Appropriate IT

Project Pegs

2009-08-21T08:16:00.000-07:00

A colleague of mine came up with this brilliant distillation of wisdom:

It is possible to force a project plan to match reality but impossible to force reality to match a project plan. So why is it the latter is attempted more then the former?

S. Yetter

Tale of Three Techs

2009-07-24T08:09:00.000-07:00

My DSL has been flakey for a couple of weeks. Today, it finally went out for good. The administrative web app on our 2Wire router said the DSL signal was kaput. So began my experience with AT&T High-Speed Home Network support.

The first person to answer my call is Macy. I’m using her real name because everyone should know it. Especially her supervisor. Macy hung up on me because I couldn’t understand her accent. To her credit, before hanging up on me, she tried to communicate by talking REAL LOUD.

I called again hoping to get Macy as I had a few things to say but Joy answered the call instead. Joy asked me some questions and made me unplug the entire deal and move it to another phone jack. She put me on hold a lot while she multi-tasked with other support calls. Joy didn’t seem terribly enthusiastic about the whole affair. Most of the time I thought we had lost contact but after while she’d come back on the call. Eventually, Joy escalated the call to Ron after she was unable to figure out the problem. Even after I had to move the whole deal to another phone jack. Did I mention that I have (had) all of my cables neatly tied and tucked away?

Ron was from California and asked me all of the same questions Joy had. He was unable to find the ticket in the system. He announced that he had some diagnostic tools and could see that the signal in our house was intermittent (tools and progress!). Then he announced that our 3mb downstream should have never worked because we were too far away from the hub (sigh. so much for progress). I was about ready to write off the entire organization but Ron was very personable and seemed very interested in helping me out. I told him we’ve had this setup for three years with no problems except in the last couple of weeks. Somewhere, something has changed. Ron asked me about every phone we had in the house and if they were all attached to filters and expressed surprise that Joy hadn’t asked this earlier. I couldn’t remember so I did reconnaissance. Basement, first level and upstairs. And there it was: Jaime’s new cordless phone. Unfiltered. Got that about two weeks ago. I unplugged it and Ron announced that the signal to the house turned strong and steady.

This two-hour ordeal really reinforced in my mind what it takes for successful support:

People
We need more Rons and no Macys.

Systems
Accurate, accessible ticket information saves time for everyone. Additionally, Ron had access to diagnostic tools that Joy apparently did not. Finally, while high productivity is a key goal, multi-tasking to the point of ineptidude is not an effective component of a solid productivity system.

Process
Ron fell back to a first level diagnostic process that started at square one. Having and using such processes is the only way to efficiently diagnose and solve issues.

The Speed of Trust

2009-03-29T13:21:00.001-07:00

The Premise of Covey's, The Speed of Trust, is that when there is trust in any business or human transaction, the transaction takes less time and thus, costs less.

Think of any transaction, whether it be buying something or talking with your boss. If there is trust, things move along quickly. If there is no trust, we get bogged down in analysis and take extra time checking things out. Trust is the lubricant for effective human transactions. Increased friction is the result of lack of trust.

Typical of Covey materials is the framing of principles around values and specific behaviors, an approach adapted by Ministry Health Care for our Patient Promise.

Trust is a key element of effective leadership. I highly recommend this one. It's an easy listen, only 75 minutes (executive summary version from Audible.com).

Personal Responsibility at the Desktop

2009-02-22T14:10:00.000-08:00

In the aftermath of a virus or malware outbreak, we typically beat up on our Client Technology and Data Center folks or even our security software vendor and demand answers, “How could you let this through? Why didn’t our technology block this threat? Where was your vigilance?” Frankly, the question we really want to ask is:

“Who’s the nincompoop that clicked on the malware that kicked this catastrophe off?”

Virus and malware outbreaks typically cause us to revisit our usage of Windows local administrative rights. In a nutshell, local admin rights serve double duty as a requirement for certain, critical applications as well as the scourge of IT Support.

One approach to keep malware from attacking a device is to “lock it down”, that is, to remove local admin rights so that the user can’t install anything on it. This approach has its advantages because it protects users from the negative consequences of their own actions. This is similar to web filtering where we keep users away from harmful sites. Standard tools in the IT Security arsenal, right?

The problem I have with employing blocking technologies as the sole deterent is that we do two things:
1) We imply a lack of trust whereby we further are viewed as “big brother”.
2) We create a nanny security environment where users assume no responsibility for their actions (for what they click on).

While blocking technologies are important and necessary, I strongly believe we need to cultivate another, farther-reaching approach: personal responsibility and consequences. Before you call me naïve, consider this: Is it better to instruct our teenagers about the dangers of alcohol consumption or should we prominently lock the liquor cabinet and call it a day? Clearly the healthier and more sustainable answer is the former. (Having said that, there are certainly times when we may have to resort to the latter!)

I propose educating users on what they can and cannot install. We don’t want them installing games and we don’t need them to help us update their virus scanners. In fact, we don’t want them to install anything without the consent of the Service Desk. If, after this simple education, a user decides to install something, we will impose simple consequences. If it takes 30 minutes for a technician to remove Google Earth, then the user will forfeit 30 minutes from their paid-time-off (PTO) account. If they click on something that requires a 2-hour reimaging and reconfiguration of their device, they forfeit 2 hours from their PTO account.

In essence, we need to employ a two-prong approach: blocking technologies AND user responsibility and consquences.

In Jurassic Park, John Hammond tells Dennis Nedry that he doesn’t blame people for their mistakes, but he does ask that they pay for them. I agree and believe that this stance would vastly cut down on the number of illicit software installations, with blocking technologies providing the final cover.

Fostering Cultural Excellence

2009-01-15T07:10:00.000-08:00

Our Lady of Victory Hospital (OLVH) routinely posts the best employee culture scores in the Ministry Health Care system. I'm often asked how it is that OLVH consistently rates so high. We're certainly not perfect nor perfectly consistent across all departments but I see OLVH's cultural strengths as follows:

Leadership by Example

OLVH leaders are "working managers". I think that makes the layer between managers and staff less pronounced. Whether it's our DON working ED shifts or the Rehabiliation Director going to the prison to provide therapy, the leaders at OLVH have their sleeves rolled up just like the staff does. I believe that fosters more of a "we're all in this together" environment.

Sincerity

Values and culture activities are treated seriously and sincerely by our leadership. These initiatives are always followed by serious and sincere action. Employees can smell disingenuous lip service a mile away.

