Cool Technology of the Week

How many times have you been wandering through an airport, a hotel lobby, or conference room and wondered if wireless was available? You boot your computer, scan for networks, try to connect and after a bit of trial and error, you conclude that the signal is too weak to sustain a connection.

The cool technology of the week, is the Wi-Fi Shirt from ThinkGeek.com.

This shirt includes an embedded wi-fi receiver, miniature battery pack and a detachable illuminated display that shows wi-fi strength in real time.

This is clearly the must have fashion for network engineers and frequent fliers.

As to the claims on the website that it will attract the opposite sex in wireless cafes, I'm dubious. As a happily married man, I do not think about such things. And besides, my pickup lines such as "I'm a Harvard faculty member and CIO" would never impress the cafe crowd.

The Way of Tea

I've written about drinking green tea, the art of Japanese incense, and playing the Japanese flute. Another Japanese tradition I enjoy is the tea ceremony, (chanoyu meaning "tea hot-water" or chado meaning "the way of tea"). For folks who visit my Harvard office, pictured here, I prepare a ceremonial powdered green tea called Matcha.

Matcha begins as a high grade tea leaf, grown in the shadows, just like my favorite Gyokuro Asahi green tea. Reduced light slows its growth, creates a deeper shade of green, and results in a higher concentration of amino acids, making the tea sweeter.

The leaves are harvested and laid out to dry. They are de-veined, de-stemmed, and stone grown, to produce a fine bright green power - matcha.

I store the tea in a tea container made of lacquered wood called a Natsume.

For the honored guests visiting my office, I place a small amount of matcha in my tea bowl (chawan) that was handmade in Kyoto. I use a deep bowl that keeps the tea warm. The bowl is irregular with several colors and imperfections. The most beautiful portion of the bowl is one of the emerald shaded irregularities.

To remove the tea from the Natsume, I use a lacquered bamboo scoop (chashaku). The amount of tea I add depends upon the style of tea I'm preparing.

Usucha, or thin tea, is prepared with half a teaspoon of matcha and 2.5 ounces of 170 degree hot water. Usucha creates a lighter and slightly more bitter tea.

Koicha, or thick tea, requires significantly more matcha, about 5 teaspoons, and 6 ounces of hot water. Koicha produces a sweeter tea.

To mix the tea, I use a tea whisk (chasen), which is carved from a single piece of bamboo. For thin tea, I briskly stir the tea and water together, creating a foam. For thick tea, I stir more slowly, without foam.

I serve the tea by presenting the most beautiful part of the bowl to my guest, who appreciates the bowl, turns it 180 degrees to show me the most beautiful portion of the bowl, then drinks a small amount of tea.

I typically serve the tea with a small sweet to refresh the palette.

You may ask, what ceremony do I use in the heat of the New England Summer? I recently visited a remarkable potter at his kiln in North Carolina, Mark Hewitt.

I asked him to create vessels for "Iced Tea Ceremony". This is truly a fusion of Southern traditions, New England practicality, and Japanese inspiration. Thanks Mark for great work.

Conservation of Aggravation

The first law of thermodynamics tells us that energy is neither created nor destroyed, it is simply converted from one form to another.

For IT professionals, I believe in the first law of project dynamics - Aggravation is neither created nor destroyed, it is simply converted from one project to another.

As CIO of Harvard Medical School and Beth Israel Deaconess Medical Center, I oversee 200 projects a year. A few examples of Conservation of Aggravation.

In 2003, we had a growing problem with Spam and I received many requests each day to implement a centralized Spam filter. We initially tried Spam Assassin, but found that it could not distinguish between advertisements to enlarge body parts and physician referrals to clinics for diseases affecting body parts. In a medical environment we wanted very few false positives (real mail marked as Spam), so we implemented Brightmail (now a Symantec product). Today, I receive many requests a day to loosen the Spam filters, which are blocking important business email such as eBay receipts, newsletters from professional sports organizations, and casual email conversations (Subject: Hi!) from friends and relatives. Aggravation has been conserved.

In 2002, Beth Israel Deaconess experienced a 1.5 day network outage when a misperforming application flooded the network and overwhelmed the spanning tree algorithm in our older network gear. In 2003, SQL Slammer and other Microsoft-related security issues caused server downtime. I spent a year creating highly redundant state of the art networks, server clusters and virtualized central storage. Uptime 2004-2008 has exceeded 99.9% for all applications and services. On rare occasions, I need to take down a segment of the network to upgrade hardware or firmware. Trying to find an acceptable 15 minute window to take down IT services is nearly impossible. Sunday at 4am? We could have trauma patients arriving in the ER then... By creating complete reliability, we have made downtime unacceptable. Aggravation has been conserved.

