Friday Q&A: What's Your Yoga Story?

Woman in a Bookshop by Aubrey Beardsley

Every once in a while we turn the tables on our readers here at Yoga for Healthy Aging, and instead of answering a reader’s question, we ask a question ourselves. Today, because Baxter and Nina are starting to write a sample chapter for our Yoga for Healthy Aging book, we’d like to ask you to tell us something about yourselves.

Q: How old were you when you started practicing yoga? And what kinds of benefits have you seen from your practice?

A: We know your stories will inspire us! So write your answer in a comment, post it on our Facebook page, or send an email to Nina: nina at wanderingmind dot com.

Nina shared part of her yoga story in her post Yoga for Emotional Wellbeing: An Epiphany earlier this week.

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Interview with the Spoiled Yogi: Erica Rodefer Winters

by Nina

When we started our blog, we didn’t have a target demographic or a marketing plan or anything like that. We just dove in enthusiastically, with faith that there were going to be readers out there who wanted to hear what we had to say. And even now if you asked me about the demographic of our readers, especially their age range, I’d be hard pressed to say. Still, I was a bit surprised when I learned that one of our regular readers was a young yoga blogger who calls herself the Spoiled Yogi. She even mentioned our blog as one of her current favorites in her post Tools for Teachers calling it a “godsend.”

Okay, I admit I was a bit curious about this thirty year-old yoga practitioner and teacher—was she just getting information to help her older students or was she actually practicing yoga for healthy aging herself? So—you know me—I just went ahead and asked. And the answers she gave will be interesting to anyone of any age because as she says, “Aging is happening all the time.”

Now you’re probably wondering why she’s called the Spoiled Yogi. Well, I know, but I’m not gonna tell! You’ll have to check out her blog at spoiledyogi.blogspot.com to find out.

Nina: You’re only thirty, yet you’re already reading our blog on yoga for healthy aging on a regular basis. Can you tell us why?

Erica: Recently, my yoga practice delivered a shocking dose of reality. For the first time, I noticed that I couldn’t unroll my mat and take the shape of a challenging posture (Visvamitrasana, anyone?) without much more than a Down Dog to warm up. Sometimes I have a hard time with change. I ignored my yoga training and forced myself into the posture anyway. The next day I regretted it big time. Ouch! Never again. (There are some lessons you just have to learn the hard way.)

Now that I’m 30, poses that I once was able to effortlessly twist myself into when I was 20 take a little more mindfulness these days. That’s a good thing, because mindfulness is one of the biggest reasons I practice yoga in the first place. The ordeal gave me a glimpse into what the process of aging is going to be like over the next 70 years (I’m a yoga student—why shouldn’t I live to be 100? Right?). All the lessons I’ve been learning for the last decade about listening to my body and preventing injury are going to become more and more important.

I know that 30 is still relatively young—I won’t be getting my AARP card anytime soon. Even if I get to retire early (a girl can dream can’t she?), I have several decades to go before I reach that place in my life. (This is a good thing, too, because my 401k would run out in about 6 months if I were to retire now!) I know I have many more lessons to learn on my yoga mat, too. Still, I know that I’ll wake up one day and wonder how on earth I arrived where I am, shocked at how quickly the years came and went. Sometimes the days seem long, but I know the years are short.

Nina: So it sounds like you’re already planning for the future by learning about how you can use your yoga practice to keep yourself healthy in the years to come.

Erica: Aging is happening all the time—when we’re 20 as much as when we’re 60. And just as we’re supposed to start thinking (or dreaming?) about our retirement NOW, it’s a good idea to make a plan for physical and mental health for the rest of your life. My plan is yoga.

I’m convinced it’s a pretty good plan. It’s a reminder that If I want to be active, healthy, happy, and enjoy life later on, I need to start getting ready for that life now by PRACTICING being active, healthy, happy, and enjoying the present moment now, every single day.

Nina: What are the most important things you’ve learned about practicing yoga for healthy aging? And how have they changed your personal practice and how you teach yoga?

Erica: As much as I love practicing the really challenging, fancy-looking poses, I know if that's my ONLY practice I'll be up a creek without a paddle as I get older and those poses become less accessible. I focus on using yoga to keep me emotionally and mentally balanced, not just to achieve more physically demanding postures. For asanas, I've learned that paying attention to alignment can help preserve mobility and strength. But I've also learned that meditating, practicing mindful eating, and practicing mindfulness in my relationships can go a long way to keeping my mind healthy, which I think is even more important. This has really changed the way I approach my practice. It's not all about going deeper into a posture any more, but about using the postures as tools to keep me at my best for rest of my life! I try to instill this philosophy into my students, too, although if they're like me they'll have to figure it out for themselves!