Connection with Staff: Honesty and Openness

From a senior leadership level, the hospital President does a great job of keeping everyone appraised of what is happening, even if the news is negative. There are few, if any, secrets. Discordance is hard to hide in a small environment so it's typically dealt with quickly resulting in less time to fester (certainly there is variability in performance here but overall this is a strength at OLVH). Conversely, good works and good staff are more visible to all. The President's weekly email is a great example of how she openly connects with staff to relay good news, bad news and give sincere kudos and encouragement to specific individuals.

Focus, Accountability and Follow-through

There is a strong current of accountability here complete with follow-through and closure of initiatives. Thus, things get done. This leads to the sense of accomplishment as well as confidence that what we focus on will be accomplished.

Trust

All of the above lead to a higher sense of trust among leaders and staff and trust is probably the main ingredient of commitment.

Tis the Season: Digital Camera Purchasing

2008-11-27T19:56:00.000-08:00

This is the time of year when I field a lot of questions about point-and-shoot digital cameras for gifts or for capturing pictures of kids and grandkids during the holidays. Luckily, a very highly respected digital camera review site, DPReview.com, is coming out with a series of reviews of cameras within various classes. Each class review will select the best cameras in their respective classes.

Their first review is of the budget camera class and includes cameras under $150. According to the review, the two best cameras in the group are (with Amazon links) the Sony DSCW120 at approx. $130 and the Panasonic LZ8 at approx $117.

Remember, this first review is of budget cameras so the winners will provide good quality photos yet may or may not have all of the features you desire. Read the reviews carefully as DPReview does a good job of specifying the pros and cons of each class of camera as well as for the individual cameras themselves. I'm actually quite amazed that both the Sony and the Panasonic above have Image Stabilization and large viewing screens. Clearly, high-end camera technology is working it's way down to the budget models!

If you're interested in digital camera buying this Christmas, check back at the DPReview site for more information and more reviews as they become available.

Enjoy,
Eric

(BTW- Don't judge a camera based on the number of megapixels it has. All new cameras have enough megapixels to produce large prints.)

President-Elect Obama's Electronic Health Record

2008-11-27T10:33:00.000-08:00

In a fortuitous coincidence, Will Weider (the CandidCIO) and I are blogging about the same topic this week: President-elect Obama's enthusiasm for Electronic Health Records.

From the Obama health plan:

A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

At Good Samaritan Health Center, it's the duplicative and unnecessary testing that we're going after in full force with our PACs initiative. Currently, images and interpretations are not well integrated into our referring physician's work flows. As a result, duplication of diagnostic exams occurs. Our goal is to ensure that high quality images and interpretations are available electronically 24/7 to all of our referring physician customers (HIPAA compliant, of course).

Off Site Office

2008-10-31T16:55:00.000-07:00

So there I am, in the middle of the woods on a beautiful late October afternoon. I'm staked out on a tall, lake point with towering pines all around me. The sun warms me through the trees while I sit in a folding chair inhaling the clean fall aroma of leaves and pine needles.

The occasion is a highly anticipated PTO day to take advantage of a dwindling fall. I'm sitting in my chair with my rifle in my lap, soaking up the sun and waiting for the red squirrels to come back out of hiding. We like to keep their population low this time of year so they don't end up chewing up the cabins, sheds and boats that are stored for the winter.

I've finally got a visual on the noisy squirrel to the east when my leg starts to vibrate and Collective Soul starts to play. My cell phone. It's a support technician informing me that our retail pharmacy vendor has made a mess of our point of sale terminals.

Frankly, the fact that the call even comes through in the middle of the wooded, Wisconsin nowhere is a miracle brought about just within the last year. I actually have two-bars of signal out on the point. She conferences in the vendor and the troubleshooting begins in earnest.

At that point, Mr. Wire-Eating red squirrel ventures out from behind a stump and stops to present a perfect shot. Just as I'm set to hit the mute button, put down the phone and pick up my rifle, I hear my name: "Eric, you said you had archived the client installation packages, can you give us the UNC path to them?"

Sigh. Yes. I can. I scowl a bit as I watch the squirrel wander off while I give the technicians the paths and other site-related information needed to restore the terminals.

The conferences ends, I put the phone back in my pocket, pick up my rifle and lean back in the chair. Once again, the aroma of fall and the warmth of the sun fills my senses. Eventually, a smile settles on my face as I contemplate the surrealism of the whole event.

Meeting Frustration Factors

2008-09-20T08:06:00.000-07:00

I participate in a lot of meetings. I enjoy good meetings when the group is charged, working well together and making progress. Even if the topic is not comfortable, if we’re still solving problems or coming to resolution and understanding, it’s a good meeting.

Conversely, I’ve been in meetings that frustrate me completely. Meetings where very little is accomplished and there is a sense of frustration and futility all around. Toxic personalities aside, I’ve discovered that these bad meetings are usually the result of two things:

1) An improper mix of big-picture personalities and detail-task personalities.
2) Lack of an appropriate, focused agenda.

Imagine you are meeting to develop a communications plan that will employ print, web and kiosk delivery methods. You need a high level plan to disseminate team and event information to a large, dispersed group. But one person on the team wants to focus on whether there should be a dash or a hyphen in one of the calendar entries. I’m not making this up. You're solving world hunger, they’re wanting to correct a typo on a nutritional label.

In all fairness, the spelling-checker personality is just as frustrated at this meeting as is the big-picture personality.

I have two suggestions. First, deploy people appropriately: Solve big-picture issues with big-picture people; solve task issues with detail-task people. Of course you will need to blend the personalities so the big-picture types don’t go off on impossible-to-achieve tangents and the detail-task folks don’t bog down in hyphen-dash debates. Both perspectives are required, just not at the same time. Thus, the right blend is a must.

Second, set your agendas accordingly. If you're after a high level plan, have a Big-Picture meeting. Communicate the objectives clearly and keep the meeting on track. Be clear that you want to hear about details only to the degree that a given idea or proposal is not impossible or unworkable. Save working out the details for the Working-Out-The-Details meeting with other detail-task members.

As with the Big-Picture meeting, keep the Working-Out-The-Details meeting flowing with a specific agenda and enough Big-Picture people involved to keep it from bogging down. The mantra at this meeting should be, “we’re looking for excellence, not unattainable perfection”.

I've found that this approach is effective when there is a fairly sizable endeavor, the opportunity is strategic or the threat is somewhat ambiguous.

