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Saturday, November 12, 2016

Thoughts on Veterans' Day, Nov 11, 2016

I was too young to fully grasp this event-- not quite 3 1/2 years old-- but I do remember when our family was notified, in Japan. It's the earliest memory I have as a child.

It was in early in the morning. We were in the kitchen. Dad was sitting at the kitchen table. I crawled into his lap-- he was wearing a white t-shirt, his face cradled in his hands, sobbing. I was trying to make him feel better, not fully understanding why he was crying so hard.

Thursday, November 10, 2016

Election of Donald Trump 2016

Again, this is a post that is intended primarily for our children, Anna and Luke, as a record of events and thoughts in their father's life that they might find interesting.

Closing thoughts on this weird day, Nov 9, 2016:

I voted for Hillary because Trump behaved in a way that was counter to every fiber of my upbringing. My Dad was a die-hard Reagan fan when Reagan was governor of California. Dad died before Reagan was elected President. That would have been a big moment. Mom followed Dad's lead when it came to politics, but after he died, she followed her own path of independence. Party didn't matter to her anymore. Morals and ethics mattered and she hated Trump because of that, before it was easy. Dad would have hated him because he was vile and crude to women, including his daughters...and because he was a city dude from New York, when dude meant dude.

I feel no remorse for Hillary's loss. I didn't like her anyway. She is the prototype career politician that is corrupting our political system and the very culture of the United States. And I can't mourn for someone who can't even beat Donald Trump. Dirtiest vote of my life.

I'm shocked by the people whom I know dearly and claim family values, yet feel no sense of guilt or filth from voting for Trump and celebrating him like a god damn hero. The hypocrisy kills me. I sure wish I could see a little more, "Trump sucks, but not as bad as Hillary", from you. I could understand that.

I want Mother Nature to know, if She starts getting even more trashed... And I want my gay, lesbian, Muslim, Black, and immigrant friends to know... if the shit hits the fan, I'll be there with you, joined by millions of others. You don't even have to call.

But here we are... and I'm going to pray and hope that Trump is the agent of good change that we need in American politics. I absolutely want him to be a great President for all of us. I absolutely want him to help Make America Great Again. Rather than wring our hands and expect him to be a demagogue, let's expect him to be great. Let's see if his ego can deliver on the brags.


Wednesday, October 19, 2016

Story for Anna and Luke: My Old Denim Jacket

I've had this Lee Storm Rider jacket since I was a sophomore at Durango High School, purchased in the fall of 1975. Most every boy in high school at that time, wore a denim jacket. This one is insulated with a flannel liner, which made it very warm in those Durango winters, when winters were deep and cold, not like today.

Dad bought it for me at Basin Co-op. I only wear it about once or twice a year now; don't want it to fall apart. The left cuff has damage from battery acid-- from jump starting our tractor. I remember Dad warning me to clean it thoroughly as soon as possible, otherwise, it would "eat it away like cancer."

The jacket was stolen while I was at a party during college, probably in 1981. About a month after the party, I saw a fellow wearing it in downtown Durango at a bar-- The Sundance Saloon. I politely approached him, though I was pretty tense. He claimed the jacket was his. I said, "I'm pretty sure it's mine and if it's mine, there's a blood stain about the size of a thumb on the left sleeve just below the elbow."

A friend was with him and my friend, Steve Janes, was with me. The fellow lifted his arm up and we all saw the stain. There was about five seconds of awkward staring at each other, then he took the coat off and handed it to me without saying anything. I said thanks, and that was the end of that.

Steve was always much more interested in fighting than me, so he was a great backup, but I was definitely not going to leave without that coat. It had all sorts of sentimental value, especially since Dad had died just a couple of years before, in 1978.