Nina: If you were going to make a single recommendation to younger practitioners out there, what would it be?

Erica: Find a mentor—someone you admire and respect, who will be there to guide you when you're lost. It's fine to follow inspirational teachers on social media and use their streaming videos and classes as a guide, but it's imperative to have a teacher who knows YOU and your practice on a more personal level. I've been blessed to have many teachers who entertain and answer my questions, no matter how silly they are—and I'm always inspired and grow so much from their words, and I hope I will be able to help others in the same capacity some day. 

Erica Rodefer Winters is a yoga teacher, writer, and editor based in Charleston, SC. As a teacher, her playful approach to yoga draws from her life experience as she guides students to explore their yoga and their lives with humor and grace. Erica writes about yoga, meditation, and health. She is a contributing online editor for Yoga Journal and writes about health and fitness for several publications. Her greatest inspirations are her daughter Annabelle, her cat Gracey, and her dog Penny. Check out her blog, SpoiledYogi.com, like her on Facebook, and follow her on Twitter and Instagram.

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A Primer on Meaningful Use and HISPs

The Massachusetts State government offers low cost HIE services including Direct transport to all the stakeholders of the Commonwealth.    Recently. Micky Tripathi wrote this FAQ which is so good that I wanted to share it on my blog.   Feel free to use it with your stakeholders.

1. What is a HISP?
A Health Information Services Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport.  There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules.  The term HISP was coined to describe specific message transport functions that need to be performed to support scaled deployment of the Direct standard in the market.  HISP functions can be performed by existing organizations (such as EHR vendors or hospitals or HIE organizations) or by standalone organizations specializing in HISP services.

HISPs perform two key functions that support scalability of exchange using the Direct standard.

a. Issue security certificates.  HISPs establish trust networks by defining policies for network participation and issuing security certificates tied to a HISP anchor certificate to enforce such policies
b. Issue direct addresses.   HISPs issue direct addresses tied to the HISP anchor certificate in accordance with conventions defined by the Direct standard

2. Do I need to use a certified HISP to attest for Meaningful Use Stage 2?
No, because there is no such thing as a certified HISP.  Meaningful Use certification applies to technology, not to organizations.  In order to attest for Meaningful Use Stage 2, you need perform certain activities using certified EHR technology (CEHRT).  For most EHR users, their EHR is certified for all of the functions that they need.  If it is not, you will need to incorporate specific additional certified technology solutions to fill the remaining gaps.  It doesn’t matter whether that additional technology comes from an EHR company or a HISP company – the only thing that matters is that the technology is certified.

3. Doesn’t DirectTrust certify HISPs?
DirectTrust is a private, non-profit organization that offers voluntarily accreditation of HISPs through its EHNAC DTAAP program.  This private, voluntary accreditation program often gets confused with Federal Meaningful Use certification.  DirectTrust is NOT a Federal certification entity, and its EHNAC DTAAP accreditation process is purely private and voluntary and has no relationship with Meaningful Use Stage 2 attestation or certification requirements.

4. What role does a HISP play in Meaningful Use Stage 2?
A HISP provides specialized network services that connect your EHR to other EHRs that are also using the Direct standard for communications.  You don’t need a HISP in order to create Direct-compliant messages, but you do need to be connected to a HISP in order to send and receive Direct messages with other parties.  Using an email analogy, you may have Microsoft Outlook installed on your computer, but if it isn’t connected to an email network, your emails can’t go anywhere and none can get to you.  Similarly, your CEHRT can send and receive Direct-compliant messages, but those messages won’t go anywhere unless you and those who you are communicating with have valid
Direct addresses and are connected to a secure network that can get the messages safely and reliably from one endpoint to another.  These are the message transport functions that HISPs perform.

There are two Meaningful Use Stage 2 attestation requirements that require Direct transport:

• Summary care record for transitions of care (TOC)
• Patient ability to view, download, transmit their medical record (VDT)

Most HISPs (including the Mass HIway) do not yet have the ability to connect directly with patients, so they are not able to assist with the VDT requirement.

For the purposes of attestation, the Meaningful Use Stage 2 TOC requirement specifies that you must electronically send a standardized summary care document to another care setting, and that you must have reasonable assurance that the other care setting actually received the document.  The HISP performs the message transport functions to provide you with the assurance that your messages have been delivered to their intended recipients.