Feel free to add comments with things you find make meetings more productive.

Accessorize!

2008-09-10T08:21:00.001-07:00

I recently bought a patch cable for my son's PS3 so he could game on-line with his buds.

Amazon sent me this email today offering to "accessorize" my patch cable.

I'm still laughing.

I mean, how do you accessorize a cable? Buy a new pc for one of the ends?

Anything but Boring

2008-07-31T21:30:00.000-07:00

I saw a blurb from US News that said college enrollment in IT related programs was down because prospective students assumed that IT jobs were "boring".

Boring?!

I initially entered IT as a programmer. I loved it because development is an act of creation, you can design and build something that solves real world problems. How can that be boring? I'll date myself and say that we wrote hospital ADT, collections, payments and billing systems in COBOL using ISAM files. And we had to compile our programs at night. The first time I used Filemaker on a Macintosh Plus I almost cried with joy. You could build databases with forms, instantly, right before your very eyes.

Next was Visual Basic with an Access database back end. I may actually have wept when I first got my hands on it. I pored through the manuals, absolutely amazed at the capabilities. Boring? Not on your life. Seeing your designs and solutions come to life before your eyes is nothing short of exhilarating.

From development to infrastructure to leadership, my path in IT has been anything but boring. Sure, there are some tasks in IT that can be boring, but I’ve not seen many in my career.

In the end, I’ve found that IT is really all about helping. It’s about helping a user with a laptop gone south with her presentation still on it. It’s about helping departments use technology to work better together. It’s about helping our organizations achieve important goals. And in HIT, it’s about helping our clinicians to provide the highest quality of care to our patients.

That, my friends, is anything but boring.

I CAN Drive 55

2008-05-07T21:05:00.000-07:00

I was listening to an interesting radio program about energy and oil during my weekly pilgrimage to Merrill. It’s a 186 mile round trip and with gas prices the way they are, this is becoming more expensive. The radio program was going into all of the issues around energy use and energy prices. Whether or not you believe in global warming or carbon footprints, you can’t disagree with the fact that overall oil demand is going to exceed overall supply very shortly.

Gas prices and food prices are linked and they are going up. Our current levels of oil use are simply not sustainable and at some point we have to sober up to this fact. Not just intellectually acknowledge it, but really take it to heart and start thinking of ways we can cut down. There are some serious world problems linked to oil and food prices. One of the ways to alleviate (not eliminate) the supply issue is, quite obviously, for everyone to use less; and one of the suggestions on the radio program was to slow down.

This seemed easy enough so I thought I’d give it a try. I normally drive 63 mph on the two-lane, and 70 mph on the four-lane. I have a four-door Pontiac with a 3.8 liter V6 and this combined driving normally nets me fuel economy right about 26 miles per gallon. Not too bad, really. For my experiment, I slowed down to 55 mph on the two-lane and 60 (yes, just 60) on the four-lane. All in all, this seemed like it would be a fairly easy experiment that I could perform over the course of two tanks of fuel.

So now I’m driving like an old-man and everyone is roaring by and giving me dirty looks. They're probably saying things about my upbringing to the person on the other end of their cell phone call. And the semis blast past me on the four-lanes and ride my butt on the two-lanes. Clearly, America is not used to driving slower.

But behold; my average fuel economy comes in at 31 mpg! That’s average mpg, with a mid-size, V6 powered car. That nets out to almost a 20% reduction in fuel usage. Just for going slower. Didn’t have to buy a new car or give anything up. If we could all cut 20% of our fuel usage, I think the national conversation might be a bit different than it is today.

I usually schedule phone calls for when I’m on the four-lane so the extra minutes of travel time don’t eat into my productivity. For this reason, I plan to continue driving this way even though my wife and kids are embarrassed. If you drive slow with me, my wife and kids might not be so embarrased so I urge you to join me.

Cheaper health care? Don't hold your breath.

2008-02-28T19:58:00.000-08:00

With the CMS (Medicare/Medicaid) April 1 deadline looming for attaching NDC codes (drug vendor ID's) to drug orders, I'm reminded of how horrifically complex health care billing is. Did you know that for each human care "transaction" such as a physician exam, intervention, prescription, diagnostic test there are an exponential number of back-end transactions required to comply with an endless stream of regulations?

Health care billing is probably at least as complex as the tax code. Imagine that every time you went to the doctor, you had to complete a form with as many rules as a 1040. Every time, every visit. That is the nature of health care billing; that is what your health care provider has to do in an attempt to get paid for services rendered.

Managing this mountain of regulation requires intelligent, well-paid people. And a lot of them. Billing specialists, revenue specialists, coding specialists, compliance specialists, risk specialists, etc., etc.

Now, I have no problem with employing bright people, but the costs over and above the actual care transaction are enormous.

The irony is that as more people complain about high costs and low accessibility, more regulation is created and the complexity (thus costs) to comply keep going up and up and up.

Oh yeah, the reason CMS wants us to jump through flaming hoops to attach NDC codes to drug orders? So that they can get a rebate from the drug companies. A rebate. Ironic, isn't it?

We're Only as Good as Our Weakest Link(s)

2008-01-10T19:51:00.000-08:00

The folks in Wisconsin are after state government's heads because mailings went out from EDS Corporation with their Social Security numbers on the labels.

I don't know what went wrong but perhaps the conversation at EDS went something like this:

IT Leader: "Team, we have an intern for the next couple of weeks. Does anyone have any easy task suggestions that would keep them occupied, out of trouble and out of our hair?

Team Member: "Hey, I've got an idea! How about we have them make labels?"

The Project Management Mindset

2007-12-06T19:36:00.000-08:00

I'm winding down my fall semester class on Project Management and came across this TechRepublic article in one of my remaining assignments. The jist is that of examining how an organization is taking to the methodologies of formal project management processes.

It gave me reason to reflect on Ministry's adaptation and frankly, the PMO process has really been embraced here. We have a fully functional PMO with some very talented Project Managers, an IT CAB of senior leaders and a CIO who demands that we follow the process.

The result is an organization that is getting better and better at making data-driven decisions around some very, very difficult priorities. Thus larger projects follow templated requests and charters that require analysis and are approved based on strategic priority by a senior level CAB. I know you're thinking, so what, that's how it should work, right? But Ministry is a mix of fourteen+ previously siloed organizations; so this is an enormous step that has advanced almost unnoticed.