Monday, October 10, 2016

Hacking Into Our Voting Systems

In 1993, Ron Gault and I met with the Federal Election Commission after our NSA-contracted team at TRW identified several very easy ways to hack into the then-emerging computerized voting systems. We warned the FEC about the possibility of election fraud and manipulation. Their response was interesting: (1) We don't regulate or certify voting systems; that's up to each state to manage; and (2) There are always errors in counting votes. We recognize there are inaccuracies but those inaccuracies are small compared to the total number of votes, and would therefore not impact the outcome.

Fast forward to the Gore/Bush runoff in Florida, where a few votes most definitely mattered. Fast forward again to today, and the sophistication of Russian hackers, as described in this Wall Street Journal article, "U.S. Intelligence Chief Suggests Russia Was Behind Election-Linked Hacks."

Our computerized voting systems are still an unregulated, unprotected hacker's dream. Their only saving grace is that they are, for the most part, only partially networked; thus the propagation of an attack is more difficult.

This is going to be a very interesting election.

Thursday, October 6, 2016

Memory for Anna & Luke: October 2011 with Grandma Sanders

I took this picture five years ago to the day, between Dunton and Rico, Colorado.

Oct 6, 2011 was my first day moving back home, after leaving Durango in 1983 for the Air Force. Coming back home was an easy, yet scary decision, not knowing exactly how I was going to earn a living or what it meant to my career. But it turned out to be one of the best decisions of my life. God took over.

This day was the first time that my mom, Ruby Sanders, had been on that road in over thirty years, since my dad, Doyle Sanders, died in 1978. She had lived alone ever since, but was always busy, loving and outgoing. I moved back to spend time with her while she was still healthy. Two and a half years later, she died in her sleep, in her bed, in her home of over 60 years, where our family was raised.

I spent a lot of time growing up, with my dad, hunting and exploring in these mountains, meadows and flats in the west fork of the Dolores River. When Mom and I saw this scene on this drive, it felt like a sign from Dad, "I'm here with you, pardner. You're back home. You're supposed to be here."

Monday, August 22, 2016

One of My First Paying Jobs

This time of year, as a kid, I’d be getting ready to take my steers to the livestock auctioneer in Cortez, Colorado.

Dad would loan me the money to buy 3-4 steers in April, I would put them on pasture-- he would charge me a grazing fee-- then feed them grain the last two weeks of August and sell them in early September, hoping for about a 1.5 lb average gain/day over those months. I would usually make about $400-$500 profit on the whole deal. That was a lot of money at the time-- mid 1970s.

The stories along the way were priceless-- all the weird things that would happen while raising those steers and taking care of them-- like the one “crazy” steer—with horns-- that would charge you if you weren’t on a horse. We warned the auctioneer, but that steer charged the handler at the livestock pen, hooked the guy’s pants and threw him over the fence. As a teenage boy, nothing was funnier.

I practiced and practiced until I could do a pretty good version of the auctioneer. I can still do it…I uncork it in the morning when shaving…pretending to sell my razor.

Saturday, August 13, 2016

40-Year Old Matches

My dad carried these matches in the glove box of his truck. He died in 1978 and I've toted them around the world, ever since. The top of the pill bottle was white at one time. It's a nice shade of yellow from age now. We spent a bunch of time in very remote places in the days before cell phones, when southwestern Colorado and the Four Corners weren't nearly as populated or visited as today, and cars and trucks weren't as reliable. You never knew when a campfire or signal fire might be necessary. I have no clue why they are sentimental, but they are... or how I've managed to hang onto them, given how many times I've moved.

These are "strike anywhere" matches, by the way. I don't think you can't buy them anymore. I don't see them at the grocers story, anyway. All you needed to light these was a good rock or, if you really wanted to flash your bad ass wild west colors, you could light them with a fast swipe on the backside of the leg on your Levi's. You can't do that anymore.

Life is fascinating.


