VISTA Enterprise Network - Successful Implementation, World Class Support

Monday, March 8, 2010

VISTA & Homeostasis: An Introduction

[1638 engraving by Peter Paul Rubens of Hippocrates of Kos, whose precept "First, do no harm" is one of the foundational principles of medicine (Wikipedia)]

Dear Reader,

Would you want to be treated by a doctor who doesn't understand the importance of the circulation of your blood? What if he knows it's important but not that the heart has anything to do with it? Would it be okay with you if he knows the heart's involved but not the brain?

In general, how much would you trust your health to someone who doesn't understand what keeps you healthy?

People were successfully treated for millennia by care providers who didn't understand these or other systems but who did know to be cautious with the things they didn't understand. They knew that if it ain't broke, don't fix it. They abided by the fundamental medical principle, First, do no harm.

What happens when people subvert this principle, when they decide a better fundamental principle would be First, get control?

Replacing the Hippocratic principle with a totalitarian one leads to scenarios like this: your doctor removes your brain when he becomes your primary care provider because it's too complicated, difficult to manage, an irritating distraction, always making your body do things without first consulting him, probably not important anyway because he can tell your heart when it needs to pump.

We make physicians swear an oath to uphold Hippocratic principles before we let them treat patients, in part to help prevent things like that from happening. Too bad we don't make medical-software programmers and managers swear the same oaths.

Over the last fifteen years, VA central management has been conducting dangerous and unnecessary surgery on VISTA's lifecycle, removing all of its living systems one by one and replacing them with simple mechanical controls that put central office in charge of everything. They call this getting VISTA under control.

As a result, VA's VISTA program is in a state of accelerating collapse that's passed the tipping point, yet VA keeps trying even harder to control and centralize VISTA. Doing the same thing but expecting different results . . . there's a word for that.

To help you understand why the way VA used to manage VISTA was healthy and why the last decade and a half have made it sick, I need to teach you about VISTA's vital signs and systems, the processes that make VISTA development healthy. All of these systems are based on homeostasis, so they're self-correcting when we let them do what comes naturally to them. To break those systems you'd have to dismantle their built-in self-correction and try to take control of them yourself. Sound familiar?

Let's start with one of two VISTA homeostatic systems that balances innovation against standardization—the tension between class-three and class-one software, that is, the tension between local and national development.

Yours truly,

Friday, March 5, 2010

The Hidden Harmony & Homeostasis

[Diagram of blood-insulin and blood-sugar levels over the course of a day, from the Wikipedia article on Blood Sugar]

Dear Reader,

The hidden harmony is present but often easy to overlook in the realms of math, physics, and chemistry, but biology demands an intuitive understanding of it because living systems exhibit all kinds of behavior that at first seems to contradict the rules and principles of these foundational sciences.

For example, consider the second law of thermodynamics (In a system, a process that occurs will tend to increase the total entropy of the universe, or, things tend to run from order to chaos, tend to run down, always increasing the unverse's entropy). It nicely explains aging, disease, and death but seems contradicted by conception, embryogenesis, evolution, and development (not to mention the Big Bang itself). Someone steeped for decades in the "hard sciences," when confronted inescapably by large-scale biology's many seeming contradictions of the hard-science principles, can either (1) turn away from biology and back to their more comfortable fields, (2) resort to miracles for explanation, or (3) search for additional cosmic principles that contradict principles like entropy, that wind things up instead of winding them down.

The second form of fluxus quo, the hidden harmony, intuitively explains what the second law of thermodynamics, entropy, does not—the capacity of living things to run from chaos to order, to wind up, to decrease an organism's entropy by unfolding layers of increasing order. The self-assembly of living systems is a miracle from the perspective of entropy but inevitable from the perspective of the hidden harmony.

In its simplest, easiest-to-explain form, the hidden harmony manifests in the ways living organisms work to maintain steady temperatures, or blood pressures, or access to glucose, or so on. This quality of living things, called homeostasis, produces what at first seem to be comparatively steady states through the harnessing and control of opposing forces.

One example of this is the way insulin and glucagon set in motion opposing tendencies with regard to the regulation of blood-sugar levels. When they rise too high, a healthy pancreas releases insulin to instruct cells to absorb more glucose from the blood, thus lowering the blood glucose levels. When they fall too low, the pancreas releases glucagon to instruct the liver to convert more glycogen into glucose and release it into the blood, thus raising blood glucose levels. Over the course of a day, blood-glucose levels are almost never at a steady state, never a status quo; rather they are always rising and falling in response to digestion and the cells' consumption of blood glucose, and when those cycles spike erratically from the consumption of sugar or from excessive energy demands the body intervenes with insulin or glucagon to channel them back into the narrow band of blood-sugar levels that supports human health.