In order to attest for the TOC requirement, you need to send CCDA care summaries containing at least problem lists, medications, and medication allergies.  These summaries must be transmitted with your CEHRT using either the SMTP/SMIME or XDR/SOAP protocol.  There is no Federal certification for HISPs, so you can send your message to its intended recipient using any HISP or any number of HISPs, as long as you have assurance that the message will get delivered.  The only certified system that you need to use is the one that creates the Direct-compliant SMTP or XDR message – after that, your message may take any number of “hops” between your EHR and its final destination, and as long as you’re confident that the message will get delivered, you will have completely fulfilled your Meaningful Use Stage 2 attestation requirement.

5. How do I get assurance that my messages are delivered?
Meaningful use attestation requirements do NOT specify how you get assurance of delivery, they specify only that you have taken reasonable steps to be confident of delivery.  The most robust way for you to be assured of message delivery is for your system to receive message disposition notifications (MDNs) for each message sent by your EHR to the intended recipient.  However, not all receiving systems or HISPs can generate MDNs, and not all EHR systems can consume MDNs even if they are returned.

Fortunately, you are not required to receive MDNs in order to be assured of delivery.  Other acceptable methods of assurance are through HISP guarantees of delivery after successful setup testing and/or notification of failure of delivery (like emails) and/or HISP central maintenance of delivery logs that can be made available as needed.

The Mass HIway provides you with assurance of delivery through rigorous setup testing, and maintenance of a central log of delivery successes and failures.  This log is made available to participants as necessary in the event of an audit.  The Mass HIway will also return any MDNs or application-specific responses or acknowledgements generated by receiving endpoints, however, the Mass HIway cannot guarantee that any receiving endpoint will generate notifications, acknowledgements, or responses.

The one exception where delivery notification is available and required is public health.  The Massachusetts Department of Public Health requires that participants receive delivery notifications in order to satisfactorily meet the Meaningful Use Stage 2 public health requirements.  Massachusetts DPH does generate automated acknowledgements, which are sent automatically via the Mass HIway in response to each message successfully received.

6. Is the Mass HIway a HISP?
Yes.  The MA HIway is a trust community that issues security certificates and Direct addresses to eligible participants and provides Direct-compliant message transport services for its participants.

7. Is the Mass HIway certified as an EHR module for Meaningful Use Stage 2?
No, the Mass HIway is not certified as an EHR module for Meaningful Use Stage 2.  Most providers will not require the Mass HIway to be certified in order to use it to help fulfill their Meaningful Use Stage 2 attestation requirements.  (See discussion above in FAQ on HISP roles.)  As long as your CEHRT delivers a Direct-compliant SMTP or XDR message to the Mass HIway (either to the LAND appliance or directly to the central site), you do not need the Mass HIway to be certified.

If your CEHRT does not send a Direct-compliant SMTP or XDR message to the Mass HIway (for example, if you are sending messages to the LAND appliance in a format other than SMTP or XDR), then you will need to change your interface to send Direct-compliant SMTP or XDR to the Mass HIway (including the LAND appliance) in order to count any of these transactions for Meaningful Use Stage 2 TOC requirements.

Even though you do not need the Mass HIway to be certified for Meaningful Stage 2 in most cases, you will still need to have assurance of delivery of messages sent over the Mass HIway to meet your Stage 2 TOC attestation requirements.  The Mass HIway provides this assurance by delivery after successful setup testing.

8. Must I be connected to the Mass HIway in order to attest for Meaningful Use Stage 2?
Yes, you need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 public health requirements for immunization and cancer registries, and syndromic surveillance.  The Massachusetts Department of Public Health will accept public health transactions only through the Mass HIway.  Thus, though there is no Federal requirement that you be connected to the Mass HIway for Meaningful Use Stage 2, you will not be able to meet core public health requirements for Meaningful Use Stage 2 without being connected to the Mass HIway.

You do not need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 TOC requirement.  However, over 100 providers and payers are already live on the Mass HIway HISP.  Thus, connecting to the Mass HIway will likely make it easier for you to meet your TOC requirements because you will be immediately connected with many of the providers you share patients with.

9. The Meaningful Use Stage 2 rules refer to the eHealth Exchange – is that the same as the Mass HIway?

No.  The eHealth Exchange is a health information exchange network comprising federal agencies and other large non-federal organizations.  The Mass HIway is not connected with the eHealth Exchange in any way.