We're still working on pushing the importance of making formalized analysis and charters of smaller projects. And I look forward to the day when department leaders come to me with IT requests that have thorough business analysis attached. Additionally, I'm very interested in developing enterprise-wide toolsets to aid in this regard.

Yet, we have made tremendous progress.

More Gray

2007-12-06T01:13:00.000-08:00

At a recent leadership meeting I was reminded of another gray area prominent in health care: The responsibility for billing accuracy. Clinicians say they don't have time, billing says they don't have the data. In the case of the meeting I was attending, the discussion was specifically around the ABN:

These areas of integration (and separation) are everywhere. How well we manage them will determine how successful we are in any endeavor of complexity.

Gray Areas

2007-11-18T14:13:00.000-08:00

The intersection of IT and Business historically carries some ambiguity. When we're talking about spinning disks in the data center or codification of business rules, the responsibilities are generally and logically clear cut. But as we move closer to where IT infrastructure and Business applications meet, roles and responsibilities aren't always so distinct.

When we dichotomize functions and roles, it becomes increasingly difficult to find someone who has enough A-Z knowledge of any given application to provide intelligence for problem solving, upgrading or disaster recovery. To make matters even more challenging, many times the application analyst or coordinator is employed by the business unit, not IT.

Somewhere in the middle lies a realm of knowledge that I like to call application administration. An application administrator is the individual who knows enough about the application and about SQL server to know how table permissions can affect the application. Or that your pharmacy application uses a VPN setup to transmit claims data. Or a server service is required to be run under a specific account for call tickets to transfer to another help desk. And they have access to server permissions and change management processes to make things happen.

This level of application expertise can reside in a third individual or be delegated to each Subject Matter Expert (SME) in the continuum.

Because each application has it's own idiosyncrasies and knowledge requirements, the required intelligence and responsibility for it's usefulness could be individually negotiated between IT and the Business.

If you have some thoughts on distributing and managing these roles and responsibilities, shoot me a comment or email.

Higher Expectations

2007-11-06T08:08:00.000-08:00

At Our Lady of Victory Hospital, we are expanding our wireless IP phone system. Our current system is a Unnamed Vendor [UV]-based setup with an interface to our Dukane Nurse Call. Except for the occasional blip at the [UV] gateway, it has worked well.

Fast forward to yesterday's experience with adding an additional gateway and more phones. It went poorly. The new phones worked, the old phones didn't. Then our implementation technician called for "support". After 15 minutes of being treated like an imbecile, [UV] support (now owned by Polycom, by the way, our enterprise video conferencing vendor) pulled the plug on the call stating our "free" support was up and it was now going to cost $200 per hour. They actually hung up the call.

Our implementation technician is not unintelligent and he understands our environment well so I can't understand [UV]'s treatment of his support call.

As life goes, I am also researching the value of a wireless IP implementation at Good Samaritan Health Center in Merrill. Unless [UV] comes through, comes through big, and comes through soon, it's not likely they will even be considered an option for Good Samaritan Health Center.

Apatheic support is not acceptable. I have higher expectations of my business partners.

Experts As Extremists

2007-10-05T07:40:00.000-07:00

How many times have you unleashed a team of experts to find a solution only for them to return with something so expensive and complicated that you wish you had never asked?

In their well-intentioned zeal to eliminate every risk, experts at times propose extreme solutions, products and practices that become difficult to justify. As these systems and their operational requirements grow, they demand more organizational energy than they deserve, as we wander farther and farther from the true purpose of our business.

I like to refocus by asking: How does [fill in the blank] enable us to provide better patient care? Or better customer service? In other words, at what point does the scale tip and lead us away from our primary focus?

Keep it Simple

2007-08-16T06:32:00.000-07:00

This is a great article on the (sadistically amusing) foibles of pc's and other techno-gadgets. It really underscores the frustration people feel dealing with technology that simply doesn't live up to it's promises (much less the hype).

This article underscores some of the reasons why I am so ruthless about keeping things simple in my hospitals. Technology is useless if it's not reliable.

Health Portal

2007-08-06T19:25:00.000-07:00

The July 23 edition of For the Record has a blurb stating that:

49.6% of survey respondents [healthcare organizations] said consumer decision support tools are one of their organizations top five priorities.

Considering the complexity of integrating consumer decision support tools with standard hospital and practice management operations, that's a pretty impressive figure. The top three reasons for doing so:

improve health
reduce overall healthcare cost
increase interest in healthcare

None of this is groundbreaking news but I finally got around to really thinking about the third one and I find it to be particularly compelling. Imagine a portal that provides the ability to understand healthcare issues including my own (family's) medical history and diagnostics integrated into the already available body of generic medical and pharmaceutical information on the web.

For most of us, healthcare is very compartmentalized. We see our physicians once per year and perhaps hit the ED occasionally. Healthcare seems tucked away as a necessary evil on our schedules. The ability to integrate healthcare and healthful lifestyle choices into daily living via a secure and informative web portal is compelling indeed.

My Contribution to Murphy's Laws (of IT)

2007-06-18T13:01:00.000-07:00

"Nothing requires more intervention than an automated process."

Eric Haglund

Small Town Tragedy

2007-06-12T23:16:00.000-07:00

Although completely unrelated to IT, I feel compelled to share this.

My eleven year-old son, Roger, lost a baseball teammate today. In a tragic bicycle accident, twelve year-old Levi Stokka, outfielder, promising pitcher and homerun hitter, was pronounced dead at the scene.

Apparently, Levi rode out of his driveway on his bicycle unaware of the truck coming down the road.

This is an opportunity to remind our children about safe bicyle riding. It's also an opportunity to shuffle around the cars, boats and trailers to make sure that drivers and children have a good view of each other where the driveway meets the road.

Finally, it's another reminder to ALL of us, albeit an extremely unfortunate one, to slow down.

May your children be safe,
Eric

Reflection:
Reflecting upon this over the past couple of days, I find myself feeling, as a healthcare professional, frustrated by never really having had the chance to help. Our Emergency Departments are filled with incredibly talented and compassionate people, a helicopter staffed with equally talented people was ready to transport him and emergency medical staff at the scene did everything they could do. We have fantastic technology and protocols available in our hospitals but in the end, Levi's injuries were so traumatic, we never had the chance to do what we do best.

Update:
Tom Arneberg has assembled a memorial website here.

Enterprise 2.0: Big or Little?

