Boston is a beautiful city with many a European tourist delighting in its Euro-feel, especially the city’s walkability. Literally, you can get around Boston pretty easily on your own two feet.  In fact, over 13% of Boston residents commute to work by walking. That may not seem high, but it is the highest percentage in the US.  Go Boston!

Unfortunately, getting around Boston by bike can be a challenge, the drivers are at times terrible and the roads can be atrocious.  Since moving to this city some 24 years ago, I have been commuting by bike to work (it’s my way of training for race season & just staying fit and eating whatever I like, including that second helping of desert) and have been doing it year-round since 1989.  Over the years, I have witnessed a very slow yet steady increase in the number of people commuting by bike. For example, in ’89, I may have seen 5 fellow bike commuters over the entire winter.  Last winter, I saw easily double that amount every evening on my commute home after dark. For whatever reason, these people are choosing to ignore the Bicycling magazine article from several years back that rated Boston one of the worst cities for cyclists in the US and are venturing forth. I welcome these cyclists, partly because seeing them ride gives me some measure of faith in humanity and also from a self-preservation viewpoint as the more bike commuters there are on the streets, the more drivers are aware that yes indeed they need to share the road.

And that Bicycling article caught the attention of our good Mayor, Thomas Menino, who took it personally and set out to do something about Boston’s poor showing. He started riding a bike, he hired a cycling czar and city hall actually started to listen to cyclists and making changes. (In the early nineties I was appointed to the Mayor’s commission on cycling which went absolutely nowhere – but that was a few years before that article in Bicycling appeared). We now

have a number of streets in Boston with a big graphic of a bicycle now painted on the right-hand side every couple hundred yards or so delineating a bike lane, the number of commuters on bike has seen a marked increase and this weekend, the City hosted its annual Hub on Wheels Ride.

The Hub on Wheels ride takes riders on either a 10, 30 or 50 mile ride around Boston. One of the highlights is the beginning when all of the nearly 7,000 riders ride on Storrow Drive, the major thoroughfare that courses from east to west along the Charles River. Let me tell you, if you’ve never seen some 7,000 people all riding at roughly the same time, you are in for a treat – its a beautiful sight to behold – so many smiling faces, people chatting, even saw one parent towing his two young daughters all three pedaling together.

While Storrow Drive was closed to vehicular traffic, on virtually all other roads cyclists rode on streets with cars.  Granted, it was a Sunday when there is no commuter traffic, school buses and the like, but it did expose these riders to a city that is one that can be travelled on bike about as easily as it can be on foot (at least in the warmer months).  Hopefully, this experience will encourage some of these recreational riders to reconsider their mode of transport to and from work, stepping outside on a beautiful fall morning to ride their bike to work arriving fresh, fit and invigorated, rather than reaching for the car keys, expanding their carbon footprint and arriving to work isolated, frustrated and tired.

[youtube=http://www.youtube.com/watch?v=XfwfGFpHrwk&fs=1&hl=en_US]

Tomorrow, with temperatures here in New England expected to reach 90+ degrees, I try to stay hydrated, full of electrolytes and may even down some pickle juice all in an attempt to keep leg cramps at bay as I do the annual Harpoon Brewery to Brewery (B2B) ride.  The roughly 8 hour ride, which begins at the South Boston Harpoon brewery, ends some 150 miles later at Harpoon’s other brewery in Windsor VT.   While there is no beer in route, Harpoon does treat us well once we get to Windsor with a big celebratory BBQ and of course, beer.

This will be my fourth year and is one of the highlights of summer for me.  Unfortunately, in each of that last three B2Bs that I have done, my legs have cramped up something fierce at about mile 120 or so.  I’ve always managed to “pedal-thru” the cramp but damn it hurts.  This year I have a three-prong strategy to avoid cramps:

1) Be sure to stay hydrated.  I’ll have 2 lg bottles on the bike and  plan to have those drained at least 3-5 miles before a given refueling stop.

2) Constantly be munching on “Clif Blocks.” Packages of these are handed out at every refueling stop.  What I do is take a couple of packages, open them up and then tuck them under the legs of my shorts, that way I can easily dislodge one, put it into my mouth without having to reach into back pocket.  These Clif Blocks have a lot of electrolytes packed into them – perfect on a hot day.

3) Don’t linger at the refueling stop. I ride with my club in a fairly large group which is fine at the beginning but as we hit mile 75, mile 90, etc., the pack really starts to break-up.  I am typically one of the first to arrive at a given stop and then have to wait for others to arrive.  Unfortunately, some of those waits can extend to 30-40min before we roll again.  While I roll into the rest stop fine, when we get back on our bikes to roll, my legs seize.   Sorry boys, this year I’m doing it differently – love to ride with you but love even more the thought of no cramps.

