A Customer Emotion Dashboard

The job of a CIO is filled with challenges.   There's a delicate balance in constant flux among:

*Short term urgencies  
*Long term strategies
*Ever changing compliance/regulatory requirements
*Day to day operations
*Budgets

What's the right objective measure of success?

Uptime?
On time, on budget project performance?
Positive feedback from your Governance groups?

All of these can look rosy but customers can still be unhappy.   The juggling of IT supply and customer demand means than not all projects can be done.   The complexity of IT work means that projects will take longer than customers expect.   All communications plans, no matter how comprehensive will still miss some stakeholders.    The end result of all of this is customer dissatisfaction.

A CIO can never achieve 100% customer satisfaction.   In fact, if only 10% of my customers dislike me on a given day, then I've achieved a stellar approval rating.

By human nature, we want to make everyone happy and avoid conflict.  When I lecture about my top 10 leadership principles for surviving as a CIO:

10. Select your change and what not to change
9. Identify those who will lose
8. Acknowledge their loss
7. Over Communicate
6. Be Honest and Consistent
5. Consensus is not essential
4. Embrace conflict
3. Focus on your detractors
2. The last two minutes of the meeting are the most important
1. You cannot please everyone

#1 is that you cannot please everyone.   There will never be enough budget, enough staff, or enough governance to ensure everything is perfect.

Normally, the naysaying can be addressed through focused customer service, planning, and conversation.

However, it's getting harder now that the economy is challenging and expectations of technology support are escalating i.e. "I just bought a new smartphone yesterday, how come you do not provide application support for it?'

The level of tension in every sector is increasing.   Civility is diminishing.

This means that I must carefully monitor the pulse of all my customers.

I've emailed my staff that at our next leadership meeting, I'd like to develop a new type of scorecard for each major stakeholder group.   I will empower my staff to rate the emotional trajectory of each group as red/yellow/green.  With such a scorecard, I'll be able to anticipate growing discontent before it escalates and then focus my time and energy on detractors, embracing conflict to proactively change strategy and tactics before it's too late to change.

A customer dashboard based on the trajectory of stakeholder emotion rather than budgets, projects and timelines - I have a feeling that it will be very effective in directing my management focus, especially in trying times.

I'll let you know how it works by the end of 2010.

Cool Technology of the Week

Over the past year, I've tested the Cisco Telepresence CTS 500 and Tandberg EX-90 video teleconferencing technologies in my home.   They've worked very well to reduce my travel schedule but they are more expensive than a typical consumer would want to spend.

This week, Cisco introduced the umi (You-Me) a home telepresence unit that will be sold by Best Buy for $599 starting October 18.   It requires an internet connection, an HDMI connection to an existing HDTV, and a PC or Mac for checking video voice mail.

HDTV video conferencing in the home for $599.    That's cool!

Forming, Storming, and Norming

In my Palos Verdes High School AP US History class (1979),  I studied the writings of Alexis de Tocqueville, the Frenchman who observed American life and then wrote Democracy in America. Ask anyone what he said, and you'll hear some variation of "America is a nation of joiners."


In my career as an IT leader, I've convened many groups, governance bodies, and new organizations.    As new groups gather, everyone wants to participate to avoid being left out of the new, new thing.

The Forming is easy, but soon after, as issues such as governance, strategy, business/operations, and priorities are discussed, there's Storming.

Everyone wants to ensure their point of view, their authority, and their visibility is preserved.    In large, multi-stakeholder organizations, this can be challenging.

Eventually, a stable governance group emerges, priorities are developed by consensus, and relationships are fostered, creating a level of stability - the Norming of the greater good.

One everything is humming, the group begins Performing, embracing change and achieving its goals.

This Forming, Storming, Norming and Performing pattern is called Tuckman's Stages of Group Development.

Since it's Thursday, a day for my personal blogs, here's my advice on Tuckman's stages.

When you're forming or joining a new group, expect conflict.  Don't fear it and don't fight it.    Acknowledge it and work with it.  Conflict (the "Storming") can create a sense of urgency among participants to solve problems.   Conflict can lead to stronger relationships and catalyze change.

During the Storming phase, the only thing that can hurt your reputation is a public outburst of emotion.   As I've said many times before, for everything there is a process that will resolve today's problems.    A year from now, no one will even remember today's problems.

Our job as leaders is to navigate the conflict that comes with Storming, listen to the stakeholders, and steer the group toward Norming.   It takes time and energy.   It takes patience.

I recently talked to a colleague about a particularly emotional public meeting that had dozens of highly charged stakeholders.   My colleague did not remember the nature of the conflict, but did remember that I listened, acknowledged the speakers, and suggested a process to move us forward.

As long as you know to expect conflict whenever you form a group, you can remain unaffected by it.

Put another way - your adversaries only win if you let them get to you.

Go forward and Norm!

The Harvard High Performance Computing Summit

This is as close as I get to advertising on my blog - my group at Harvard Medical School (HMS) runs a yearly high performance computing summit to foster information exchange among colleagues.  Here's the story:

Over the past 5 years, the dramatic increase in biomedical data has catalyzed a need for high performance storage, high performance compute clouds, and new approaches to making information technology accessible to researchers.  At HMS, we have made great progress in addressing these needs and we continue to plan for the future.

The availability of genomic data and new information-rich data collection approaches of all kinds (such as imaging) require new approaches and new methodologies.  Computational methods, once a sideline for biomedical researchers, have become a required enabler of discovery.  Some laboratories no longer  have a wet-lab component, but instead use computational methods as their primary research method.  The scope and scale of research computing is no longer supportable by systems sequestered under the lab bench or in ad-hoc data closets.  The resources that are needed now require skilled IT professionals, scalable and fault tolerant infrastructure, and adaptive learning from other fields that have already undergone this transformation such as high energy physics. Storage requirements have grown from gigabytes to terabytes to the petabyte scale.   Processing power has grown from clusters of a dozen computers to thousands of simultaneous processing cores.

