Healthcare provider CEO – a perspective on IT

Attended the 16th Annual Conference of the Healthcare Informatics Society of Ireland (‘HISI’) today.  Excellent keynote from Michael Dowling, President and CEO of the North Shore -LIJ Health System USA.

He made some opening remarks about a number of the key drives for change in the US: consolidation (insurers and providers), budget issues, healthcare reform movement.

WRT to IT he claimed to have seen less progress than he would have expected (given that Healthcare is one of the most technologically advanced industries) – probably because (1) fragmented healthcare industry and (2) lack of great products.

He argues strongly for a subtantial commitment to IT – if providers want to trak outcomes and to manage the continuum of care.  He is looking for his investment in IT to generate quality, productivity and efficiency – with better outcomes for the patient.

He had some interesting views on RoI and investment in information technology.  Quick RoIs do not occur – and people too often build false expectations.  IT will not solve the healthcare cost problems. These are down to technological advancement, democratisation of advertising by pharma, demographics (in 100 years we have added 35 years to the average life), life style/ behaviour (e.g. child obesity).  Many of these issues are not being addressed at the right level.

Mr Dowling made a number of other observations:

  • need to move from pay for service (ie volume) to pay for value
  • IT must be used to connect different providers right across the contuum e.g. hospitasls, socil services, ancillary services
  • important to implement systems which do notlock people into doing what they are doing today
Finally Mr Dowling reminded all of us about the risks of losing the human factor though over dependence on technology.  He expressed his frustration tihw so much unproductive email (referecing the quote ‘the problem with communication is thinking it has occurred’).
Al in all an excellent key note from a CEO committed to investing in information technology to improve patient outcomes.  And a CEO who is very upbeat – in spite of the current economic challenges in all markets.


Why publish your data?

Attended the ‘Opening Up Government Data’ day in DERI, in Galway, today.  Some interesting presentations and demonstrations of tools such as Google Public Data Explorer and Simile Widgets – to enable you to work with linked open data.

In one of our breakout sessions we discussed why companies would choose to share their data – ie publish it in formats which are easy for others to consume (e.g. csv, not pdf).  Granted many businesses have web sites, describing their offerings, providing some background on the company, potentially inviting comment or queries and answering some Frequently Asked Questions.  But very few offer much data arising from their product or market research, their production statistics or their sales campaigns.  In general they would regard this information as confidential and constituting some element of their ‘Competitive advantage’.

Today’s seminar really focused on government publishing data which it might be argued belongs to the citizens.  However, understandably, there was plenty of discussion around this in terms of the efforts required to publish it, the potential ownership of the data, maintaining the data going forward, etc.  There was some discussion as to whether ther should be a charge for this data on the basis of the costs associated and the potential for companies to generate come commercial benefit.  Plenty of solid reasons were put forward for publishing the data – transparency, accountability , etc.

Much of this debate brought me back to thinking about privacy, Mark Zuckerburg’s general approach with Facebook, differing attitudes to publishing personal information on sites such as Facebook, twitter, google+, foursquare, etc.  Why do some people choose to share their views on politics, on the economy, their location in a restaurant – whereas others want nothing shared?

I think this question ‘Why publish your data?’ can be addressed in all of these contexts – individuals, government and corporates.  And the answer is  – because the person or the organisation sees some value in its publication.  At the personal level the social networks and smart phones have made publishing data so much easier.  What we are now seeing emerge for business and government are a range of platforms and tools which may all of this a lot easier for government and companies.  And a little like individuals – not sure that anyone has really worked out where all of this is taking us.

Some newspapers have figured it out – by making their content available, by marking it up semantically, they become more relevant to more entities for longer.  But that’s a little different to publishing data which is a product of lots of research completed at your own cost – on the basis that it’s good for society or that of I do it then someone else will publish other data in exchange which I can exploit.


Small IT team but very dependent on IT

Working as a consultant in Ireland I have had the privilege of working in lots of different innovative businesses.  Many of these businesses make great use of a wide range of information technologies – both on premises and cloud based, packaged and custom built.  More often than not management has an understanding of the importance of IT to the business (and to the future of the business) but faces challenges in how to support and exploit these opportunities.

There is a growing awareness of the opportunities offered through managed services, data centres, cloud computing.  In general these and related solutions offer the opportunity for management to focus on strategic objectives and value-add, while outsourcing some of the plumbing.  There are also real possibilities in terms of replacing or upgrading systems with minimal capital outlay.

However I see many examples of applications support and development headaches – with respect to legacy systems. (People seem to confuse ‘legacy’ with something from the dark ages – it often references software implemented in the last few years). In many cases the legacy applications have been heavily customised (by an inhouse team or the third party vendor).  As a result the company is left with a major exposure to/ dependence on a relatively small group of people e.g. one or two apps support people in-house or a small apps development team within a small third party vendor.

This seems to be a recurring pattern – a key apps support person leaves and operations are significantly impacted (time spent finding a replacement, getting the replacement up to speed, rescheduling planned development work, etc).  The size of operation does not merit retention of additional support personnel – so it is difficult to avoid the hiatus arising on departure of a key staff member.  If the apps support is supplied by a third party – then they most likely also struggle to maintain any depth in the support team.

So what is the impact of all of this?  Well, the very information systems which are meant to be adding value become a liability, a risk to the business, a delay on business initiatives, an impediment to change and innovation.

I am often asked to provide a fix – how does the company sort out this issue?

Traditionally we would have checked to see whether development has been executed in a controlled manner – user specifications, testing, training, documentation, etc.  In a smaller environment inevitably short cuts will have been taken.  Also, depending ion the development environment, they may have migrated to an iterative methodology, based on prototyping.

The longer term answer will often include a migration away from current systems, accompanied by gaining an understanding of the true cost of customisatiom.  The analyst and programming build is often only the small part of the cost of customisation – the real cost (which has to be balanced against the benefits) often arises from the dependence created on key inhouse personnel and/or third party vendor personnel.  And from  my experience most of this customisation could and should have been avoided.

So what can the company do in the interim – when they have lost the key people (either inhouse of at the third party vendor)?  Obviously look to add a replacement person(s) to the team – with appropriate skills/experience in the relevant tools, platforms and/or business environment.  But as soon as possible the company needs to start putting in place a strategy to migrate from the current serious business exposure to an operationally and, potentially, strategically advantageous situation.  Any such situation in which the day to day ops of the company are contingent on the continued availability of one or two people needs to be addressed.  And generally this will require elimination of much of the heavy customisation to migration to alternative business processes and supporting applications.

For those who have not yet hit the problem – think carefully before you customise, before you engage with vendors who do not have a roadmap and a broad platform.  Build sustainable business processes and sustainable applications.