Now I’m really not sure how many vistors of this predominantly healthcare IT site actually ride a bike or for that matter have done long rides such as this one I am about to embark upon.  If you have not done a longish ride (say more than 30 miles) I strongly encourage you to give it a try.  The bicycle truly is one of humanity’s finest inventions and being out on a bike for a couple of hours truly opens up your senses to the beauty of this planet we call home.

Now if we could only find a way for a broader cross-section of the populace to get out and ride their bikes to do errands, to get to work, etc., who knows, maybe catastrophes such as the one currently happening in the Gulf of Mexico would be less likely.

Tomorrow is the Big Day.

Tomorrow I race the Queen of the Classics, the Tour of Battenkill.  Though I originally intended, maybe half jokingly in this year’s predictions, to “podium” (that’s a top three spot for you non-racer types) in my category at Battenkill, I have now set my sights a tad lower as I just have not been able to get in the volume of training needed for this brute of a race.

My new goal:

To not have a pulmonary meltdown on one of the last climbs (Meetinghouse Hill) of this 62 mile, paved and dirt road race in upstate NY.

Wish me luck – I have a feeling I’m going to need it!

[youtube=http://www.youtube.com/watch?v=8b2IvgpgNk8&hl=en_US&fs=1&rel=0]

Due to a tremendous workload at Chilmark Research, creating cogent, free content is expensive, at least to us.  Therefore, to provide value to you dear reader without taxing our synapses to the breaking point this post will give you a few highlights from te week that caught our attention.

How much is too much?

The recommendations for meaningful use paid a fair amount of attention to the issue of consumer/patient access to their medical records.  The big question, however, is just how much access is appropriate?  Does one let the consumer see absolutely everything within the record including all notes despite how esoteric they may be, challenging to understand and potential for mis-interpretation?  For some perspective:

A very thoughtful, extremely funny and intelligent physician who goes by the twitter handle of @doc-rob wrote about his own practice’s deliberations on the subject and the comments are just as insightful as his.

The Boston Globe had an article in today’s edition on Beth Israel’s decision to let their customers/patients have full access to the complete record.

And the Wall Street Journal’s own Health Care Blog also drew attention to the Boston Globe article with again, some great comments.

Outside of mental health, where there are some extremely valid reasons for not sharing clinician notes, the consumer should indeed have full access for as we have seen in countless other industry sectors, information liberation solves far more problems that it creates.

CCHIT looking to become contortionist?

This week, CCHIT’s Mark Leavitt hosted two townhall meetings to present changes that CCHIT is considering in its certification process.  Prompting these changes is CCHIT’s clear desire to be the go-to certification entity for all “certified EHRs” which is the only technology that will receive reimburse under the HITECH Act.  Going through the slidedeck our quick conclusion was that CCHIT is bending over backwards to try and address concerns in the market about their certification process.

What Chilmark likes about the proposed changes:

A three tiered process that acknowledges different technologies and architectures for EHRs (e.g. modular apps and roll-your-own) that fall outside of the common EMR vendor model upon which CCHIT was founded.

A pricing model that is fair and reasonable.

What Chilmark is not so crazy about:

Like anything, the devil is always in the details and what CCHIT presented is still pretty thin on details.  At first glance, we see a growing complexity in the certification process as often times, software does not abide by strict boundaries.  This is especially true from EMR-Comprehensive vs. EMR-Modular.

Not convinced that CCHIT has the resources available to keep up with technology developments and changes to insure innovative products reach the market quickly.  More complexity is typically a time sink of major proportions.

The HIPAA and EMR blog’s author, John did sit in on both CCHIT townhall meetings and has a good write-up/analysis that is worth the read.

Mark Leavitt also wrote a piece for California Health Care Foundation’s iHealthBeat providing his perspective on the monumental changes coming to healthcare and of course the great role his organization plans to serve in those changes.  My advice to Mark, don’t count your chickens before they hatch.

Get a Life

Last Friday, the Pew Charitable Trust released their latest study on consumer use of the Internet for health.  Chilmark has a lot of respect for their work which is always thoughtful, well-reasoned, applies good methodology and results always have a few surprises.  Unfortunately, have yet to read the full report, only the post that the lead reseacher, Suzannah Fox, wrote on the report.  Do know this though, if you are even remotely interested in understanding how the public is using the Internet to address their health issues and also want to understand underlying demographic differences, just go read the report.  I’ll be doing that myself on Sunday as I recover from the infamous Harpoon Brewery to Brewery ride tomorrow.

