Thursday, September 15, 2011

Rethinking IT for the Modern Era

CIO's today need to ask themselves two questions. Would I have built my IT organization across the pillars of people, process, technology, structure and strategy to look like it does today? If not, what would I do differently? Why does a CIO need to ponder and pontificate on the state of IT? Because the pace of innovation continues to accelerate and we are rapidly approaching the end of steady state IT. It's time to Rethink IT and question all of our sacred rules.

For years IT has been focused on eliminating change in the name of stability, trying to reach the perfect steady state. However since the only constant is change IT has failed miserably in the mission, to the extent that many disagree it was a goal in the first place. I argue if change was the goal, then why is change within IT so difficult? Change management is not part of the core DNA of IT, but it should be. Instead IT does a bad job with change and a worse job with continual change. Yet change is the starkest reality of technology. I don't see anyone using Windows for Workgroups 3.11 or MS Word 5.0 anymore. Technology progresses and the pace is always quickening.

About 15 years ago the primary method for a customer to get support for a product was to call a 1-800 number. Quickly those requests starting coming in the form of emails in the mid 1990's followed by text chats and call-me-back requests in the early 2000's. Then in the mid 2000's we added social media such as MySpace, Twitter and LinkedIn along with discussion forums where customers could use a self-help model relying on other customers. In that same 15year time span many companies have, via bolt-ons and platform extensions, taken their original CRM solution and added functionality to support these new models. Still built on the original foundation of an inbound 1-800 call, we have added new staircases, wings, doors, chimneys, and floors to create the solution needed to serve the customer. What has resulted is something more analogous to the Winchester House than a family home. As a microcosm of IT, this approach of keeping legacy cores and extending solutions has created unwieldy, expensive, inefficient solutions. Rob Carter, CIO for FedEx, is on record stating that the greatest threat to FedEx is the complexity of IT. Rethinking IT, breaking down the old preconceived notions and forgone solutions, is the only way to address the critical mass of legacy IT.

Companies change their headquarter buildings more often than the applications which drive and manage their revenue stream. Architecture, for both buildings and software, is a managed planning step where decisions are made to support current needs and to the extent possible incorporate flexibility to meet undefined future needs. At some point in the lifetime of a building, or software, the limits of the architecture are reached becoming unsuitable for sustaining growth and must be overhauled or demolished to meet new demands.

Software, because it's viewed as inherently simple to change, is much more likely to be modified. Each modification makes the software a little bit slower, a bit harder to support, a bit more difficult to extend, and more expensive to operate. Add hundreds of modifications over decades and it's not surprising how many companies find themselves paying the legacy tax where changes, even minor changes, can cost millions of dollars. One aspect few consider is that little code is every eliminated. Multiple times in my career when asking why a process is executed we have found the answer in the code, the answer being because nobody told IT to eliminate that process or that algorithm. I contend there are millions of lines of superfluous code running every day which add to the ball of complexity and cost yet deliver NO VALUE! Worse, often those processes limit the business in what they can do which in turns limits the revenue generation capability of the company. There is a cost!

It's reasonable to expect that just as we moved through four technology iterations in 15 years (1-800 to email to text to social media), the next four iterations will take 10 years, and the next four after that only 5 years. IT can no longer afford the time and the business can no longer afford the cost of extending applications through bolt-ons. The only solution available today that provides the flexibility required is migrating to a services framework where new functionality is developed as a service available to other services as needed. Just as services replace monoliths (think ERP, CRM, SFA, MRP, etc.), application composition replaces application integration. The side benefit of moving to services is their natural alignment with cloud computing. In fact cloud computing as a holistic vision for IT is the execution of software services sitting on a virtualized hardware infrastructure. Amazing how things work together!

When the CIO resolves that no, the IT organization would look dramatically different if designed to meet today's needs, the first step on the Rethinking IT journey is under foot. Realizing the cost of not changing is greater than the cost of change means the second step is under foot. The remaining steps are to build the blueprint and roadmap and then effect the change with a particular emphasis on making change stick.

Of course the other option is to continue the status quo. Then it's time to ask question three: What happens to the CIO when IT is forced to forgo generations of innovation because of the time and cost required to update their ghastly complex legacy solutions?

Monday, September 5, 2011

Cloud in Healthcare

A recent discussion on LinkedIn reminded me of my past exploits in deploying cloud solutions in Healthcare. I was involved in several projects with great organizations including Kaiser Permanente, The Diabetes Foundation, St Judes Children's Research Hospital, the LSU Eye Center and the Mayo Clinic. During these efforts we applied cloud in some really interesting ways including the following:

Diabetic Retinopathy: We presented on this at HIMSS in 2005. Our project addressed the rampant increase in diabetes among the poor of Louisiana. The two challenges were getting people to visit the doctor because the doctors were only available on certain days of the year, travelling to remote areas as part of their humanitarian efforts. The second challenge was finding qualified doctors who cloud leave their practices to travel. Our solution used low cost imaging devices to capture images of the back of a person's eye. It turns out the eye is one of the earliest ways to detect diabetes. The images were then uploaded to a cloud from which remote Doctors could identify early onset diabetes. Our goal was to improve service by using an automated filter to flag potential issues reducing the number of images reviewed by physicians. The approach resolved both challenges making the imaging locations available for a significantly longer time, some permanent, and didn't require the doctors to travel.

Long Term Digital Medical Image Archive: Digital medical images are captured in PACS systems which typically use expensive SAN technology for performance and redundancy. The challenge is that 98% of medical images are never used again after their first two weeks. As a result healthcare providers want to move the images to a low cost, long term archives as quickly as possible. HIPAA requires providers to keep the images for the life of the patient plus seven years, so retention is required. We developed a private cloud solution which provided an economical model for storing the images while also improving the ability to share the images between imaging centers, the hospital, ER/trauma centers, out-patient facilities and the primary physician's home office.

Electronic Medical Records: to be of use an electronic medical record (EMR), a folder containing a person's entire medical history from allergies and blood pressure readings to digital images and prescriptions, requires ubiquity in availability but strong security. Our solution used a cloud for the storage and management of EMR's. Each EMR was accessible through three methods. First, a person can grant others access to the account by creating logins. Second the person can grant temporary access by using their finger scan or RFID necklace. Third, a Doctor can request a limited version of the EMR in an emergency. Using WiFi enabled tablet devices the EMR's were visible via a browser from any enabled site (each site had it's own unique key which provided an additional layer of security so someone could not access the records from an unapproved location such as from home or the parking lot).

Disease Modeling: One area I found fascinating was the ability of medial researchers to create mathematical models to predict the course of a disease in a patient. They could identify with amazing results how weight, diet and even some genetic factors impacted the disease which could then be used to identify treatment regimens. Pharmaceutical companies could use the models to develop advanced chemical compounds. The compute power needed for even a simple analysis mandated the use of a cloud.

There is one other germane application I worked on however due to its proprietary nature and the potential value of the program I don't want to disclose it since I'm not the owner.

As I have repeatedly found, cloud really unlocks us from classical linear thinking in how we create solutions. We are in the early days of clouds and people way smarter than me will come up with solutions that will make us all stand in awe.