Mass Communication

As I'm sure you're aware, Iranian President Ahmadinejad released a letter to the 'Noble American' public this week. The Internet provides instant access to the letter as well as to feedback from everyday American citizens.

I find that the text and predictable politics of the letter are secondary to the amazing event itself: The president of an adversarial country can instantly address another country's citizens with such a document and then get immediate feedback from the average citizens of that country.

That must be an historic first, someone please correct me if it's not.

Kicking the Microsoft Habit

John, my Microsoft Licensing project partner, and I just finished a WebEx conference with the Marion IT leadership folks during which we presented our Ministry licensing direction. (Ministry Health Care is affiliated with Marion Health System). Unlike Ministry, Marion has elected to renew their Microsoft Enterprise Agreement contract. During the presentation, they asked some good questions about how we intend to handle a variety of ambiguous compliance situations such as Citrix access and remote access. John and I had previously identified these as issues needing solutions and intend to resolve them vis-a-vis Ministry IT desktop management processes and policies. These are admittedly not easy issues to solve without rolling up the sleeves. Sometimes it seems that compliance and efficiencies don't always seem to be compatible bed-partners. In Microsoft-speak, one of the benefits of enlisting in the EA is that compliance becomes almost a non-issue because you essentially license to the head or device count. Once the contract is executed, you go on your way merely checking in once a year to "true-up" the counts (and write another check). Anything short of that becomes trickier because of Microsoft's licensing rules.

Frankly, I believe these sticky issues are exactly what Microsoft wants: they want this to be difficult, they want us to remain dependent on the EA and keep writing the checks. It's at that point in the presentation that it occured to me that what Ministry is doing is like quitting smoking and walking away from the tobacco industry: it's going to be painful at first but well worth it in the long run. Freedom of strategic choice and millions of dollars are at stake here. This is not to say we walk away from Microsoft product completely, we only walk away from the dependency. Once we kick the habit, we can evaluate product and version upgrades from a stronger, more objective position.

Because Marion is continuing the EA, Ministry will reap the benefit of using their numbers to maintain Level C discounting. In a way, they will "carry us" for the next contract period. However, by going first, I believe we will be able to return the favor by sharing our processes, policies and technologies with Marion that will detail how to survive and thrive with full compliance and effectiveness- all while kicking the EA habit.

IT Service Management (ITSM) for the Pharmacy

Historically, small hospitals have numerous departmental systems with ambiguous IT service management plans, if they have a service management plan at all. Most often, the server lives in the department itself where the status of backups, patching and security is uncertain. It's a recipe for disaster and seems commonplace in the small hospital pharmacy.

At Our Lady of Victory Hospital, we completely rearchitected the delivery of our QS1 retail pharmacy application to address these concerns. We pulled the server out of the department and reinstalled the server applications on a RAID-5 server with all of the redundancies we IT folks hold near and dear. We took over the back up and patching functions. We eliminated the ambiguity of the client application by creating procedures to install the software on a standard OLVH workstation and absorbed the clients and server into the standard OVLH network infrastructure and domain authentication. It took some negotiating and give-and-take discussions with the vendor but we were able to reach an agreement.

To fully understand and maximize the availability of the QS1 system, we mapped out every component and every connection and asked the questions:
1- Is this component or connection critical to the operation?
2- Who is responsible for it's function?
3- How can we bolster it's availability so it doesn't fail?
4- How can we restore it's function as quickly as possible if it does fail?

It's important to note that for every departmental system, someone probably already knows some of the answers to the questions above. The problem usually lies in the fact that the answers are not known to all and Murphy insists that those with the knowledge will not be working the shift during which an outage will occur. Thus, it is imperative to talk through each item, assign responsibilities, plan for maximizing it's availability, document the processes in a step by step manner and make that documentation easily available to the department and IT.

Since completing this project at OLVH, our incident call volume around the QS1 system has decreased and our ability to almost immediately restore service has skyrocketed. This has resulted in significantly higher pharmacist satisfaction and confidence.

We are going through this exact process now with the QuadraMed system at Good Samaritan Medical Center in Merrill. Using QuickBase (our team portal creator), we have created a Pharmacy ITSM portal where we are compiling and centalizing all intelligence around:
1- Support, hardware and vendor contacts
2- Related organizational policies
3- Knowledge base articles pertaining to all technical configurations
4- Processes for installing and restoring services

Additionally, we are compiling a list of barriers to service continuity. These barriers address issues such as differing support expectations and the reality of limited resources. While some of these issues may not be immediately solvable, it is important to surface and address the issues and perceptions as partners.