10. Do I have to be connected to the eHealth Exchange in order to meet my Meaningful Use Stage 2 attestation requirements?

Absolutely not.  While the Meaningful Use Stage 2 rules do allow special dispensation for eHealth Exchange members, few providers will attest using this mechanism.  No Massachusetts providers or payers are currently members of the eHealth Exchange.

11. Who are the other HISPs in Massachusetts, and can I join any HISP that I want?
There are a wide variety of HISPs operating in the Commonwealth.  Whether you join any particular HISP depends on a number of factors.  The biggest factor is which HISPs your EHR vendor allows you to join.  Some vendors require that you use a specific HISP (either their own or the one they are integrated with), while other vendors (such as Meditech and Epic) allow the provider to choose which HISP they would like to connect to.  CMS and ONC do not require that you use any particular HISP for meaningful use, but in practice, your EHR vendor will dictate which HISP options are available to you.

If your vendor allows you to choose which HISP to connect to, you can connect directly to the Mass HIway HISP.  If your vendor requires that you use their designated HISP, you will have to connect to the Mass HIway through their HISP, as long as their HISP is connected to the Mass HIway.
Please contact the Mass HIway (http://www.masshiway.net) if you have any questions about your connection options.

12. Is the Mass HIway part of DirectTrust?
No, the Mass HIway is currently not a member of DirectTrust.  DirectTrust is a voluntary private non-profit collaborative that is helping HISPs to connect with each other.  The Mass HIway is connecting directly with the major HISPs operating in the Massachusetts market.  The Mass HIway may join DirectTrust at some point in the future if it provides additional value to participants.  Providers, EHRs, or HISPs do NOT need to be part of DirectTrust in order to meet their Meaningful Use Stage 2 certification and attestation requirements.

13. If I’m in another HISP, can I still be on the Mass HIway?
Yes.  You can connect to the Mass HIway even if you are a member of another HISP.   The Mass HIway is actively connecting with the major HISPs operating in the Massachusetts market so that messages can be sent between HISPs.  You do still have to join the Mass HIway by signing a participation agreement even if you are in another HISP.  As a member of another HISP, you will pay whatever fees are charged by your local HISP and your Mass HIway fees will be waived.  Once you have joined the Mass HIway, your local HISP will configure your system to enable access to the Mass HIway network.  Your local HISP will still provide you with your security certificate and your Direct address, but you will be able to send and receive messages over the Mass HIway network.

Below is a current list of HISPs that are expected to be connected to the Mass HIway.  The HISP market is evolving rapidly so more HISPs will be added as demand grows.  Please contact the Mass HIway (http://www.masshiway.net) if you would like to discuss your connection options.

HISP Live date
eClinicalWorks April 2014
Surescripts April 2014
eLINC/SES April 2014
Allscripts/MedAllies TBD
Athenahealth TBD
Wellport/Alere TBD

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Building Unity Farm - The Ducks

As the weather begins to improve (we’ve even had an afternoon above freezing - wahoo!), the ducks are beginning to wander farther from their duck house.   This week, they discovered the rain cistern that collects runoff from our farmhouse roof.

For hours, they’ll bathe, preen, and drink their fill of the circulating rainwater.  They’re very social and tend to travel in groups.  They’re calm and have learned to recognize us as helpful rather than threatening.

We have 10 ducks at the moment -
2 Chocolate Indian Runner ducks
2 Fawn Indian Runner ducks
2 Welsh Harlequin ducks
2 Swedish Blue ducks
2 Rouen ducks

They spend the day wandering the farm yard, finding insects in the compost pile, eating the tender sprouts of any greens they can find, and playing in puddles.   As dusk approaches, we walk near them and they know it’s time to return to their duck house, a 4x8 building with food, wind protected warmth, and hay bedding.   We keep their water sources outside the duck house to reduce the mess.   Ducks can turn any pasture into mud.

They have a heated 50 gallon stock pond and a 5 gallon waterer in the 14x10 foot pen built around the duck house, caged on 5 sides to prevent predators from reaching the ducks at night.    A duck house with 3 square feet per duck seems about the right density.

Our large pond is about 50 feet from the duck house and the surface is still covered with ice and snow.  It’s 6 feet deep so water is still circulating but the ducks cannot reach it.   We’re confident that with the arrival of Spring, the ducks are going to be spending all day in the large pond.

