The Adjustment Bureau

On my flight to Tokyo, I watched The Adjustment Bureau, a Philip K. Dick inspired film about a supernatural team of agents who ensure each person's path through life (their fate) is followed according to plan.

I've written about Regression to the Mean and the need for constant reinvention which makes life seem entirely non-linear.   When I consider the circuitous path I've taken in my career, it's interesting to think about the inflection points - my own adjustment bureau that led me to where I am today.

Here are five random but pivotal events:

1.  In the early 1970's my parents were admitted to law school in Southern California.   I had free time after school to explore my own interests while they were taking classes.  I rode my bicycle to a local surplus store that specialized in integrated circuits discarded by local defense contractors but still completely functional.   By the age of 12, I taught myself digital logic, analog signal processing, and the basics of microprocessors.  I learned to program in machine language and built an Altair microcomputer in 1979, becoming the first student with a dorm-room based computer at Stanford University.   My parents' law school admission led to my IT expertise - a non-obvious association.

2.  While I was an undergraduate at Stanford and a medical student at UCSF, I ran a 35 person company which specialized in business process automation software.  It enabled me to purchase a house in Marin Country and anchored me to the San Francisco Bay Area.   The Dean of Students at UCSF during that time did not believe that a medical student doing advanced clinical rotations should be allowed to run a company simultaneously and gave me a choice - divest the company or defer medical school.   I recognized that medicine was my future and divested the company, which eliminated my Northern California ties and ultimately led to my taking a job at Beth Israel Deaconess and Harvard.   A Dean of Students with a strong opinion about medical student entrepreneurial activities led to my career in Boston - another non-obvious association.

3.  On December 10, 1997 while working in the Emergency Department at BIDMC, my cell phone rang and the CEO of CareGroup informed me that I was going to serve as the CIO of CareGroup beginning at 8am the next day.   The external auditors at the time told the CEO that giving a CIO job to an unproven Emergency Physician was administrative malpractice.   The CEO firmly believed that a clinically focused, web-savvy, risk taker was better than a traditional process oriented CIO.  Nearly 15 years later, many people believe he was right.   A CEO who took a very controversial risk on a 35 year old with limited leadership experience resulted in my career as a CIO - a challenging outcome to predict based on my life history up to that point.

4.  In 2001, the new Dean for Medical Education at Harvard Medical School had a dream - moving the entire medical school curriculum to the web and mobile platforms (early Palm technology).   He asked for my advice given my experience at BIDMC moving clinical records to the web.  Although I had no experience in educational technology, I worked with a team of students, faculty and IT developers to collaboratively create the Mycourses learning management system, serving as a part time Associate Dean in addition to my CareGroup CIO role.   The project went well and I was eventually asked to serve as part time Harvard Medical School CIO, which the CareGroup Board gave me permission to do (I became a 1.5 FTE, 100% at CareGroup and 50% at Harvard simultaneously).   A sojourn into educational technologies led to my becoming responsible for 10 years of infrastructure and application work at Harvard Medical School, including the evolution of high performance computing and storage clusters to support the life sciences, unique challenges that were not even imagined in 2001 - a definite non-linear path.

5.  In 2005, I took a call from ANSI, asking if I would attend a meeting to discuss harmonizing standards as part of program conceived by the first national coordinator for IT, David Brailer.  Although I did not consider myself a standards expert, I agreed to serve as chair of HITSP.  As a consequence of 5 years of work with healthcare standards I became part of many national, regional, and state healthcare IT projects.   A phone call about standards led to my federal and state roles, which became the basis for my Harvard professorship.    A call from ANSI and a Harvard professorship - very hard to predict that!

What's next?  At BIDMC, the Chief Executive Officer selection process will result in new leadership this Fall.   New mergers and acquisitions will result in an accountable care organization built around BIDMC.   Complex healthcare information exchange, registries, and business intelligence tools needed to support healthcare reform will accelerate my hospital CIO, state, and national activities.

All of this is happening while I'm working on replacing my Harvard Medical School CIO role with a full time successor.

It's July of 2011 and hard to know exactly how the inflection point of my evolving Harvard role will affect the future,  but I feel powerful forces are aligning to create a quantum leap forward in electronic health records and health information exchange technology.

A year from now, I'll look back and assess what The Adjustment Bureau had in mind for me.