Context of IT

Influential CIO and blogger Dr. Halamka published an excellent post today on the role of CIO titled Job of CIO – Content versus Context.  Dr. Halamka and Healthcare IT is not alone on this and IT organizations across all sectors face similar challenges to deliver more with less and little or no wiggle room for innovation.  Compliance, technology refresh, security and operations ends up taking the entire budget with no room for innovation.  That is the real picture in almost every IT organization and more often the role of CIO and the entire IT organization gets valued by how the expectations are set and managed, yes the context compared to the content on latest technologies and buzz.

Unfortunately there is no Silver Bullet solution for all the problems that Dr. Halamka highlighted in his post. However, there are several learnings for IT organizations, enterprise solution vendors and service providers to IT organizations. I am eager to see his next post about on his speculation on the IT organizational model for the future that improves the context of the work.

Now coming back to the learnings,  IT organizations can take cues from startups, from lean principles like lean IT or lean startup to try to squeeze innovation out of existing operations budgets.  As a person who has straddled between the startup and IT organization worlds, I also see the challenges associated with it introducing lean / agile methodologies in a traditional IT organization, which is mostly organizational and cultural and has to be overcome first.

For enterprise vendors and services providers, IT organizations will love you when you provide capability to enable IT to charge back for the service business is using. Though charge back for IT services may not happen soon, at the least it will enable IT organizations to track who is using what and use as a leverage for budget increase.

If you are not already tuned into Dr. Halamka’s blog, here is the link

Saravana Rajan


Can enterprise software and IT be sexy ?

When was the last time you were irate to use a software application ?

I bet it wouldn’t be long ago and you face this every day and most probably it was at your work.

Why enterprise applications are the way they are – grey, not intuitive, slow, outdated and takes you back to 80’s ?  There have been many swipes on enterprise applications from user experience designers – very rarely enterprises have such a role! – and savvy saas application providers.  Here is a swipe from a sexy company 37Signals and I agree.

Why Enterprise Software Sucks ? from 37Signals

“The people who buy enterprise software aren’t the people who use enterprise software. That’s where the disconnect begins. And it pulls and pulls and pulls until the user experience is split from the buying experience so severely that the software vendors are building for the buyers, not the users. The experience takes a back seat to the feature list, future promises, and buzz words.”

Is this just an user experience problem ?

Well, user experience is one of the problem on the way how enterprise software applications are purchased or designed if it is designed in house, however, I think the real problem lies in the secret sauce of strategizing, leading, planning, developing and deploying IT systems and in a whole running an IT department.

So what is the secret sauce that can make enterprise software and IT sexy again?

How come new software vendors and saas based product companies churn out sexy software and new features at an incredible pace with probably less than half the resources ?

Why enterprise really have to struggle it out to complete a project successfully, even if it is a project based on a commercial off the shelf(COTS) product ?

More to come…

Saravana Rajan

Thursday afternoon reads

1. China’s fake Apple Stores:  (Bird Abroad)

– the facade can be imitated but not the culture and every detail of a brand like Apple cannot be imitated.  Still this could have faked more than few customers.

2. No New Social Networks Launched Today (Borowitz Report)

– A friend of mine told me that in Silicon Valley every business plan thats being hatched up now is about a social network of some kind – are we in another tech bubble?

3. Tale of two countries: The Growing Divide Between Silicon Valley And Unemployed America (Tech Crunch)

4. Clinician to Clinician Communication (Healthcare Informatics)

– In this world of social networks, paying using your smart phone, come to healthcare world you will find FAX and Phone as the greatest thing since sliced bread.  There are numerours reasons for that, lets not get into what’s wrong with Healthcare, that’s another conversation over a beer.

Nhin Direct project is taking a think small and simple approach to connecting the physicians with other physicians using existing applications,  communication protocols(SMTP and XDR) and what not.  Simple direct to direct communication is key for healthcare technology adoption among providers.

5. The DNA–People, Processes, And Philosophies–Of Innovative Companies (Fast Company)
– innovation starts from within a person, who believes that a world can be a better place and the system (organization or country or any entity) they are in has to foster a culture of innovation.  If the system doesn’t foster, its just one more barrier to bring down for the innovator and create a new system.

Health Informatics insights: remote health monitoring

I just got better from a month long ordeal with an infection, which required daily visits to a care provider to assess the state and provide care. Though, the care was exemplary by Ontario CCAC, there are areas of improvement needed in care coordination among providers and remote health monitoring to increase efficiencies.

Remote health monitoring, means different things to different people.  The following report from California Health Foundation offers the current state of the market with a clear definition on the terms and the state of the market.

The Connected Patient: Charting the signs of remote health monitoring

Image Source: California Health Foundation – The connected patient: charting the vital signs of remote health monitoring.

