chieftech’s blog

AN estimated 5000 deaths, two million GP and outpatient visits and 310,000 hospital admissions could be prevented every year if an effective IT system were rolled out - saving up to $7.6 billion in health costs annually, according to an analysis for release today.

I'm always a little cynical about this kind of number of crunching. I'm all for saving lives, but remain unconvinced that we can actually build the better IT systems they call for - the health industry doesn't have a great track record here after all.

However, listening to a news report on the radio today about a community protesting about the reduction of services at their rural hospital here in NSW today, I couldn't help thinking that we don't just need better technology, but better ways of managing complex systems like the public health system. We need global systems that allow local solutions, not one big homogeneous business process engine for health care.

This is because not everything in health (and other community service areas too) can be boiled down to a transaction, like medication or lab tests. Even if we can achieve it, improving health transactions with IT will only take us so far in improving patient outcomes (and ultimately saving tax payers money).

The stakes a are high for Project Eden, the codename for a long term project to rollout a single electronic document and records management system across all arms of Australia's Defence forces.

The scale of the project is huge and the final cost is expected to lie somewhere between $A100m-$A500m.
Defence estimates it will need to handle 50,000 users within two years and up to 100 million new objects per annum. There will be users at up to 600 locations in Australian and overseas .

Defence has been evaluating vendors since 2006 and has missed previously announced deadlines for making a selection.

I felt very nervous reading this.

I've previously been involved in a very large electronic document and records management system (EDRMS) project for a large international mining company using one of the major systems, so I have a pretty good idea of what the ADF is trying to achieve. I also have a pretty good idea about the challenges, which aren't necessarily technological (and where there are, there aren't necessarily what you might think).

One of the things that concerns me about any implementation like this is that we confuse the desire for a single information system architecture (e.g. one logical EDRMS system to rule them all) with creating a homogeneous information environment that they will try to make everyone use.

This goes beyond simply making the EDRMS easy to use. The typical approach is to use a uniform user interface to meet that goal but all we really end up doing is meeting the lowest common denominator rather than actually satisfying different user needs. Similarly, we also risk ending up with a rigid information architecture that makes the conceptual information system architecture easier to implement, but doesn't actually fit how work is done.

Often these things look great to the guy designing them from his desk in a nice air conditioned office, but the view is very different once you are on the ground (or in my case, 500 metres underground).

Of course, it doesn't have to be that way. I hope they are considering:

• The organisational change aspects and dealing with what I call the "what's in it for me gap" (a user-centred design approach is essential);
• Applying open information access policies within the ADF, with information restricted by exception and managed through activity monitoring and version tracking*;
• How they can apply a Web Oriented Architecture approach, and standards like CMIS, concepts like De-perimeterisation, and even new database architectures like NoSQL; and
• Learning from recent experiences of applying social computing techniques to how people organise, discover and use information (rather than just relying on taxonomies and mechanical search engine techniques).

*Radical I know, but necessary unless you want to end up with a more complex and expensive version of the existing file shares! This isn't about changing information security classifications, but about dealing with information, which is currently hidden by obscurity.

Business Information Managers

Twenty percent of business managers rated the information that they get from IT as poor, according to the Gartner Business Pulse survey conducted from June through August 2009*. "Information management has never been an explicit job role: IT manages the technology, business manages the domain, but who manages the information?" said Ms Logan. "Companies have allowed a huge gap to open up, and consequently, everyone has been the manager of their own information."

There will be an increasing trend to combine business and information management expertise in a single role, carried out by a single person, rather than a "business and IT partnership" with two people, two hierarchies and two sets of reporting relationships. One company already taking this approach achieved all its objectives including a cost reduction for the department of 10 percent in the first year. Gartner expects 20 percent of companies to employ business information managers by 2013, compared with 5 percent in 2009.