In 2006, we implemented electronic prescribing for our clinicians. We replaced unreadable handwritten paper and free text typing (take some Tylenol) with structured, standards-based, secure electronic messaging from doctor to pharmacy. Clinicians welcomed the idea of more accurate, safer medication practices, requiring fewer callbacks from Pharmacists with questions about handwritten scripts. However, clinicians rapidly discovered that older prescriptions, written before the new system required structured prescribing, had to be retyped because the computer could not automatically convert "take some Tylenol" to "take Tylenol 1-2 tabs every 4-6 hours as needed for pain". They wanted accuracy and ambiguity to be acceptable simultaneously. Aggravation has been conserved.

In writing this, I feel so much better that I've shared the challenges of being an IT professional. Will this catharsis lead to less aggravation? Nope. Within 48 hours of this blog being published, 25 salespeople will call and email me about Spam solutions that block all bad emails but allow eBay/sports/casual email, about highly reliable infrastructure components that require no maintenance, and about e-Prescribing systems that do everything for everyone. Some of these sales offers will make it through the spam filter. (Do these folks believe that CIOs have the time to read unsolicited sales emails?) Some salespeople will pester my assistant to the point that she whimpers in frustration. I have no doubt that aggravation will be conserved!

How to Take a Vacation as a CIO

I've written that being a CIO is not a job, it's a lifestyle. Given the CIO's responsibilities, is a vacation possible? Can you really unplug? Here's the way I do it.

1. Pick a second in command to run the operation while you are away
Just as a military operation would appoint a commander or watch officer, assign someone else to run the operations while you are away. Broadly communicate that this delegate is in charge and can make decisions in your absence.

2. Email a bit in the morning and at night
When I go on vacation, I do email early in the morning before my family gets up and I email late in the evening after my family goes to bed. This means that I can resolve all issues and keep my email queue empty. When I return to the office, there is nothing waiting for me. A great vacation is one that is easy to return from. The burden of having 5000 emails and 5 crises to resolve is high, so I invest a bit of time each day to ensure my desk is empty when I return, minimizing the emotional cost of a vacation.

3. Set expectations with an out of office message and enjoy each vacation day
Since I have a Blackberry strapped to my body 21 hours a day, I generally do not use out of office messages. During August, while I'm climbing in Yosemite, I cannot physically answer email most of the day. My out of office message provides the details of my climbing schedule and sets expectations when I will be reachable.

4. Own the appropriate mobile technologies
I own a Blackberry 8707G six band phone which works on every square inch of the planet with cellular technology, including Japan. Every airport I land at has GSM/GPRS or UMTS, ensuring I can connect as needed. During my 2 weeks of climbing and hiking in August, I will not bring a laptop and will exclusively rely on my Blackberry to keep my email queue empty.

5. Avoid major infrastructure changes during your vacation
Change is the most likely cause of downtime. By minimizing major change during your time away, you can reduce the risk of outages during vacations.

6. Pick the time of year when stakeholders are on vacation
If senior management and other major stakeholders are on vacation, there are fewer urgent requests for new projects or issue resolution.

7. Avoid vacations during a time of organizational instability
I've been in organizations with major leadership changes i.e. CEO, Dean, your boss etc. I recommend avoiding vacations during times of great transition, since you want to be around to defend your position and your department as needed.

8. Be able to return in case of emergency
Last year, the Joint Commission arrived for a surprise accreditation inspection on the first day of my vacation. It was so important to demonstrate our medication reconciliation system and communicate our plans for quality improvement applications that I agreed to travel back from my vacation for a day to ensure we had the best showing possible.

9. Build a Partnership with your family
My wife and I have been together for 28 years (I married the first woman I dated in college), and she's very tolerant of my various activities from working long hours to climbing isolated mountains. My wife, daughter and I spend time together every day and we support each other's lives, realizing that at times the best support is allowing each other time alone.

10. Tolerate ambiguity
Take each day of your vacation as it comes, and go with the flow. If you need to make a critical call, that's ok, your family will forgive you. If you are late responding to important email that's ok, your customers will forgive you. Staying loosely connected, not disconnected, and reacting to events without worrying about a precise schedule will make your vacation restorative and your return to the office easy.

Using these approaches, I'm able to balance family time, personal time, and work time on vacation in a way that works for everyone. From August 9 to August 24, my blogs will slow down and my email will flow only in the night and morning hours. I hope you'll enjoy a bit of time off too!

How to be a Great Boss

In my career, I've reported to CEOs, Professors, Doctors and Deans. I've had good bosses and bad bosses. I've had bosses who have leveraged me as a strategic asset (my current bosses do) and others who have not.

In my opinion, there are 10 characteristics that make a great boss. These are based on my own reporting experiences and are the behaviors I try to use with staff I supervise.

1. Responds rapidly - In general, employees escalate issues when they feel anxious, conflicted or powerless. When an employee asks for clarification of a strategy, help with a political conflict, or a decision about resource allocation, bosses should respond rapidly with a decision, so that the boss is not the rate limiting step to progress. A boss does not need to carry a Blackberry, but should acknowledge every email the same day it was sent, even if the resolution will take a little longer. My personal goal is to clear my Inbox completely before bed each day, ensuring every issue is responded to and resolved if possible.