Monday, July 25, 2016

Buck Meets Magpie

I caught this moment behind our house in Durango, July 2015. The magpie came swooping in and landed softly on the buck's butt and sat there. The buck kept eating, head down. The magpie just sat there. Then the buck twitched his tail. Magpie didn't move. Buck raised his head, turned around to look at the magpie, and they met nose-to-nose. The buck went back to eating, and the magpie sat there for a few more moments, then flew off, satisfied that he had accomplished his shenanigans. :)

Sunday, July 17, 2016

Don't Worry, Just Think

For my daughter and son...

This thought came to me this morning: "Don't worry, just think" and the meaning that came with this thought was, "thinking" means you are learning and reflecting and actively involved in solving a problem, if you can solve it, or accepting it if you can't. Worrying means your are digging a hole.

Stop digging. Start thinking.


Saturday, July 9, 2016

My Early Days in Cyber Warfare

I was prompted to write this blog by the release of a new movie, Zero Days, about the US cyber warfare strategy against Iran's nuclear weapons program.

In 1989, I resigned from the Air Force as a C4I officer (Command, Control, Communications, Computers and Intelligence). My specialty in the Air Force was nuclear warfare planning and execution. I was also an airborne nuclear launch control officer; one of a handful of officers selected to fly aboard the Operation Looking Glass airborne command post with the responsibility to "turn keys" and launch all 1,000 Air Force nuclear intercontinental ballistic missiles (ICBM), as well as disseminate coded Presidential orders to launch nuclear armed submarines and bombers. Little known fact: We held all the same codes that the President carries in the "football" and had the ability to issue those launch codes and orders without the approval of the President.

After the Air Force, I took a job with TRW, working for Ron Gault. Ron had a deep background in nuclear weapons surety-- the combined expertise of security and safety, as described in this Department of Defense Directive. He hired me because of my background in nuclear weapons C4I. He had deep knowledge at the engineering level of the weapons-- the warheads, propellant, rocket motors, cryptography, guidance and targeting systems, etc. I had deep knowledge at the national command and control level. Between the two of us, we knew more about the top-to-bottom operation of our US nuclear weapons than any two people in the world at the time. Ron is still in this business and is now known as "The Godfather" of nuclear surety.

We applied our knowledge of nuclear command and control in various ways, working for TRW, the Air Force, Navy, Army, and National Security Agency. In particular, we specialized in very formal and sophisticated risk and threat analysis associated with our US nuclear weapons, making sure that they could only be used as authorized and intended, protecting them from both deliberate hostilities from enemies and terrorists, as well as accidental misuse by US military and civilian personnel. We were responsible for identifying and exploiting any and all vulnerabilities in the US nuclear command and control system, from the President to the warheads. We would dream up every imaginable threat scenario, then try to model it, probabilistically. For some of the more outlandish scenarios, we would collaborate with the national labs, such as Sandia and Los Alamos, to build the technology and implement the scenario. The code words to describe the nuclear incident scenarios that we were most concerned with were Pinnacle, Bent Spear, Broken Arrow, NUCFLASH, and Empty Quiver.

Under the Nunn-Lugar Cooperative Threat Reduction Program, our US-based work eventually led to the same sort of threat analysis but this time applied to the nuclear weapons that were associated with the former Soviet Union. After the collapse of the Soviet political system, so followed the collapse of the military command and control structure of their nuclear weapons, especially those weapons that were stored outside the boundaries of Russia in what are now known as the former Soviet bloc. Virtually every US-hostile country and terrorist group in the world were highly motivated to exploit this breakdown in Soviet nuclear weapons' control. Those hostile forces were literally racing the US to get their hands on those weapons and technology before we did. Under Project Sapphire and other related operations, we won the race.

Those enemies of the US have never stopped their attempts at acquiring a nuclear weapon. Sooner or later, those enemies, particularly terrorists, will likely succeed, but not by stealing a weapon or building one. I believe they will acquire a nuclear capability through a state-sponsored third party such as North Korea, Iran, or possibly Pakistan. In this scenario, a terrorist organization will negotiate with one of these nation states that possess a nuclear weapon who is also hostile to the US, or western society in general. Neither North Korea nor Iran will ever use a nuclear weapon directly against the US or a US ally because they know that it would mean the end of their country. They will collude with a terrorist organization that has no nation state, and cannot be directly targeted for retribution by the US.