2007-05-06T20:13:00.000-07:00

Here's an interesting post from Tom Davenport (Harvard Business Online) about Enterprise 2.0. Tom's stance is that E2.0 will be the next "little" thing rather than the next "big" thing. He says:

Enterprise 2.0 software and the Internet won't make organizational hierarchy and politics go away. They won't make the ideas of the front-line worker in corporations as influential as those of the CEO. Most of the barriers that prevent knowledge from flowing freely in organizations – power differentials, lack of trust, missing incentives, unsupportive cultures, and the general busyness of employees today – won't be addressed or substantially changed by technology alone.

There's certainly much truth to what he says and I love a crusty, cynical stance as much as any other curmudgeon. But I think Tom is missing the long term here. Of course the front line worker won't be as influential as the CEO is, he/she is not paid to be. They have different informational needs for different decision scopes and they communicate and collaborate with different teams.

In my opinion, E2.0 is about empowering those teams and to that end it looks pretty compelling. To assume it's the magic bullet for business is to fall prey to marketing.

Is E2.0 the next "big" thing or "little" thing? Only time will tell but I'm hoping that it's at least the next "medium" thing.

Stifling Innovation, or Moving it Somewhere Else?

2007-05-01T07:32:00.000-07:00

Interesting article at ZD Net about how CIO's are so focused on "keeping the lights on" that innovation at the tech level suffers.

Lack of innovation can be a potential catch-22 as we downsize FTE counts and Lean out processes. These efforts can vastly reduce available tech time for what I call the Triple-R's: Reflection, Research and Refinement.

Of course, business strategy and requirements ultimately drive the direction of IT but without innovation, the IT effort will ultimately atrophy.

I suspect that if techs no longer have time at the workplace to innovate, the dedicated ones will find time away from work to do so anyway. To paraphrase Ian Malcolm from Jurassic Park: Innovation finds a way.

I also expect that these moonlighters might be easily stolen by the competition if they don't feel adequately rewarded for their efforts.

Wikipedia, it's Good Enough

2007-04-15T19:59:00.000-07:00

I love Wikipedia. I use it so often that I have incorporated the Wiki search plug-in on my Google desktop (see below).

What I find so addicting about Wikipedia is that I can get instant definitions and knowledge jump off points for any topic, person, system, concept, ideology, song or whatever else. Sure, it's not always definitive information, but like everything else on the web, it's "good enough".

The Good Enough concept drives the web (for better or worse). In the development world I come from, slow and flakey user interfaces (the browser) would have been grounds for dismissal. But something happened in the web-ifying of the masses, they seemed to take the flakiness in stride, it was "good enough".

So goes much of the data on Wikipedia. It's good enough for 90% of my queries. If I don't trust the exactness of the information found, it gives me just enough information to enhance my understanding of the topic as well as provide me with the terminology I may need if I wish to continue my research.

Sometimes, you just want to know what time it is, you don't need to know how to build a watch. Wikipedia fits that need.

More Microsoft

2007-04-07T13:56:00.000-07:00

My CIO forwarded this article on Microsoft's demise.

It's an interesting article that has some arguable points. It seems to me that Microsoft's problem is the same as most other established, big businesses: Their own success forces them to spend too much organizational energy on protecting what they have instead of taking risks to create something new. Ironically, some trends I read show that business is ready for Web 2.0 functionality but isn't comfortable buying such technology from self-proclaimed hackers such as this article's author. They would rather buy from a Microsoft, HP or IBM (sorry, I don't have the reference for that).

Additionally, maybe the small office loves the Mac and techies love open-source but I'm not so sure they are anywhere near as manageable in the magnitude of 12,000+ units such as we have here at MHC. Wintel has already won that war. It may be hip and trendy to tote a Mac but I believe the TCO numbers come down on the Wintel side when we're talking high quantities (I'm not a Mac basher. I love Macs and installed a bazillion of them at Howard Young Health Care in the early 90's).

Microsoft has the cash to reinvent themselves. They need to do some net-zero thinking to develop new strategies. But as long as they're beholden to Wall Street, it's going to be tough sledding to move away from the desktop application model that butters their quarterly bread. The computing impetus moved away from the desktop model and Microsoft missed that trend because they were too focused on making the desktop better; they just couldn't think outside the box.

But I wouldn't count them out yet. And frankly, it really doesn't matter to me who's name is on the technology we buy, rent or lease, as long as it satisfies the functional and managerial requirements.

Balancing Competencies in IT

2007-03-19T19:05:00.000-07:00

There are many team and lifecycle philosophies for IT these days. Microsoft's MSF has some interesting stuff. I was reminded of this as I was evaluating one of my IT shops in terms of it's performance and lifecycle competence and came up with a lifecycle of core competencies around implementation of IT:

Analyze the requirements
Create and communicate a recommendation
Create the support plan
Procure the necessary technology
Implement the solution
Implement the support plan
Document configurations, processes and procedures
Follow up

(We could argue the order of these but that's a different conversation).
Because small IT shops have limited staff, depth and performance in each competency can vary wildly because the interests, personalities, passions and dislikes are disproportionately represented (think of the single person shop as an extreme). Unfortunately, excellence in one area and mediocrity in another leads to the perception of overall mediocrity. Like a sophisticated home audio system, the end result is only as good as the weakest component.

I believe we can smooth out the variations in performance by employing excellent service management process and template designs that address the full lifecycle of implementation. Piece of cake, right?

The ITIL Elephant

2007-02-14T19:19:00.000-08:00

Ministry Health Care has reorganized IT into a centralized, shared services model. One of the priorities is to implement standard service management processes in the new organization.

Daunting as it is, we have done some auditing and gap analysis already so we have an idea of where to concentrate: Change Management. Yet because the disciplines are so tightly integrated, you can't just pick one and completely ignore the others. Finally, there has to be a realization that at some point, we have to create working processes within management systems that we will either buy or develop, or both. It's one thing to talk esoterically about the values and philosophies of ITIL and another to actually create processes that will work where the rubber meets the road. To those ends, we're looking at concentrating our efforts on what I call bundles:

ITIL Bundle 1- Service Desk Bundle to include the management of requests, incidents and release communications.
ITIL Bundle 2- Change Bundle to include the management of approvals, tasks and schedules associated with the changes and configuration items we are changing.

These bundles form a core IT Service Management (ITSM) system from which the other disciplines can insert or extract applicable data, preferably from automated monitoring systems.