Of the four roles (the other three: Legal and IT Hybrids, Digital Archivists and Enterprise Information Architects) I think this is one of the most important. The role is actually very familiar to me and I'm not sure if its a new role as such, but more of a recognition that IT serves a direct purpose in an organisation.

Its also interesting to think about it in the context of this CIO magazine article, which challenges the typical service orientation of the IT department:

"The alternatives begin with a radically different model of the relationship between IT and the rest of the business -- that IT must be integrated into the heart of the enterprise, and everyone in IT must collaborate as a peer with those in the business who need what they do."

I wonder what impact such a role would have on the adoption of Web 2.0 inside and outside the firewall?

Hat tip to Michael.

Kurt Nielsen, the hospital’s director, says that while the doctors are not particularly adept at information technology, they have gradually embraced it. And it helps that the staff was involved in developing the innovations.

“My staff at the hospital is very, very satisfied,” he said. “We build these systems in an incremental way, and seek their input throughout.”

Talking of Social Business Design, I've written before about the need for new approaches to IT in healthcare. It sounds like the Danish have the right attitude more than anything else.

The technology annual report
We wrote an article about this a few months ago in the form of a memo from the CTO to the CEO, laying out the concept of an annual report for technology. Click here. Since we published this, we have received valuable responses from technology leaders. The concept seems to resonate. One head of IT strategy in a leading electric utility said he was keen to implement this concept in his own.  “This makes perfect sense," he said.  "Just like the annual report for the enterprise  communicates with investors and seeks to build enthusiasm in this community, we in IT need to build enthusiasm among all those involved in providing funding for IT. Establishing and sharing an IT balance sheet covering both tangible and intangible assets will raise awareness in our executive committee and provide a much better platform for the dialog around technology enablement.”

You mean you weren't doing this already? Scary.

No wonder senior IT execs and even intranet managers have trouble selling the value of new concepts like Enterprise 2.0 - they aren't even promoting internally the benefits of what they do now... (to busy benchmarking themselves perhaps?)

The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld.

Himmelstein, an associate professor at Harvard Medical School, said that in its current state, hospital computing might modestly improve the quality of health care processes, but it does not reduce overall administrative costs. "First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system," he said. "And for doctors, generally, it increases time they spend [inputting data]."

Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.

This is a quote from an interview by Computerworld with one of the authors of a research paper published in the American Journal of Medicine on the impact of IT on the delivery of health care in the United States.

Their conclusion, based on the data: not much.

However, I think there are some hints here about the root cause of the problem:

• Don't expect benefits from systems built as a means to an end;
• Build systems to fit the people, not the other way around; and
• Real ROI data takes time and effort to gather.

This is also all very interesting when you consider my recent posts about measuring the value of Enterprise 2.0 versus the clear and obvious bottom line benefits of three-letter acronym systems... because it sounds like these health information systems were sold on the same sort of 'hard' ROI numbers.

Hat tip to Nicholas Carr.

NSW Government, through the NSW Government Chief Information Office (GCIO) and NSW Procurement (NSWP), is issuing this Request for Information (RFI) to the ICT Industry seeking options for alternative delivery and acquisition models for the provision of software solutions that meets Government’s needs and objectives.

The New South Wales Government is keen to investigate all potential alternatives to acquiring and using common enterprise software applications and solutions, across a broad spectrum of categories, for Government Agencies.

Vendors and their partners, both small and large, are encouraged to respond to this Request for Information with their products and solutions based on the categories described in the document under “current thinking”, outlining how their offerings interoperate with other solutions and how the use of their solutions can better meet the Government’s objectives.

This is an opportunity for the ICT industry to provide innovative solutions to be used as input for a potential second stage, more formal approach, to the market for a range of options by which Agencies can procure software products, solutions and/or related services to meet their front line service objectives, in the most cost effective way.