Living systems are densely woven with such homeostatic systems for preserving an organism's health, as is the cosmos itself, since we evolved to be healthy within the normal conditions of our environmental niches.

[Photo of James Heilman juggling from Wikipedia article on Juggling]

In all these cases, the appearance of stasis is an illusion; both forms of dynamism are always in operation. First, there will be a cosmic river—an overt flow of materials and energies upon which life depends. Second, there will be a hidden harmony—two or more primary systems set in opposition to channel, set in motion, and modulate that cosmic river, and many secondary systems that stabilize and reinforce the primaries.

With all this flux going on, it shouldn't be called homeostasis. It should be called homeoflux.

Like juggling, any apparent steady state is actually a state of continual change (the moving balls) that is itself driven by a more fundamental underlying pattern of change (gravity, mass, and the juggler). If, for fear of dropping the balls or making a mistake the juggler tried to just hold them still, the act of juggling would be at an end, the episode of juggling would die, because in a truly living system it is the fluxus quo that produces what we think of as the life within the system.

So it is with the human body. The flow of blood, lymph, cerebrospinal fluid, air, food, water, hormones, nerve impulses, chemical reactions triggered by photons striking the skin, the flowing transformation of biochemicals along metabolic pathways, and many many other things beside, the flow of all these things must continue for our life to continue. Stop even one of these flows, and sooner or later we sicken and die. The body is not flesh at all but is instead a flow, a nexus, a crossroad of many rivers, and we die when the rivers stop flowing through us, when they go their own ways and leave us in an apparent status quo (although the truth is that we go on flowing in different ways after we die, as we dissolve into the tributaries of other rivers).

So it is with managing VISTA. The effort to control VISTA, to hold it tightly, to decide what will and will not get worked on, these efforts kill a VISTA adoption. All of the elements of the VISTA model have to actually flow channeled but unimpeded to create a homeostatic VISTA system capable of supporting a hospital. A VISTA lifecycle is a living system, a form of nonorganismic life, in which the flow must go on; thirty years of experiments with the alternatives have proven the truth of this to anyone who has bothered to learn from its history.

At this point, if you don't feel comfortable with the fundamentals of fluxus quo, I'm gong to say the burden is on you now to ask about it. Fluxus quo is one of the essential principles that makes VISTA work, but as for what must flow and how—the fundamentals of its health, to succeeding with VISTA adoption—well, the devil's in the details, and it's time to talk about them.

Let's move now from the principle to its manifestations. Let's explore some of the homeostatic systems that must function correctly for the production, development, and maintenance of VISTA.

Yours truly,

Thursday, March 4, 2010

Fluxus Quo: The Cosmic River & the Hidden Harmony

Dear Reader,

Recap of this entire blog using our new terminology: The VISTA community achieved a harmonic fluxus quo from 1977 to 1995 by harnessing homeostasis, modeled on the way biology harnesses flux to achieve stability. We will preserve and extend today's VISTA renaissance the same way, because it is the only sustainable path available to human beings, the only way to transform very complex interactions and dependencies into a self-reinforcing system.

Now, to explain homeostasis: Wikipedia and other traditional references are going to be of limited help here, since they explain it at only the most shallow, Platonic level, like a mechanism, without any appreciation for its cosmic significance. We need to define it in terms of fluxus quo.

For the discussion that follows, we need more concise terminology to describe the two main expressions of fluxus quo, because homeostasis uses the second to channel the first, which will be hard to explain without more descriptive terms.

I considered borrowing the contrast between kinetic energy and potential energy from physics and applying it to flux, but that dichotomy is too Platonic, built upon the assumption of stasis as the normal condition in which energies can be wound up (potential) and discharged (kinetic) according to the principle of entropy. Instead, let's use rich metaphorical terms borrowed directly from Heraclitus, the original philosopher of flux.

For the first kind of flux, the nonstop change in all things that goes on around us all the time, whether we see it or not, let's call it the cosmic river, the one you can't step in twice because it is always changing and so are you and everything else.

For the second kind of flux, the invisible flow of principles whose conflict produces the cosmic river, both the things in it and their flow and transformation, let's use the term hidden harmony, to capture the idea of the harmony in the bending back of forces against one another to produce apparent stability.

Now for homeostasis itself.

Yours truly,