Each member of our poultry family - the chickens, the guinea fowl, and the ducks show mutual respect for each other.   All the species wander into each other’s spaces, huddle together for warmth, and get along.    About the only difference is that the ducks do not roost for the evening - they prefer an outdoor space to an indoor space and only seek the warmth of the duck house during snow and wind.    Rain is prime duck weather.

Duck care is easy - refill their water sources, provide them fresh greens (we make “duck soup” with lettuce, peas, and spinach in water), and fill their multi-flock crumble containers.   As a treat we feed them mealworms and scratch grains.

At the moment, our 29 guinea fowl, 10 ducks, and 11 chickens - 50 birds in total, seems like an ideal number for our property.    All are disease free, uncrowded, and follow a highly predictable routine.   Unity farm has poultry living in unity.

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The Power of Mental Exercise, Part 2

by Ram

Autumn Light Festival by Melina Meza

Nearly a month ago, I wrote about the power of mental exercise (see The Power of Mental Exercise, Part 1). I had suggested incorporating some form of mental exercises in your daily list to keep the mind fit. Can you recall what I wrote and the exercises that I suggested? If you are unable to recall that information, it is time for you seriously start incorporating mental exercises as a daily life-style practice. In neuroscience, memory consolidation and recall closely reflect neuronal strength and signal transmission between neurons that are involved in memory. Short-term plasticity (STP) and long-term potentiation (LTP) are terms used in neuroscience to indicate cellular mechanisms that underlie learning and memory.

It is incorrect to assume that as long as the brain is working fine and memory is reasonably good, there is no need to pay attention to it. In reality, our brains are like the car engines, just as the performance of the engine is enhanced as long as the oil is changed regularly, similarly the brain actively grows and rewires itself in response to stimulation and learning. Brain fitness, mental fitness and mental exercise all mean the same thing: it is the act of performing a mentally stimulating task that keeps the brain fit and also wards off mental and physical diseases. Medical science has clearly elaborated the effects of mental stress on our physiology and its role in the disease process. Several scientific studies find that mental exercise can either prevent or delay the onset of the disease.

Both Ayurveda and Yoga describe the disease process as taking its roots first in the mind and gradually spreading to the body where it shows up as specific symptoms. Western medical science also accepts the mind-body connection through which emotional, mental, social, spiritual, and behavioral factors can directly affect our physical health.  In a landmark study done in 2006, Exploring Interventions to Reduce Cognitive Decline in Aging, scientists demonstrated the beneficial and enduring effects of brain fitness program in an elderly population. The study showed that seniors who received mental training could counteract the decline in mental performance that is seen in the elderly better than seniors who did not receive any kind of training. The researchers concluded that individuals who stimulated their brain more frequently experienced a slower rate of cognitive decline than others. In another study from Australia,  Mental Exercise Nearly Halves Risk of Dementia, scientists found that being mentally active diminishes the risk of age-associated dementias by nearly 50%.

Stimulation of the brain can occur in a wide variety of ways. The brain is constantly changing for people of all ages, and learning something new or novel builds and remodels new neural network connectivity. Mental training exercises must occur so that the brain can continue to grow. Today I’m going to present a variety of mental fitness exercises that you can perform in any setting. Since this is a yoga blog, I have come up with exercises that relate to yoga.

Memory Exercises

Our memory is the brain's filing system as it stores everything we have learned and continue to learn. The brain is made up of 100 billion neurons. During learning, neurons get “wired up” to each other and communicate through thousands of connections. Memories are formed when these connections are strengthened. Memory plays a crucial role in all cognitive activities, including reading, reasoning and mental calculation. Memorizing the lyrics of a new song, a mantra that you recently heard in the yoga class, street signs in a new area, and so on boost the level of certain chemicals that are responsible for the memory storage and retrieval. The information making up memory is stored in many parts of our brain, including areas that oversee the laying down of memory, some that are involved in storage and some that help with retrieval of these memories. It is easy to notice when memory fails or declines. To maintain a good memory, you need to train for it.

1. As you turn the pages of a yoga deck (cards with yoga poses) try to memorize the Sanskrit names for each pose. In the process, not only are you learning a new language but you are also laying down new neural connections each time you memorize and recall a pose and its corresponding name. It is a perfect way to stimulate the brain. The next time you see a picture of a pose in a magazine or if you happen to hear someone providing instructions for a particular pose try to recall the name of the pose in Sanskrit. Alternatively, try to recall the correct pose when you hear similar sounding names (for example, several my students get confused with Uttanasana, Utthita Parsvakonasana, Ustrasana, and Upavista Konasana).

