin a mile wide and could hardly contain myself. I stuttered, "Manish, this is fantastic! I am so, so happy for you. You have such a big heart - you need a woman to help fill it up. This is GREAT!"

"Thank you.", he responded and then with mild apprehension, "But is it OK that she is coming with us on 'our' trip."

Again, the mile-wide grin, "Are you kidding? Of course it's ok. It will no doubt enrich the trip. Frankly, I am honored that the two of you would share your maiden voyage together to India with me. This is GREAT!"

And so, early one evening I boarded a plane in Abu Dhabi with my friend and his fiancée to begin a long awaited adventure to India.

Manish & Charuta preparing for take off:

CCAD = Audacious

This trip did involve some time in Abu Dhabi and some work too! So a word about that as well.

Abu Dhabi (AD) , the largest emirate of the United Arab Emirates (UAE) has undergone spectacular growth during the late 20th and early 21st centuries. In 1960 this was a fishing village with an estimated population of 25,000. By 1985 the population had grown to almost 300,000 and today there are over 2 MILLION with growth projected to reach 3 million by 2030. Fueled by oil wealth and a massive ex-pat labor force, AD has transformed itself into a thriving and diverse community.

The leadership has clearly attempted to balance preserving old traditions with the advantages of a modern society. Major investments in infrastructure, education and healthcare are diversifying the economic base and creating an enviable standard of living.

Everything is larger than life with huge and beautiful architecture:





As part of their efforts to to take healthcare to the next level the Emirate has partnered with Cleveland Clinic to build Cleveland Clinic Abu Dhabi (CCAD), the largest and most modern healthcare facility in the region. The facility will be owned by Emirate and operated by CC. Their shared goal is to bring the exceptional quality and patient experience for which the Cleveland Clinic is known to Abu Dhabi. It is a truly audacious and worthy goal for both organizations and, if successful, could serve as a model for similar ventures in other parts of the world.

As you might imagine the challenges are immense given the scope, scale, complexity, and cultural differences.

It has been said that while Fred Astaire was a great dancer, Ginger Rogers was even better because she did danced backwards and in high heels. I told some of my colleagues in AD that if the Cleveland Clinic is Fred, they are Ginger. To which they replied, "Yes, and we do it on sand too!"

At the job site. Some proof that I actually did some work on this trip too:






In the "belly of the beast" construction is well underway and there is an incredible maze of pipes and wiring:




Important job site safety tips brought to you by Homer Simpson. D'oh! :





It is truly a privilege and honor to play my very small part in this important endeavor.

CCAD = Audacious.

Verba volant, scripta manent

A Latin proverb meaning "spoken words fly away, written words remain"

...or as I've often said, "Don't write down something that you wouldn't want to read later in the New York Times."

Good advice to ponder as we watch the fall of several high ranking US Generals in part because of their use of email.

Of course, it would be best to resist temptation.

Hat Tip: Dr. Massimo Ferrigno.

Welcome to Abu Dhabi

It's good to be on the road and blogging again. Had previously been as far east as Israel and Kenya so this is also a new personal record for traveling east.

My initial impressions: wonderful diversity of people, dress and culture and a place that likes everything supersized:



View from the Intercontintal Hotel. Note that there are almost no sharp edges or corners on the buildings.

More to come but wanted to get a first post up!