When thinking in terms of a system or toolset that could actually be created, this core must be interoperable with other systems so that all of IT can use the same Serivce Desk and Change Management portals even if they have differing system monitoring tools. Preserving as much data as possible in a single database structure provides more consistent statistical capability for proactive management.

For the core to be effective and interoperable, it seems to me that it needs to provide four windows into IT:

1- The customer window. For inflowing requests and outflowing status and solutions.
2- The technicians window. For provision of worklists and data required by the technicians servicing and enhancing IT systems.
3- The managment window. For creation of all things statistical around problems, finances, service levels, etc.
4- The interface window. For interfacing separate monitoring and management systems into the core. For example, a network monitoring system should be able to automatically generate an incident into the core system.

While this may not strictly follow ITIL disciplines, I believe it provides a realistic starting place to begin shared process implementation.

Robust

2007-01-08T18:08:00.000-08:00

I'd really like to use this word again. There are times when Robust is the only adjective that really says what I want to say. Unfortunately, consultants and software developers absolutely ruined this word in the 90's. It was so overused that it's mere utterance was banned at Ministry Health Care. Have you noticed that using this word now completely blows the credibility of the subject matter at hand?

I'd like to bring it back because there are times when I need it. Perhaps if we wiped the slate clean and put the following guidelines in place:

Consultants and sales personnel remain strictly forbidden from using it. For life.
What you're describing truly is robust.
You can demonstrate that if someone calls you on it.
You can only use it once per month.

Let me know.

ITIL Configuration Database 101

2006-12-05T19:42:00.000-08:00

The configuration database in ITIL parlance is essentially a database containing all confuration items that support a service. When you dig into this, it's actually quite deep and thus for the IT shop that hasn't been keeping up, this task can be a bit daunting. So here's an easy start- UPS Service Management. You know those UPS units you have everywhere? What is the status of their batteries? I don't know what your experience has been but I've seen units completely drop output power when the battery goes belly-up. Even the "Smart" ones will do this.

Although this seems like a small detail to worry about, it's really the small details that tend to trip us up, isn't it? Imagine a UPS that supports some switches goes under on a Sunday afternoon. No one noticed the warning beeps because it lives in an obscure closet off the beaten path. Instant support crisis. No, it's better to be proactive about these things and the more small obstacles to service we eliminate the better our overall service is and the fewer fires we have to extinguish.

Here's how to get ahead of this one:
Inventory and tag all of your UPS units. Yes, even the little white ones IT Pro's look down their noses at because they're so "home office". They still hold up important devices and instruments so you'll need to go hunting for them as they likely came in with vendor systems. As you find them, get the pertinent information and record it (see the screen shot above). This is an excellent time to ask if the unit is needed in the location you found it. Reduce, relocate and consolidate as necessary.

Once the units are inventoried and tagged, you can do some research to find the required replacement battery part numbers and a source. You can determine your own life cycle based on your own comfort level and the manufacturer's recommendations. I've seen the same battery pack last as long as 4 years and as short as 18 months. I flag units for replacement after 24 months and replace them before 36 months. The configuration database allows us to sort based on last replacement date so we can easily see which units are ready for replacement packs. You can save shipping and PO generation costs by making a volume order on a predetermined cycle of physical battery replacement. I do it twice a year for whichever UPS units are due.

At this point, we are ready to establish relationships to the UPS units. Relationships are really the power of the CMDB. These UPS units can be flagged as "Parents" to specific servers, or "Children" to rack power. In this way, we can begin to map out all of the devices and relationships that encompass a service.

I realize this is an incredibly simplistic and obvious exercise. Nevertheless, it does serve to demonstrate the simplicity and proactivity espoused by ITIL and ITSM.

Mass Communication

2006-11-29T18:57:00.000-08:00

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

2006-11-10T10:42:00.000-08:00

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

2006-11-02T16:19:00.000-08:00

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.

The Office-less Office

2006-10-23T18:13:00.000-07:00

Last week I presented my Microsoft Licensing Team's recommendation to senior IT leadership. We spent countless hours researching and analyzing both Microsoft's offerings and Ministry Health Care's usage patterns and strategic directions. One of our recommendations is to simply walk away from the Microsoft maintenance models (EA and SA) on the vast majority of Microsoft product we use. The three main reasons to do so are:
1- Avoidance of enormous costs- millions of dollars in maintenance payments
2- Lack of business case for newer product functionality
3- The changing model of corporate intelligence respositories

I find Microsoft's document-centric architecture to be out-dated for the enterprise. In Microsoft's document-centric world, expensive content editors (known as Office applications) are required and the complexities and decisions of document design, format and usability are pushed to the desktop. Microsoft tries to pull this into a coherent whole with SharePoint but that strikes me as just a facade. I believe the blog, wiki and records-based repositories of enterprise intelligence and knowledge bases make more sense today.

The new models of knowledge repositories maintain most of the design, format and usability centrally so that added content is consistent. Only modest content editors are required because the "fancy stuff" is already defined by the repository. I think specialized blogs could even take PowerPoint's place.

Admittedly, there are high-intensity users of spreadsheets and desktop databases that need to be addressed but I think we are getting ever closer to the Office-less office. I have nothing against Microsoft and even have a soft spot for some of their products (like Visual Basic), but for Ministry Health Care, the Office upgrade avoidance strategy is worth millions of dollars.

Hot Stock Tip

2006-10-18T18:29:00.000-07:00

Check out this really tempting stock tip I got. Note the in-depth analysis and the brilliantly communicated future outlook.

"Me Gilbert. You buy my Stock. Make big Profit!"

These announcements crack me up. Does anybody actually bite on this stuff?

"IT Still Doesn't Matter"

2006-10-11T17:27:00.000-07:00

So says Nicolas Carr. Again. But before you get offended, read the article. The article's actual point is less provacative than it's title.

I think Mr. Carr is reacting to the bloated, 90's IT lovefest that resulted in the dot-com Bust. A time when IT marketing scam-artists made all kinds of promises that simply failed to come true (or be true). There are very few magic bullets in management and to assume IT is a panacea is to fool yourself. IT is not about fashion statements and keeping up with the Joneses. It's about appropriate application of technology to solve business problems and capitalize on opportunities.

Carr's article is a good read.

Sustainability

2006-10-08T15:50:00.000-07:00

I love this term for what it implies: thinking ahead and making decisions that have accountability to the future viability of the subject at hand. There is a lot of talk regarding sustainable food and energy policy, good stuff. But what about the sustainability of business operations? If all businesses in our communities keep squeezing the payroll and looking for ways to cut the FTE count, who's left with the ability to afford our products and services? If you follow that philosophy through to the end, who's left? Do we simply assume that some other emerging business will pick up the displaced employees in our communities?