2. Using the same yoga deck pick up five cards in a sequential order and mentally note down the name and other details scribbled on the card. Recall the information after 5 minutes preferably in the same sequence. Recall the same information after 10 minutes.

3. Open your favorite yoga text, such as the Yoga Sutras and the Bhagavad Gita, and select a passage to memorize that week. You can start by memorizing the passage in English. Bonus points for memorizing it in Sanskrit as well!

Attention Exercises

Attention and memory cannot operate without each other. Attention is necessary in all our daily tasks as it enables us to maintain concentration and focus on the task. Any object that is attended to will remain in the memory, while those that receive scant attention will leave no memory traces behind. One of the ways to improve attention is by simply changing our daily routines or habits. This forces the brain cells to wake up from routine tasks and pay attention again.

1. When it comes specifically to yoga, if you have a habit of doing the poses right side first, practice the same by starting on the left side before the right and vice versa. Also, try practicing in a different room or space in your house and either find or create an entirely new sequence to practice.

2. The next time you decide to practice yoga, set a timer for a specific time (say 45 minutes). When the timer beeps, crosscheck whether you were fully attentive to your yoga or how often you were distracted. Try and recall all the steps you performed on the mat. If you found yourself distracted, be aware of it the next time you do a similar task.

Visual-Spatial Exercise

Our three-dimensional world is filled with colors, figures, shapes and sizes. Visual-spatial information is about seeing, organizing and remembering. It is the ability to distinguish one object from another, distinguishing a printed object from its background, recognizing a pattern of symbols, images, or words, understanding the relationship of an object situated in space to oneself or identifying an object when certain parts of it are visible. Individuals with visual-spatial difficulties have trouble with pictures, maps, schedules or diagrams. Visual-spatial impairment is often an early symptom of a problem with the nervous system.

1. At your yoga studio, look around and note everything you can see both in front of you and in your peripheral vision. Pick out five items and their exact locations. Write down as many details of the location and items as possible. After completing your yoga practice and before exiting the place, recall from memory all the five items, their location and other details. Challenge yourself to recall again all the details after two hours. (In a home setting since you are very familiar with the placement of objects in the room, try the above mentioned exercise in a different room or space in your house.)

As we age, it’s important to not only flex our physique but our mental makeup as well. With this two-part series on the importance of mental fitness, I hope you are more aware of how to exercise the different functional aspects of the brain.  Can I ask you to challenge yourself with daily activities that will help you break a mental sweat and sprout your neuronal branches thereby keeping the brain in shape? Good luck with the mental workout!

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ACO Systemness and Integration

As Accountable Care Organizations take on risk contracts which align incentives to create continuous wellness rather than treat episodic sickness, there is a drive to create “systemness” by moving from acquisitions of practices and hospitals to integration.   There are many ways to accomplish this such as moving to a single EHR with a single database for all sites, by enhancing interoperability of existing software, and by building care management databases that incorporate data from every care location.

Developing a strategy requires a multi-factorial analysis - requirements, cost, competing priorities, regulatory imperatives, and cultural barriers to change.      From March to July, Beth Israel Deaconess will be working on an integration plan for its acquired and affiliated clinical sites.   From an IT perspective, I’ll create a task force that will design an analytic framework for decision making and then develop a prioritized list of projects.

Here’s the early thinking.

A analytic framework might include:
*Impact factor (number of providers, staff, patients)
*Workflow implications
*Degree of implementation difficulty
*Cost/return on investment
*Benefit (safety/quality, security/compliance, efficiency)
*Cultural/Behavioral factors (i.e. politics that can be an enabler or barrier)

Projects could include
*Hospital Information System consolidation (fewer silos than we have today)
*Ambulatory EHR consolidation (less heterogeneity than we have today)
*EHR replacement (new software that works better for evolving requirements)
*New Care Management capabilities (social, mobile, analytics, cloud)
*New enterprise-wide decision support capabilities (clinical and financial)
*Physical network consolidation
*eMail consolidation
*Telephone consolidation
*Domain consolidation (identity management via a single platform)
*Administrative system consolidation (supply chain, human resources, learning management)
*Desktop image standardization
*Storage consolidation
*Data Center consolidation
*Single PACS/Enterprise archive
*Integration engine consolidation
*Outsourcing selected functions
*Centrally managed security tools and staffing

Of course, priorities have to be driven by requirements, given that time and resources are limited.   Our hope that is a July strategy deliverable can be turned into FY15 budgets that enable us to tackle the highest priorities, knowing that the journey to systemness will take years.