Key insights: little has changed in the last four years with mixed results from pilot projects

Why little has changed when the economic benefits offer several millions and billions of dollars in savings and efficiencies ?   The author of the report points to the structural issues of the US health care system, which tends to be fragmented and focused on episodic care.  I believe that this is not just a US problem and is a common issue between the publicly funded Canadian healthcare& and friends south of the 49th parallel.  By far the biggest barrier to more pervasive adoption of DM has been the continued fragmentation of operations and information technology across health systems.

That is a well known problem with the providers paid on a fee for service basis.   In the US there are recent developments with the introduction of HITECT act and Accountable Care Organizations towards an outcomes based system.  In Canada, from my view the change appears even slower and the outcomes based model is being discussed at the provincial level, who are essentially payors of the service.

Though there are several drivers for remote health monitoring including communication technology advancements, mobile data standards, the chronic care tsunami we are facing as a society,  there are some significant challenges in adoption at the physician office,  consumer engagement and payment models for this service.

In spite of the challenges there are significant economic benefits and prospects to remote health monitoring both in US and Canada.

& Rethinking Our Approach to Disease Management: Technology and Information Flow Considerations

IHE International meeting in Toronto

Keith Boone presented about CDA and CCD history at the IHE dinner in Toronto last night.

Highlights from Keith’s presentation:

– Interesting to know that CCD came from Vancouver Island Health Authority Electronic Medical Summaries project.

– Schematron for message conformance over XSD and it’s an ISO standard. Good to know.

– What is the difference between a document and a message?

Whenever you go back and ask for Information and if you get the same thing back then it’s a document. It is persistent compared to a message, if you are caught up in document vs messages.

– Where in the world is XDS ?

– Checkout CDA Tools

– Keith also has a new book coming out in May 2011 on CDA.

And here is Keith’s post on his speech if you are looking for meat.


Great to hang out with the standards geeks from IHE and meet great people and catch with up with old friends who are involved in improving healthcare and healthcare standards.

Thanks to HIMSS for the wine.

Saravana Rajan

Sputnik Moment


Sputnik Moment : The Soviet Union’s 1957 launch of the Sputnik satellite was a catalyzing event that spurred a generation of investment in space and science in the United States.

It is what U.S. President Barack Obama called a “Sputnik moment” during his State of the Union speech last night. To be simple, if you know you have to change the way you do stuff and do it now, to see a different result, then you are in a Sputnik moment.

We all face Sputnik moments in our lives, in the organizations we work for, in the projects we lead.   It takes awareness and constant external feedback to realize Sputnik moments in the first place. Once we realize it, how do we respond ?

What tools do we have in our tool set to deal with Sputnik moments ? we have few options ,

  1. Ignore it and be oblivious to it – only to realize its not going away or in case of projects or organizations we see it getting killed or folded up
  2. Throw money at it – it may help in the short term but it comes back once the money runs out or the problem consumes the money and grows beyond it.
  3. Implement processes and tools – We all have a feedback loop associated with our actions. At an individual level, we can learn from our mistakes, learn from other’s mistakes. At the project level we have built in processes and tools to learn from past projects and at the organizational level, we have the same processes and tools.   Does that qualify as a learning system and mainly does it help us to identify and face  Sputnik moments in a timely fashion?

We can build processes and tools, but do they enable us to respond to the external changes or do they hinder us to respond to those changes is the key question ?

In most cases ( this is from personal experience and anecdotal evidences), our traditional systems or methodologies or processes or tools  seems to fail us when we need them the most.  This is evident from organizational failures and missteps on new innovation ( Innovator’s Dilemma as Clayton Christenson calls it) and project failures abound that we see every day.

What we need is a Agile approach to deal with external and internal changes to our environment and react to the change in a swift and quick way.  There is a paradigm shift in the thinking behind creating a True Learning System. Organizations and teams designed as learning systems can self organize themselves and continuously learn to respond swiftly to the changes to their environment.

Taking from the agile software manifesto, below is the mantra behind the true learning system.  Just the second line is specific to software development world and you can replace it to “Working product / solution over comprehensive documentation”.

Individuals and interactions over processes and tools
Working software over comprehensive documentation
Customer collaboration over contract negotiation
Responding to change over following a plan

Source: Agile Software Manifesto

Now you may ask,  is that all we really need to identify and respond to Sputnik Moments ?

Well there is a lot more, you will have to see it to believe it. You will have to experiment it to believe it.  You will have to adopit it to see the power and results.  I will share my experience from my projects in IT, sales/marketing and personal experience in general.

But you have to start some where,  and here is the best place.

Check out Open Agile:

Saravana Rajan