Speak Flower

by symtym on 12.21.09

Originally publised at symtym.net.

Speak Flower

What is flower? At this time it’s an abstraction—a placeholder for several concepts centering on what would healthcare look like if…? And, more specifically what would personal health information (PHI) look like if…? A flower was chosen as the abstraction because it is easily and universally understood, regardless of language, anywhere in the world—a flower is a flower. Where a flower is flower carries the additional abstraction that there is a common ground—characterized by property and implementation.


Wonder if PHI were to be characterized as personal property? A property that is permissively shared with family, friends, and health enterprises. A property that was complete and whole, and personally accessible anywhere on any device capable of providing a browser window. A property that could be permissively and directly shared with a health enterprise, regardless of the origin of the information at the time it was created. This property would also be accessible by any health enterprise on any device capable of providing a browser window.

Such a property, with such a degree of permissive accessibility, widely implemented would have two striking effects. First, it would serve to standardized the act of accessing PHI to a set of software and hardware configurations that would guarantee a browser window offering this capability. Second, because of its wide implementation it would drive the unit cost of a single installation (device) significantly downward. We have seen and experienced this in the evolution of email from a computer and software application standpoint to a free web service accessible on a multitude of devices. What is needed is not a new technology, what is needed is the leveraging of user devices, user interfaces, and user expectations of ease–of–use with existing secure communication protocols.

If PHI is a personal property meant to be shared, than the constructs of accessibility must be readily and massively available now. If not, then we have negated the notion of personal property for the many, because only the few will have the means. We would also create (what we have now) a prohibitive cost of implementation and siloing of PHI. Where there is a tremendous cost to implement, there is a tremendous vesting of property interests (by enterprises) contrary to the notion of PHI as personal property. Where cost to implement is zero or very low the conflict between property interests may become zero to low.


Wonder if PHI were to be implemented in a simple, consistent, and easily accessible manner? Where the number of human health conditions, including the ailment subset, must be presented in a simple and consistent manner. For PHI to be permissively accessible anywhere and on any device capable of providing a browser window will require that those conditions have both a standardized content structure and standardized content meaning: syntax and semantics. Simple and consistent can only mean a single universal syntax and semantics.

Simple and consistent will need to force a common syntax and semantics. It must also force a common secure communication modality to assure an easy and permissive accessibilty anywhere and on any device capable of providing a browser window. Massive adoption depends not on elaborate means for exchanging and standardizing existing PHI, but rather upon common syntax, semantics, communication protocols, and a standard method of presentment—the browser window. It’s this common anatomy or form of PHI massively implemented that will drive down costs and potentially neutralize the enterprise versus personal property interests in PHI.

Speak Flower

Why speak flower? Because it conjures simplicity and consistency—which conjures universal availability and accessibility. A common vocabulary carried on a common band presented in a common manner. Regardless of our personal standing in society we all have a common relationship—that at some time, past, present, and future, we are patients. This commonality of this relationship begs that the information pertaining to that relationship be treated in a common fashion. We all benefit when we consider that we are all patients.

{ 9 comments… read them below or add one }

Fran 12.28.09 at 15:52

I love this concept!

Dirk Stanley 12.28.09 at 18:03

Thanks! We’re putting the concepts together, and we love participation! Check in on this web site again sometime soon, you’ll see where this conversation is going. :)

alan 1.7.10 at 17:14

I still don’t get it. Are we talking about a separate server based storage area for records? Or a link that simply binds together all proprietary medical software EMRs? If this is the case, won’t it require access to each EMR proprietary software – which would be a nightmare for every CEO. Just because there is a pressing need, what makes you think that private for profit companies would agree to make it happen?
I remember in ‘the olden days’ there was a push by a non profit consumer based organization that urged all patients to carrie a microfiche (old technology) with their health info -lab tests, EKGs, meds, etc. It never took off. Simply wanting it didn’t make it happen. So where do we go from here? How do you create a ground swell for a product that doesn’t exist yet; where a Google or Microsoft advertising budget could crush or mislead concerned citizens. Doesn’t a project like this require a federal mandate to push companies to make it happen?

symtym 1.7.10 at 17:22

The problem with current EHRs/EMRs is that they have created numerous silos of a person’s health data. That data may reside in incomplete and incompatible forms, which is the reason behind standard adoptions and interoperability. Can the person’s health data be stored once (1 silo) in whole (complete) form and be accessible by all providers? What would it look like and how would it function?

Gregg Masters 1.17.10 at 20:59

Tim and Dirk, I’m diggin’ the idea big time. In March of last year I posted the following on ‘leasing or subleasing’ my health data (PHI) to providers during the care process; see:


This was a somewhat controversial claim; yet, I wonder whether we’ve reached a consciousness where this pyramid inversion may be closer to a cultural reality? The informatics pieces seem to be lining up by day.

Poly Endrasik 1.26.10 at 22:42

I like the flower idea and have always been a promoter of data / files that have useful metadata as part of the file (not simply a sccanned tiff image dropped into an EMR). In my thoughts a PHI or PHR (another name being used) enhanced pdf file should be automatically created and available to the patient (either via a portal and / or download to a medical memory card) when the updated EMR record had been created, just like the bill / codes.

admin 1.26.10 at 22:49

Good point! Metadata is extremely important. One of the ideas is that Flower would has all health information as structured data–this would facilitate delivery of content in many fashions: displayed on device browsers, generate PDFs, etc.

Dirk Stanley 1.31.10 at 20:42

Alan -
All good points -
We think marketing Flower to patients will create the demand for a common language, e.g. The benefits of :
1. Fewer med errors
2. Fewer unnecessary tests
3. Lower cost of care
4. Lower waiting times
… are enough to get patients to ask the question, “Dr. Stanley, do you Speak Flower?”.
If patients understand the benefits of having a doctor who speaks Flower (by having an EMR that speaks Flower), then the software companies will help meet consumer demand.
Flower is a patient empowerment tool, and with that, we’re hoping it reminds healthcare that the patients are paying the bills and may ask for better service.

Regina Holliday 2.1.10 at 04:01

Dear Dirk,
Thanks for creating a space for these kinds of discussions. The only way we are going to get change and greater access to the EMR/EHR is for people to ask for it in as many ways as possible. I would love talk with you about the flower metaphor sometime. There are some good visuals there… in both the illustrated page and the written word.

Thanks, Regina Holliday

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