We talk about healthcare reform. We talk of an obesity epidemic. We talk of just a few, often preventable, chronic diseases that consume some 70%+ of healthcare expenditures. We talk of global warming and potential impact of warmer temperatures on infectous diseases. We talk of runaway increases in healthcare costs but token measures to reduce them.

How about we talk about getting people out of cars, off of sofas and just start riding a bike?

You may or may not be aware of this, but this week is Bike to Work Week, an annual event that has been slowly but surely gaining steam, even in a city such as Boston which is notorious for its lack of bike friendly features (narrow roads, surly drivers, poor bicycle storage facilities, etc.).  Despite these challenges for the Boston bike commuter, this morning roughly 300-400 people rode in this morning and gathered at City Hall Plaza for breakfast, and the weather wasn’t all that great.  Really quite heartening to see and experience.

I’ve been commuting by bike for many years now and the more cyclists/commuters I see on the road, the bigger smile I get on my face and honestly, the safer I feel.

As I rode in this morning with a contingent from my Boston neighborhood, under police escort (very cool) I spoke to many of my fellow riders, virtually all of them relatively new to bike commuting (within last 5 years).  The reasons for riding/commuting were about as varied as their bikes but universally, all of them simply love to ride their bikes and all expressed the same sympathy, I wish I would have started sooner.

While it is indeed great to see all these new cyclists/commuters, here in the US it is estimated that a paltry 0.4% commute to work by bike.  What would happening if we could make that 4%, 8% or even 10%?  How might that affect our nation’s health and wellness? How might it help address preventable illnesses (did you know that a bike commuter, on average loses 13lbs in the first year of commuting)?  How much money might we saved if we invested here instead of other areas (Hmm, how far might $19B go if it was dedicated to bike commuting programs?).

Which got me to thinking…

What would it take to actually build a culture similar to what one might find in the Netherlands, or Denmark where commuting by bike has become part of the cultural fabric of society?

At the Bike to Work Day meet-up this morning the Swiss Consulate had a display set-up to promote tourism, of course, and the bike friendly culture that they have created there.  Spoke with one of the representatives who told me that they believe in a bottom-up strategy to support cycling and have developed a multi-prong approach that includes:

Teaching children how to ride bikes on the streets safely. Children actually have bike riding classes as part of curriculum.

Insuring all trains and all buses in the country have racks to accomodate bicycles.

Providing public, secure bike storage facilities that are ubiquitous.  She showed me a picture of one such facility in Basel that was huge and filled with bicycles.  Oh, to have something like that in downtown Boston would be fabulous!

Investing in creating and promoting a nationwide network of bike trials and routes throughout the country.

I walked away very impressed and ready to pack my bags and bike for a trip to Switzerland to spend the summer.

Within the US there are some communities where great thing are being done.  Davis, California has always been held up as one community with an extremely friendly bike culture, Portland, Oregon is another and Minneapolis has quite a growing cycling community. Might we not take these examples, learn from them, and distributed their “best practices” to other cities, other towns, other states?

We, as a country looking for new solutions to our healthcare crisis, need to refrain from over-thinking this and look for simple, proven solutions.  Why not start with promoting citizens to ride their bikes and go beyond simple and cheap public service announcements to putting some real effort into policy development and real $$$ to support cycling as a viable and critical form of transportation.  The bike may just be the prescription this country needs most to improve our health, lower spiraling healthcare costs and while we are at it, lower our carbon footprint.

Some helpful sites for those wanting to bike commute:

Bike Commute Tips Blog

More Bike Comuting Tips

Earlier this month we wrote about what is arguably some of the most innovative concepts (well, they have really only piloted one, which is now preparing for broader market roll-out) from any health insurer – that from Humana and its skunk works, CrumpleItUp team.

Following SlideShare presentation provides an inside look as to how this team leveraged new marketing media techniques/technologies to get the word out about Freewheel!n.  Some good lessons here for others to emulate, and not just payers.  Our only regret, the slide show does not have a “lessons learned” slide on what they would do differently in the future.

[slideshare id=860722&doc=fwsmcon-v2-1229723651304477-1&w=425]

As I hinted in my previous post, I’ll be taking it easy next week and will only put up a post if something really, REALLY important happens.

I’ll be heading to the namesake of this company, the small rural town of Chilmark MA, located on the island of Martha’s Vineyard. My first visit to Chilmark was when I was 6 months old (family’s been going for some 100 odd years) and I have been going back on almost a yearly basis ever since. Actually spent a couple of years down there as well shortly after college. Despite the massive crowds which the Vineyard now attracts at the height of summer and some of the less desired changes that have come about, it is still a magical place for me and I get really excited just thinking about it.