Industry is encouraged to respond to this RFI to ensure their views are considered in the development of future procurement strategies, including vendors able to offer open source solutions or Software as a Service

Unfortunately, unless you are registered on the NSW eTendering system you won't be able to access further information about this Request for Information (RFI). However, this RFI is more interesting than it might look - on the face of it, the NSW Government is saying we are open to new (and more cost effective) ways of acquiring enterprise software. I wonder if Google will be responding, as the NSW Government is already a client?

However, it would be great to see the NSW GCIO office also look at the process of how they go about acquiring software, and not just look at the basis on which the software is provided because the RFI process is still likely to limit who responds. Also, one of the powerful features (and influence) of the open source movement is that it has allowed organisations to try before they buy rather than the poker game like approach taken by government IT procurement processes.

Responsibility for this situation is apportioned widely -- from users who lack basic ICT skills, to IT staff who can't or won't connect with the people they serve, to a tech industry which iSociety says is over-hyping its products and failing to deliver on its promises.

But the report gives particular mention to the "lost generation of low-tech managers" who don't understand what technology is about, and therefore fail to make the right strategic decisions.

"Much of UK management make up a 'lost generation' that does not understand ICT, because it did not grow up immersed in technology," the organisation said in a statement. "Technologists, who do have this knowledge, tend to be sidelined in key decision making and are disconnected from the management mainstream. In effect, low-tech managers are forcing the UK economy into a low-tech equilibrium."

The quote above is from a news story about a 2003 report that was in part the inspiration behind my consulting philosophy. The report, Getting by, not getting on: Technology in UK workplaces, was an output of the UK's Work Foundation's iSociety project but unfortunately it appears to have disappeared from the Web.

The reason I'm mentioning it again now is that I'm reflecting on the comments to my post, Enterprise 2.0: Show me the money (a spreadsheet might help).

Everything this report talks about is still true: Yes, the vendors are over-hyping Enterprise 2.0 and some of the geeks have trouble explaining it. But fundamentally, if you don't want to even try to understand the impact of this technology trend then you too are part of the problem of getting by, not getting on.

Meanwhile there are plenty of organisations that are trying to get on. I've even worked for some of them. And Headshift has its own list of clients as well.

BTW Coincidentally, Lee Bryant from Headshift blogged about this very same report back in 2003 too. :-)

Following along the lines of my own post and also Mike Gotta's comment, SAP's Nenshad Bardoliwalla makes some great points here about placing enterprise social computing in the context of organisational processes, which might already be supported by a transactional system. From this he concludes:

my advice to both the zealots and naysayers of Enterprise 2.0 would be to take an existing, legitimate pain point, like offer creation, or product development, or customer service, and start by benchmarking your current metrics. If an Enterprise 2.0 tool can move those metrics in the right direction in a provable way, you will have real, hard ROI. If the tool doesn't contribute to moving those process metrics in the way you hoped, then you might have a problem with your executive sponsor.

However, I think this is one approach, but not the only approach.

Moving from theory to actual implementation, we have to be careful about deploying social computing tools in a way that constrains them to a single process. This has implications for users, but might also be affected by assumptions about the systems and actors invol ved in that process.

I also think for some people that this approach still won't be acceptable, as it points to demonstrating value after the fact. We may also still have trouble arguing the causal relationship between social software and improvements to the process in absolute hard undeniable fact (although not impossible, it will require rigour). Considering that challenge from a cost-benefit point of view, this is where the emergent properties of social computing kicks in - like water, provide the tools and let the users work out the optimal level for themselves.

The other thing I think this misses out on is the use of social software in the enterprise to change the transactional process into something that is inherently leaner. I agree with Bardoliwalla on the point that we don't want to replace transactional systems, but on the other hand we can't assume that the transactional system reflects the optimal process (either the process mapping has created an inefficient model or a social computing solution would manage some requirements more effectively). In some circumstances the cost and risk of implementing a formal transactional system are so high that some processes are never systematised anyway.

Finally, not every kind of organisational activity is a process. Some of it is loose and messy - decision making, planning, innovation, etc.

Hat tip to my colleagues at Headshift for this one.