Unfortunately few of my colleagues in high performance computing have the time to share approaches and learn from their fellow leaders at other institutions. Four years ago we set out to solve this problem by creating the Biomedical High Performance Leadership Summit to exchange ideas, approaches and solutions to the challenges facing biomedical IT organizations. We are convening it again this year with the hope that the biomedical researchers and service providers can learn from other computational fields and build infrastructure to meet research needs.

This year's conference has four themes:

    * Scaling storage: managing storage in the age of the petabyte (and beyond)
    * Organizational scaling: building sustainable HPC centers
    * Collaborative computing: grids, clouds and open computing
    * Getting science done: making HPC work for researchers

I invite leaders in biomedical high performance computing to join me at the summit,  which includes keynotes from myself and George Church, industry updates from Chris Dagdigian and Addison Snell, and key lessons learned from John (Jay) R. Boisseau and Phil Papadopoulos.

For more information check out the website.

I hope to see you at Harvard for the Summit on October 17-19!

Wall Poster Resources for Meaningful Use and Standards

Robin Raiford from Allscripts has created 32"x48" and 42"x60" wall posters which illustrate all the Meaningful Use Stage 1 Measures and the Standards associated with them.  You can have them printed at FedEx Office (formerly Kinko's) or other poster printing shop.

If you want to view them on a small screen, you'll need to use the zoom feature of your PDF reader and scroll around to see the content.

I hope you find these useful.

Clarifying Certification

NOTE  - this post was extensively revised at 3pm on October 4, 2010 based on new information from authoritative sources.

On October 1, CCHIT announced certification of 33 complete and modular EHRs.  Drummond Group announced 3 certifications.

Meaningful Users must utilize "Certified EHR Technology".   Many folks are asking about the terms "complete EHR certification", "modular EHR certification", and "site certification". Let's start with the regulatory definition of “Certified EHR Technology” and what it takes to meet that definition.  How this certification is achieved - complete, modular, or site does not make a difference.

45 CFR 170.102
Certified EHR Technology means:
(1) A Complete EHR that meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary; or
(2) A combination of EHR Modules in which each constituent EHR Module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary, and the resultant combination also meets the requirements included in the definition of a Qualified EHR.

Complete EHR means EHR technology that has been developed to meet, at a minimum, all applicable certification criteria adopted by the Secretary.

EHR Module means any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary.

For example “all applicable certification criteria” for an Certified EHR Technology designed for an ambulatory setting would be to all certification criteria adopted at 45 CFR 170.302 and 170.304 (general certification criteria, and ambulatory specific certification criteria).  For inpatient EHRs it would be 45 CFR 170.302 and 170.306 (general certification criteria, and inpatient specific certification criteria)

Regardless of whether one uses a Complete EHR, a combination of EHR Modules or a Site certification, all certification criteria need to be met in all settings.  In other words, a proper combination of EHR Modules, if seen as a black box, would be a Complete EHR.  In order to meet the definition of Certified EHR Technology, no matter how one achieves it (using a Complete EHR, combination of EHR Modules, or Site Certification) all the boxes need to be checked.   See this FAQ posted by ONC.

It's likely that many existing EHRs will achieve modular certification - having most but not all needed functionality.   It's perfectly reasonable to use your existing EHR for the majority of the functionality you need, then supplement it with a data warehouse or health information exchange to achieve all the certifications necessary.

There will be many interesting lessons learned in this first round of certification.

1.  As I've reported previously, the Syndromic Surveillance implementation guide in the Standards Final rule is incorrect.   However, until it is fixed, vendors must implement the wrong data exchange in order to be certified because that is what the NIST testing site specifies.

2.  Some vendors may opt to be modular EHRs now and evolve to become complete EHRs as data exchange issues are clarified.  

3.  Testing procedures are going to evolve in these early days of certification and that is going to be challenging for vendors to support.   For example, NIST currently offers an e-prescribing validation procedure for NCPDP e-Prescribing formats using EDI but not XML implementations.  The HIT Standards Committee and the Standards Final Rule did not limit the transaction to just the EDI type.   Thus, it's likely NIST will change their testing criteria to support both EDI and XML.

  In the end, it will fall to the purchaser to ensure their goals are aligned with vendor plans.     If purchasers are seeking modules to expand the capabilities of an existing EHR, that should be clear.   If purchasers want a complete EHR and their preferred vendor is currently a module,  purchasers should request an agreement that the vendor will offer a complete EHR in a set period of time.

Cool Technology of the Week

For years, I've said that the ideal computing device for clinicians is simple:

1.  Under 1 pound
2.  8-12 hour battery life
3.  5x7 inch form factor that can fit into an white coat pocket
4.  Easy to disinfect (medicine is messy)
5.  Can be dropped 5 feet onto carpet without significant damage

I predict that the iPad and the plethora of new similar devices are going to be the emerging clinical platform of choice for healthcare in 2011.

The latest announcement from RIM, the Playbook, seems to address my requirements list very well - it's small, lightweight, and advertised as stable/reliable/secure/enterprise ready.

Of course, it will be interesting to watch how the developer marketplace responds given that its operating system (QNX) is not Android nor the iPhone/Ipad iOS.

However, since all my applications are browser-based, in many ways we do not care what device users choose as long as it is secure.

Nirvana for clinical computing devices is finally arriving.   That's cool