In the mid-1990s, our threat analyses identified numerous opportunities for hostile nations and ideologies to utilize commercial-off-the-shelf (COTS) software and hardware as a medium for attacking our nuclear command and control system. Commercial software-- such as Windows, Unix, and DOS-- and commercial CPU chips and memory were making their way into the periphery of US weapons systems, including our nuclear command and control. Many of those chips were being manufactured overseas where enemy states and actors could easily insert malicious code into the firmware. We proposed to TRW that we initiate a formal research and development (R&D) program into this growing threat, and it was approved and funded.

Fast forward to 2010 and the Stuxnet virus that targeted Iran's nuclear centrifuges by inserting malware in commercial-off-the-shelf industrial control systems, which was a component of a larger cyber warfare strategy against Iran known as Operation Olympic Games, as portrayed in the documentary, Zero Days.

Ron and I, and our team, were the first on the scene of cyber warfare that exploited COTS software and hardware. It was easy to see then, that this would become a new battleground-- why drop bombs or take more overt measures when you can do much more damage through commercial software to an enemy state, with no attribution to your forces?

As a career, healthcare has been rewarding, but not nearly as interesting or rewarding as working with Ron during this time. I often find myself wanting to return to this line of work, but, of course, it has its downsides and dangers. My 2-year old daughter, Anna, and 6-month old son, Luke, keep me grounded in reality. They more than fill the gap of reward and fulfillment.

Tuesday, July 5, 2016

Returning to the Roots of Clinical Decision Support

Long story short, I was re-reading this paper about the origins of the HELP system at Intermountain Healthcare. I was the Director of Medical Informatics at LDS Hospital from 2000-2004, many years after this paper was published. I was lucky enough to be tutored and mentored by all of the authors. While reading the paper with time to reflect back, I realized that the healthcare industry turned clinical decision support inside out when we almost subconsciously moved from very targeted and specific clinical decision support applications that were clearly benefiting patient care and cost of care, towards EHRs that were simply general data collection tools. We've been trying to squeeze the decision support blood out of the EHR turnip, ever since, to no avail.

When Pryor, Clayton, Gardner, and Warner (and later Classen and Pestotnick), were developing computer applications to support patient care at Intermountain Healthcare's LDS Hospital, they built very specific, target applications. They didn’t use a backend, longitudinal EHR as the basis for their applications. They collected the data that they needed about a patient in a particular clinical state, and they ran computerized decision support against that data. Our smart phones are good examples of specialized applications. We call upon specific applications when the need arises to perform a specific task. In medical informatics, it was these specialized, targeted clinical decision support applications that clearly made a positive difference for both patients and clinicians.

Somewhere along the evolution of computerizing healthcare, we turned all of this success from specific decision support into a general tool we call an EHR (or EMR) that has so far shown almost no value to clinical decision support. Going forward, we will return to the roots of this success. The data collection templates for patients will be tailored specifically for the patient type, and the subsequent computerized decision support will also be tailored specifically for the patient's state. The “EHR” of the future will look more like a smartphone with dozens of applications that support very specific patient types. The data we collect will not be the general data that is currently collected in EHRs, but rather very specific data for a given patient type. We will knit this specific data together, on the backend, to form a longitudinal record.

We (Health Catalyst) are in a good position to make this turn to the future, given that our applications and analytics are very specific to patient types.