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About Yoga for Heart Health and Circulation

by Baxter

As I have been working on a new online program for yogauonline.com this week, I’ve been thinking a lot about heart health and how yoga practices help to maintain or improve circulation in the cardio-vascular system. This is the system that includes the heart muscle, the arteries, capillaries and veins and circulates blood, plasma, red and white blood cells, and hormones and enzymes. This is also the system that moves all these things throughout the body, delivering fuel to every cell in the body, removing the waste from same-said cells, delivering hormones and messenger molecules, like enzymes and complex protein molecules, that turn on and off so many functions in cells and organs. And this is also the system that moves white blood cells around the body to address infections and foreign body invasions that make it past our skin and inner linings, like bacteria or the dirt that gets ground into a scraped knee. So, even though some would like to think of the circulatory system as a closed loop of heart and blood vessels, it essentially is in contact and interconnected with every other “system” of the body. When the heart and blood vessels are maintaining appropriate “circulation” moment by moment in the continual changing inner environment, a very important part of our overall health is taken care of!

If we assume that we might be starting off with a circulatory system that is operating sub-optimally, how could yoga practices improve the functioning of the circulatory system? Let’s start with the active asana practice. In moving your body through a series of yoga poses, either individually for a minute or more or linking them together with the breath, as in vinyasa practices, you are contracting and relaxing most of the skeletal muscles of the body. This tightening and relaxing has a pumping effect on the arteries and veins that can help to assist the heart pump in moving the blood and its passengers throughout the entire system. Because the venous part of the system that helps return blood back to the heart that contains a lot of waste molecules and lowered oxygen, assisting the heart pump in this way can be especially helpful. Also, the veins can sometimes weaken and allow back flow (that’s right, flow away from the heart). We all know these kinds of veins by the term “varicose” veins. But the pumping action of the muscles on the veins can get those stagnant areas more efficiently moving in the correct direction. And any poses that get the legs—the most common limbs to be affected by varicose veins—upside down, such as one of our all-time favorites Legs Up the Wall pose, ends up using gravity to benefit circulation. This pumping action and inverted pose effects also help get the lymphatic fluids back into the main circulatory system.

Another way that the circulatory system is negatively impacted is by the following three conditions: chronic stress, the development of high blood pressure and the clogging of the arteries. Any of these conditions can ultimately result in more serious changes to the ability of the heart and blood vessels to do their jobs at all. The first two problems can be positively influenced by using yoga stress management practices to  shift of the autonomic nervous system—that’s right, by using the powerful ability of yoga to shift the body from the Fight or Flight setting to the Rest and Digest setting. One specific response in the circulatory system that takes place when you make this shift is with the muscle tone of the arteries and, to a lesser degree, the veins. What do I mean? When stress levels are high or as a result of a gradual increase in blood pressure over time, the smooth muscle layer that surrounds the arteries and a thinner layer that is found in veins tends to contract and narrow the diameter of the blood vessels. This means the heart muscle has to work harder and harder to pump blood through the narrowed blood vessels. If this state of affairs goes unchanged, it can eventually lead to failure of the heart to pump properly for good. If, however, you start uses the yoga practices that we know will lower stress levels and shift the nervous system to the parasympathetic side (see The Relaxtion Response and Yoga, the smooth muscle layer of the blood vessels relaxes, taking some of the burden off the heart and ultimately lowering blood pressure as well. And the more regularly we practice yoga for stress management, including  gentle sequences, restorative sequences, easy inversions, mindful meditations, yoga nidra, and appropriate pranayama techniques, the better the response if likely to be.

And for those clogging arteries that for so long were said to be directly related to cholesterol levels but now seem to be more strongly influenced by an underlying inflammation in the lining of the vessels, those same practices that quiet the nervous system have been shown to decrease inflammation in the body. There still needs to be more research done on just how much decrease in inflammation yoga can provide, but the initial research is very promising. In addition, the Dean Ornish research over the last 15 years has shown that a multi-prong approach of vegan diet, exercise, meditation, yoga and group support not only can slow down those clogs we call atherosclerosis (which can lead to heart attacks and strokes), but can actually reverse the blockages in some cases. Remember, this includes other modalities as well yoga.

Finally, if the heart is not beating at the correct rate for the task at hand, the circulation can be seriously compromised, causing anything from mild dizziness to complete failure of the heart to do its job. These arrhythmias can include the heart beating too fast or too slow. Recent research shows that in both healthy or unhealthy heart rhythms, yoga practices can help improve the heart’s electrical conduction system. (We’ve written about some of these effects in previous posts including Yoga, Heart Health and Tachycardia and Yoga, Heart Health and Atrial Fibrillation.)