The Eau Claire metro area in Wisconsin is known for having low wages in comparison with other Wisconsin metro areas. There are the usual theories bandied about, including the percentage of UW students, etc. The theory that always puzzles me though is the one that says there is an abnormally high percentage of service workers: retail and restaraunt employees. But these are typically low paying positions. So how can an abnormally high number of low paid employees keep an increasing number of service-based businesses in business? That doesn't seem sustainable to me.

ITIL, Microsoft Style

2006-09-26T20:34:00.000-07:00

After doing a bit of of reading and modeling some of our processes, I find that I prefer Microsoft's spin on the ITIL framework. Microsoft makes a point of acknowledging that their own Microsoft Operations Framework (MOF) is based on ITIL. That's a good thing because ITIL processes are based on an enormous amount of data and proven design.

There are three things I like about MOF:
1) It is more team oriented.
2) It emphasizes lifecycles.
3) It integrates with Microsoft Solutions Framework (MSF).

Microsoft's Solution Framework is a process framework for designing, developing, testing and releasing applications. Think of it as ITIL for developers. I believe that together, MSF and MOF cover more of the typical HIS IT activities than does ITIL alone.

I haven't quite figured out if Microsoft developed and published MSF and MOF out of the goodness of their hearts or if we can expect some kind of licensing model. Past experiences would point to the latter. If nothing else, perhaps a way to lock in Visual Studio developers.

In any case, I still see significant value in these frameworks and team concepts. Here are some good introductory books from Amazon on MSF and MOF.

Bling, Revisited

2006-09-22T20:22:00.000-07:00

I've had a few folks email me and either ask how I define Bling or tell me flat out that my motorcyle is Bling and I need to step off of my soap box. Fair questions and I'll take another shot at this.

I define Bling as something you buy, not for its functional, artistic or other esoteric value to you, but for what it communicates about you. In other words, Bling is something you buy because you want to show off your current, or wished for, status in life.

Cadillacs are Bling (Let's be honest, a Buick is just as nice, just as well made, just as powerful). Hummers and Beemers are Bling, too. If you buy it for the sole purpose of impressing or showing off, it's Bling and it's wasted money. That's my definition. It's money that has a better purpose in this world. Here is a better purpose, among many others.

Back to motorcycles. My wife and I have over 30,000 miles on ours and we bought it to ride, not to impress the neighbors. That makes it a shameless toy, a luxury item. But not Bling. Here in America we're truly spoiled with our ability to buy luxury items. Enjoy and appreciate what you have, but let's not get carried away.

Let me know what you're definition of Bling is. At what point do you feel it's time to spread the wealth?

PUTN

2006-09-22T09:47:00.000-07:00

Today I was up early to make my trek to Good Samaritan Health Center in Merrill. I stopped at McDonald's for coffee and noticed that they have a great new customer service- they'll put the cream and sugar in your coffee for you. That's really nice of them because I don't like struggling with the cup and lid with visions of stained ties, scalded genatalia and other such unpleasantries.

What I really like about this setup is that they use their current technology to provide better customer service. They do this with a new transaction code for "putting in" cream and/or sugar. The transaction code is PUTN (get it?). The use of cold transactional systems to provide cream in my coffee brought a smile to my face. McDonald's found a simply-elegant way to insert better customer service into an existing process using existing technology. And those who know me know that I absolutely love simply-elegant solutions.

As I reached for the coffee cup with "2C" (2 creamers) hand-written in silvery-ink on the lid, I thought, "Kudos McD's". However, proving there is always more room for improvement, that silvery ink on my lid left a gray smudge on the tip of my nose that I didn't notice until after my meeting with senior leadership.

Assumption Hall of Shame

2006-09-14T12:14:00.000-07:00

Those of you who know me, know that few things get me riled up as fast as an implementation team that operates on a batch of undocumented assumptions. How many milestones have you seen blown out because someone expected something in your environment that wasn't true? Worse, the expectation was never documented and presented ahead of time? I'd like to blame vendors for this but I've seen our own internal teams make the same mistakes.

This makes me ballistic every time. Why? Because coming up with a list of expectations and assumptions is not a hard thing to do, and would go far to make implementations proceed smoothly. Sit down with your team, go through the implementation and ask, "What do we assume here?" for each step in the process and each connection to be made. It's too important to ignore, yet it all too frequently is.

Here's a few good ones by an unnamed transcription vendor that delayed go-live and required many unplanned hours of drop-everything-and-run work this week:

Undocumented assumption #1: Our Dictaphone server had a public IP address (huh?)
Undocumented assumption #2: All users have administrative rights to their pc (huh?)
Undocumented assumption #3: All users have their own pc (in healthcare?)

I've seriously considered a new blog filled with vendor names and their puzzling assumptions to post for all to see. I would call it the Assumption Hall of Shame. But I'm too nice. So far.

Site-to-Site VPN a God-send for rural clinics

2006-09-10T16:09:00.000-07:00

One of my hospitals has three, hospital-based clinics. Of course all are rural and of the three, one of them (Victory Medical Group in Owen, WI) is just plain out in the sticks. Between the cost of WAN connections (even with USAC grants) and the lack of WAN providers in Owen, we've just never been able to justifiy a serious WAN link.

When we built the new clinic, we installed a DSL connection so that we could provide faster Internet service as well as some VPN access for Owen staff back to the hospital. This was a nice step forward but still not where I wanted to be.

Enter the Cisco 3002 VPN hardware client. This network device uses the $60/mo DSL link as a secure channel back to our regional VPN concentrator. Implementation has provided exactly what I was looking for: an affordable way to extend our network to the Owen clinic. The user experience at Owen is exactly as it would be if they were back at the hospital. Logging in is the same and accessing network resources is the same. We also have a legacy UNIX-based practice management system that will now be able to access IP-based printers at Owen through the VPN.

The 3002 is around $800. Compared to a T1 link to Owen, this solution pays for itself in about 45 days. It's not a perfect solution and I would advise anyone considering this type of solution to thoroughly analyze the risk associated with relying on the public Internet for this kind of connectivity. At Owen, patient care would not be affected if the link was inoperable.

Rural healthcare is typically very challenging financially. At the point when we wish to implement patient care IT in Owen, we will need to re-evaluate Owen's WAN connectivity. For now, however, I'm pretty pleased with this set up as it accomplishes the objectives at a price the clinic can afford.