Sunday, June 26, 2016

I Feel Like a Fake

I wrote this blog as a public declaration of what I suspect haunts others, privately, in hopes that all of us can find an emotionally comfortable place to manage these emotions in a positive way; and as a record for my young daughter and son so that they can hopefully find comfort knowing that their father struggled with many of the same things that they will probably struggle with, too.  By the way, I'm not hoping to alleviate the emotional struggle described below, only manage it effectively and positively. I never wish for the relief from hardship, because hardship makes me stronger. I only wish for the strength that comes from it.

By most measures, I’ve had a life that has been blessed with an abundance of adventure and experiences. My LinkedIn profile summarizes the professional adventures, but doesn’t mention the many personal adventures and experiences that have come my way, which, to me, are equally full of blessings and personal growth, if not greater. For the most part, I think my contributions to life and the lives of others has been generally positive. There’s no doubt that I’ve stepped on toes and made my share of offenses, but most of the time, the wake has been constructive.  You'd have to ask others to get the real truth. Many of these opportunities, and whatever success I had with them, had nothing to do with me or my skills. They were simply the luck of life and opportunity placed within grasp; so I grabbed them, just like anyone else would. 

You would think that I could just accept all these blessings and be thankful for them… try to share them with others... and hope that they keep coming and that I can keep giving back.

But, I can’t… or at least I can’t without struggle.

Quite often, as was the case yesterday, I’m asked to give lectures and speeches that, for the most part, always end up being a summary of my life’s lessons learned, up to that point. They are a mixture of my professional and personal observations about life, usually centered around a particular topic. Yesterday, the topic was “Machine Learning, Big Data, and Population Health Analytics.” A mouthful of buzzwords, for sure. My goal with that lecture was to inform the audience of mostly healthcare executives and physicians so that they could make better decisions about the technology that is having such a big impact on their lives and careers.

All of these lectures are about advice and guidance. I’ve given over three hundred of these in the last 30+ years. While I’m always honored to give a lecture or presentation, and share my life’s lessons, it pains me to do so. I’m a nervous wreck-- before, during and after. While lecturing, it’s not uncommon for me to nearly faint from nervousness-- I manage to avoid it and hide it from the audience.  If anyone approaches me after the lecture to offer a compliment, I break into a nervous sweat. On the one hand, I am enormously thankful for their compliments, but on the other hand, I feel enormously undeserving. Of course, I’d much rather have the compliments than the alternative, but no matter how many compliments I might receive afterwards for a lecture, I always feel undeserving and false, and the more compliments I receive, the worse I feel, emotionally.

These emotions are all rooted in a duality of confidence and insecurity. On the one hand, I can acknowledge the accomplishments and experiences in life that are, on some level, unique and some would say impressive. For example, not many people have had the responsibility of turning keys to launch all 1,000 nuclear ICBMs in the US arsenal. That's a pretty big deal and it's fairly common for people to be interested in learning more about my experiences in that realm. But on the other hand, the older I get, the more I realize that there are countlessly more impressive achievements and responsibilities that people who are never recognized... never complimented... accomplish every day. And if they were trained and placed in the same positions as mine, they would do exactly what I've done, and probably do it better.

Though I have confidence in the knowledge that life has bestowed upon me, there is nothing about me that is particularly wise or capable. I’m one of the most average, bell curve people you’ll ever meet. The only thing that might not be average is the enormously good luck and diverse opportunities that have come my way.  I feel disingenuous to receive compliments from people who have worked much harder, and have much greater lessons, knowledge and advice to share than me. Who am I to stand in front of an audience and portray my life or knowledge as anything noteworthy?

I keep going back to the well, again and again, trying to find the water of comfort with this awkward situation…trying to find a way to be comfortable with simply sharing the blessings of life’s experiences that have been placed upon me, in hopes that the sharing will inform and inspire others. I keep trying to be comfortable with all of it, but the older I get, the more I realize how much I don’t know, and the less deserving I feel. The older I get, the worse the emotions and feelings trouble me.

I wish I knew how to make sense of it all, and how to turn these emotions into something positive. Until I can figure it out, I’ll keep facing it down.