So what do I do once I get there? Well for one, simply relax. This consists of canoeing around Chilmark Pond, walking Lucy Vincent beach (one of the most beautiful beaches in the world – painting above by my cousin, Andrew Gordon Moore), splashing and swimming in the ocean, riding my bike, eating lots of fish & shellfish, and doing a lot of star gazing.

Another, more recent activity is an ephemeral one.

You see, I take some of those beautiful, smooth rounded rocks one finds on the beach and build sculptures. This is an ephemeral act for they never last long as either people, their pets, wind or waves always knocks them down leaving me to build new ones the next time I’m on the beach. I was doing this for a few years when I finally hit upon the idea a year ago: Gee, why don’t I take some pictures of these sculptures, one of which I have added to this post.

Art has always been an important aspect of my life. I’ve dabbled in different mediums but keep coming back to sculpture, which I now combine with photography. What I love most about the whole process of creating and capturing these sculptures is the ability that creativity has in taking my thoughts in a completely different direction. Never is there any deep thinking here, at least it doesn’t seem that way. It is more iterative, expressive and develops out of somewhere in that gray matter of mine that I do not have a firm and conscious grasp of. Quite refreshing change from the logical, analytical thinking of an analyst.

There is also another reason for me to be particularly excited about this trip. I recently bought a Yak trailer which I will attach to my bike, load it up with a week’s worth of gear (including that digital camera) and ride from Boston to Woods Hole where I’ll grab the ferry to Vineyard Haven then cycle up to Chilmark. I’ve always wanted to do this ride, just never had the right gear to make it happen.

So with that I bid you all adieu and pray that no big news hits next week (in my experience the Labor Day week is typically slow for news). On September 8 & 9th I’ll be down in Washington DC to attend the annual AHRQ event (why are govt websites so ugly?) and will post directly from that event. If you plan to be there as well drop me a line (john at chilmarkresearch dot com) and we can set something up.

As you know, I commute by bike to work. Been doing this for some 20+ years despite Boston ranking as one of the least bike friendly cities (according to Bicycle magazine) in the country.

Yesterday, one of the Boston Globe columnist wrote a piece on her own cycling experiences in and around Boston. I actually ride frequently in the town of Milton which she references and unfortunately know the two riders that were hit (I’ve raced against them, they are both excellent, very experienced riders). While the article is a reasonable one for the average Globe reader, what shocked me in reading it today was the huge number of reader comments to the article, which now number over 370.

Clearly, as more cyclist take to the road to do their part for the environment, or improve their health or just save money (gas averages $4.00/gal in Boston) we are seeing a growing tension between those on the road in cars and those on bikes. No easy resolution on this one as a quick scan of the comments showed more ignorance on the part of drivers as to bicycling in general and more specifically, bike commuting. Maybe it is time for some PSAs (public service announcements) to educate both sides.

In full disclosure, here are my own cycling/commuting habits:

• I will roll through red lights after stopping and making sure there are no approaching cars. This happens about 30% of the time, the other 70% I wait for the light to turn green.
• At a light, I will ride up to the front if it is red to get in good position when the light turns green. I’ll typically do a quick sprint start to get across the intersection and in front of the traffic behind me. The main reason I do this is to get out in front of cars when they are starting off to insure that they see me. It is also to insure that I don’t get hit by some car turning right who has not signaled (yes, this has happened to me).
• I do signal when I am turning, though less so when turning right as compared to turning left.
• I virtually never ride in the wrong direction down a one-way street.
• I do “take a lane” in rotaries as I want to insure that I am clearly visible to drivers. I also go extremely quick though rotaries (typically 25mph+) so as not to be an impediment to traffic.
• I ride about 3 ft out from parked cars. I have been “doored” twice. It hurts and I don’t want to experience it again. Sometimes on the narrow streets of Boston drivers get upset with me as this 3 ft rule results in me taking a lane but when an opportunity opens up (e.g., no parked cars 30 yds or more) I pull right over.
• I don’t ride on MUT (multi-use trails) and most bike paths (they usually become MUTs anyway) as they are simply too dangerous with people on roller blades, folks walking their dogs on retractable leashes, (which always seem stretched to the limit), Moms with strollers and barely walking toddlers, etc. etc. Its the road for me.
• I always wear a helmet. I’ve cracked three due to crashes.

If you ride, be safe out there and use all of your senses to be aware of your surroundings (people riding on city streets with iPods plugged in their ears are idiots). If you are new to commuting, in time you will develop almost a 6th sense. Use it, it will keep you out of a lot of trouble down the road.