Mixed feelings for the ASP model

2006-09-08T13:53:00.000-07:00

Richard MacManus has a very interesting post at ZD Net about Google Office pieces, including some screen shots (here). The prospect of little 'ole Google challenging Microsoft for office apps makes for pretty heady stuff.

Where I fail to get excited though is with the whole ASP model. Why? Because a lot of the work I do is off-line. Most mornings, I work in the car on the way to the office (my lovely wife drives). I also work on weekends at my in-laws cottage on a secluded lake (take my word for it, nothing high-speed takes place at that cottage, including Internet access).

So the very times I carve out for creative development, I'm cut off from my tools in an ASP world. In the email space, Microsoft Outlook saves the day with it's offline model. What are the odds of the Googles and Intuits (Quickbase) providing offline capabilities? Slim to none I would guess.

The other issue is trusting the ASP to preserve the integrity of your data and not finding ways to use it for their own marketing or competitive advantage.

When it comes to the ASP model for critical applications, I'm still wary. I'll let you know when (if) I change my mind.

A New Philosophy

2006-09-01T07:25:00.000-07:00

My CIO dropped a subtle pearl of wisdom at an enterprise IT leadership meeting we had yesterday. It's elegantly simple and it goes something like this:

We don't base our decisions around philosophies. We base our decisions around analysis.

The intent is that conventional wisdom should be challenged at times and reevaluated in light of current data. That strikes me as an excellent decision making philosophy.

InstyMeds is a Winner

2006-08-29T18:41:00.000-07:00

We installed InstyMeds about a year ago and couldn't be happier with the product. InstyMeds is an ATM style prescription dispenser that is essentially a stand-alone pharmacy with dedicated phone lines to pharmacists. We use it in the Emergency Department at Our Lady of Victory Hospital (OLVH) primarily for patients who need scripts after our hospital pharmacy is closed. Because OLVH is in a very small farming community, the only available pharmacy other than our own is a 30 minute drive to Chippewa Falls. Previously, the community was without reasonable access to prescriptions on nights and all weekend long.

Implementation went very well. InstyMeds was completely up front about all IT requirements and assumptions and had all thoroughly documented (other vendors take notes here). The dispenser itself is large and made up of a bunch of USB-based devices set into a cabinet. Although it resembles a high-tech Rube Goldberg machine on the inside, it's been extremely solid.

The only downside is cost. InstyMeds rings their register for drugs and filling charges. In a high volume environment, money can be made but in our ED, we're lucky to break even. Still, this is a highly needed community service for which the InstyMeds service is perfectly suited for.

We'd love to help, but first....

2006-08-29T12:28:00.000-07:00

Cisco earns my wrath today for the way they handle warranty claims. You call the hotline only to be told that before they can help you with your service claim, you'll need to fill out a THREE page web form. Worse yet, the form is full of marketing questions that have absolutely nothing to do with the switch that is now smoldering in earnest back in the closet. Perhaps this is our punishment for not handing over SmartNet money.

Cisco isn't the only guilty party here. This seems to be common on the net where we are required to create a different account for every Tom-Dick-and-Harry-dot-com that exists, even if we just want information or to browse the site.

To be fair, once I jump through the flaming hoops, I get great service from Cisco. But a web form full of irrelevant questions is a lousy customer gateway if you ask me.

No problem, it's just a standard web page.

2006-08-17T12:19:00.000-07:00

How many times have you heard this from your vendors?

Only to find out it needs Flash version x, Java version y and Cookies enabled. Oh yeah, and it wants to talk to a server via a port that is most certainly blocked by your firewall.

It amazes me how technically ignorant many vendors are of their own products. Or how many make the curious assumption that if it works in their office it should be a "no brainer" at your secure site.

We've been refining a checklist for vendors that must clear the IT organization to ensure there are no surprises when we implement technology. I think this is a terrific idea and something that most do in one form or another. Where it fails however, is in its own assumption that IT will even get the chance to fill in the checklist for all vendors. It seems to me that if the implementation is non-technical, a new drug wholesaler for example, IT will likely be bypassed.

It will also be bypassed when the sales person tells the decision maker, "No problem, it's just a standard web page..."

We Could Learn from the Amish

2006-08-15T06:59:00.000-07:00

There are two things I respect about the Amish (and Mennonites):
1- They don't embrace technology without fully evaluating it first
2- When they do embrace technology, it is evaluated on how well it will bring them together

As IT organizations, I believe most of us probably do #1 fairly well. But how are we doing with item #2? Do we evaluate systems and implementations on how well it will bring the organization together? Or do we just evaluate based on how well it will serve our local or departmental needs?

At my organization, we have implemented Microsoft Active Directory. There are more than a dozen organizations under a single domain. That was a huge step forward from having a similar number of separate domains in the NT world. So we used technology to bring us together.

Unfortunately, we then quickly found a way to separate ourselves again by doing our own site-specific group policies. This probably made some kind of sense in the beginning. But in retrospect, it doesn't look like a good decision to me now because it has reinforced the differences and kept us apart instead of creating standardized commonalities that would have brought us closer together.

Now we're looking at a federation and user provisioning system. Looks like a second chance to learn from the Amish. I'm hoping we'll get it this time.

Christians

2006-08-13T15:40:00.000-07:00

I saw a bumper sticker the other day with this quote by Ghandi:

"I like your Christ, I do not like your Christians.
Your Christians are so unlike your Christ."

It's made me think about how I conduct my life lately. Am I worshipping God? Or worshipping the dollar? Do I follow Jesus? Or do I follow my employer? Am I compassionate and willing to help? Or am I impatient and unkind?

All we Christians need strength in our journey to become more like Jesus.

Bling

2006-08-13T15:12:00.000-07:00

This word describes all things wrong with America today: Bling. It's over-indulgence. It's waste. It's showy. It's pretentious. Frankly, it's ridiculous.

Did you know they have shops where you can buy bling for your pets? Bling for your car? How pathetic. If you ever have the desire to squander your money away on bling, go here instead: http://www.heifer.org/

For $120 you can change someone's life by buying them a goat. You can buy cows, chickens and other livestock for people in need. The beauty of Heifer International is that they teach people to take care of themselves, they don't just hand out money. Click on the link and read more, you'll be impressed.

If you're tempted to bling-out your car or your dog, do the world a favor and send the money here instead.