Yoga, therefore, can be said to improve circulation by improving blood flow and the return of lymphatic fluids to the heart, reversing the impact of chronic stress on circulation, lowering blood pressure, slowing down or reversing atherosclerosis, improving the heart rhythm and improving overall heart health. Wow, all those amazing effects makes me even more excited to be presenting my upcoming online lectures on Yoga for Heart Health on April 1st and 3rd. Consider joining me for that! I will give you a link you can use to sign up in the near future.

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Yoga for Emotional Wellbeing: An Epiphany

by Nina

Sand Dollar by Melina Meza

I don’t have a particularly exciting story about why I started practicing yoga. (It’s kind of humorous actually. When I was in my late twenties, I was working at a small software company and we wanted to start an on-site exercise class. One of our co-workers said that his wife could come and teach us, so we decided to give it a go. We had no idea she was a yoga teacher! So there we were, for our first class, and she asked us to stand in “Mountain pose,” with our big toes together and our heels slightly apart, which was the opposite of the foot position I was used to doing in ballet and modern dance, my previous forms of preferred exercise. And just standing that way felt so wonderful for my body, I thought, whatever this is, this is for me!). However, I do have a more dramatic story about why I decided to become a yoga teacher.

During the period when I was studying yoga with Rodney Yee and writing our first book together, Yoga: The Poetry of the Body, Rod helped me understand how my yoga practice was benefiting me in emotional and spiritual ways, as well as physical ones. It turned out that by practicing regularly at home—something I had taken up intuitively rather than with any specific goals in mind—I had been learning to manage my stress, balance my emotions and cultivate equanimity without even realizing it. (If you read the dialogues in the book Yoga: The Poetry of the Body, you can witness Rod helping me toward that realization.) And as someone who had suffered in the past from chronic stress (working full time at a software start-up while raising two children!), which had led to a bout of agitated depression, I began to see the tremendous power yoga had for helping people with emotional difficulties of all kinds, including stress, depression, anxiety, anger, and general dissatisfaction or unhappiness.

Then, one morning when I was practicing yoga with Rod and his best friend, Ian, Ian began talking about how he had just learned that a colleague of his had committed suicide.  (Yes, sorry to disillusion you, those guys chatted constantly while they were practicing.) And while I was in Shoulderstand, I kept thinking about about Ian’s story, and filled with compassion for his friend—for the suffering he must have experienced to lead him to take his life—I began to cry. I realized then that while I could not help Ian’s friend, I did have quite a lot of knowledge that I could use to help other people who were suffering. And while I had no particular ambition to become a yoga teacher per se, I understood at that moment that I really should look into finding a way to share what I knew. Yes, it was one of those actual epiphanies (and I had it while I was doing a yoga pose).

After that, I started doing two things. First, I began taking as many workshops as I could from teachers like Patricia Walden, who teaches workshops on Yoga for Depression (I took that more than once!) and Yoga for Emotional Healing, and Roger Cole, who teaches about the physiology of inversions. Then, I enrolled in a three-year teacher training program at The Yoga Room, in Berkeley. Clearly I believe in being thoroughly prepared! Finally, when I felt ready (and when I got the go-ahead from Patricia, who was informally mentoring me) I did begin teaching workshops on Yoga for Emotional Wellbeing, Yoga for Stress and Yoga for Better Sleep. Those were rewarding—there is nothing like having even just one person tell you that you made a difference in their lives by teaching them a simple practice, like breath awareness—and I still teach them occasionally. But I eventually realized that writing is still my forte and that I could reach a larger audience through my writing than by teaching local workshops.

When Baxter and I came up with the idea of starting a blog, I realized that a blog could be the perfect venue for me; having our own blog would allow me to give myself the power to write about what I wanted to write about, the way I wanted to write about it (frankly, the way some publications edit/rewrite you can be positively painful). And because the blog was free and accessible world wide, I could reach people who would never be able to study with me in person.

Because I not only write for the YFHA blog but I’m also the Editor in Chief, I work on the blog at least five days a week (and sometimes behind the scenes on the weekends). And that takes a lot of dedication. But that original epiphany I had in Shoulderstand and my ongoing passion for sharing what I know about the emotional and spiritual benefits of yoga—as well as the physical ones—are a wellspring that never runs dry.

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