2. Embraces process - Every problem, even a crisis, can be resolved by initiating the right processes. Each organization should have budget processes, position control (new hire) processes, governance processes, communication processes, conflict resolution processes, and human resource processes that can address every issue. If a boss cannot respond immediately with the resolution of an issue, he/she should identify the processes needed to bring it to closure. Giving employees definitive directions about which processes to pursue and guidance about how to pursue them is a great way to resolve complex issues.

3. Micromanages and Macromanages - Some projects are so complex and require such alignment of stakeholders that the boss needs to get involved with the details of the people, budgets and project plan. Most projects require just general oversight of progress. A boss should get involved in the details when asked to help, but otherwise should follow project progress at a high level, leaving the details to those experts who are immersed in the project specifics.

4. Empowers - A boss should use his/her authority to support direct reports, giving them the freedom to execute their projects per their best judgment while giving them the political support they need to be effective. As a project sponsor, the boss can help with stakeholder alignment, project vision, and building a guiding coalition in support of the project.

5. Provides Resources - Staff counts and operational budgets should be increased yearly based on workload, strategic plans, infrastructure demands, and compliance requirements. Of course, most organizations are resource constrained so it may not be possible to fund all new staff needed, but since each project is a function of scope, time, and resources, the boss needs to pay attention to resources to avoid turning a "lean and mean" organization into a "bony and angry" one.

6. Stands by you in good times and bad - One of the great joys of IT is that the organization rarely gets credit for the thousands of things it does right, but is often criticized for the few things that go wrong. A boss needs to support employees with personal thanks and praise when things go right and support them when things go wrong. The organization should not punish the individual but should ask how processes can be improved to avoid bad outcomes. Whenever we have downtime, project delays, or budget overruns, we improve our processes to reduce the likelihood of future problems, supporting our employees completely along the way.

7. Communicates Consistently - I would much rather hear often from a boss about strategy, priorities, politics, and rumors than be surprised with sudden changes in direction or given emergent deadlines. Everyone in the organization is happy to work hard, but they need to the flexibility to plan their own schedules and control their own destiny. I try very hard to communicate to all my staff via blogs, email, town meetings and very predictable priority setting. With consistent communication, I will never be accused of "priority deficit disorder", a corollary of attention deficit disorder which occurs when executives and organizations forget the priorities for year long projects half way through them.

8. Delegates and trusts - A boss must build a trustworthy team of people and delegate the details to them. I try to master the technical and process details of all our major projects but as my authority becomes broader, my depth of understanding of the details shrinks. My teams support each other and I watch their progress. Unless I see someone on the team impeding the work of others, I leave the team alone to execute the projects using the standardized processes we have established together.

9. Has boundless energy and enthusiasm - Bosses should be your greatest fan and marketeer. They should show real passion for your work and tell the world about it. An optimistic, highly visible, and energetic boss keeps the employees optimistic, visible and enthusiastic. Of course, the boss should also respect the need for downtime and temper that boundless energy during employee vacations, family time, and weekends.

10. Focuses on the trajectory and not the position - Every day the organization will have some new need for an IT project that is deemed critical for quality, safety, compliance, profitability, or customer satisfaction. Governance committees need to triage these using objective criteria. More often then not, new projects will be placed in a queue behind existing priority projects. The boss must realize that on any given day, 10% of the organization will feel that their needs are not being addressed, but that over time, all projects get done based on the prioritization of governance committees. If the track record of the organization is that projects get done consistently and needs of stakeholders are addressed year to year in a way that keeps most people happy, the trajectory is good. I especially apply this concept to audits. Every kind of audit - security, governance, strategy review, or specific technology -will identify dozens of opportunities for improvement. Every year gets better and better, but the position is never perfect. That's a great trajectory.

Let's hope you have a great boss. If not, keep the faith. The one constant in this world is change and over time you'll have one. In the meantime, be the best you can be by using the 10 behaviors above with your staff and you'll succeed.

Cool Technology of the Week

Today is my 150th blog entry since I started Life as a Healthcare CIO in October of 2007. Over the past 7 months, I've become a real fan of social networking technologies and have been an active participant in Blogger, Facebook, LinkedIn, Plaxo, various Wikis, and countless Webex collaborations. I'm a champion of any technology which democratizes the communication process, turning anyone into an author, publisher or broadcaster. One such technology is Social Networking Radio from blogtalkradio.com

The concept is simple. Using a simple phone line and an internet connection, anyone can broadcast their own internet radio program worldwide. You create an account, establish a broadcast schedule, invite guests and the public to participate, and you're broadcasting. Shows are streamed live and available after the broadcast as Podcasts/MP3 downloads.

I recently participated in a 90 minute live Talk Show with Dr. Anonymous on Blog Talk Radio to discuss electronic health records, life as a CIO, and my experience as a doctor.

It's easy to use and free.

Social networking meets internet broadcasting, turning anyone into a DJ or anchorperson. That's Cool.

Dreaming of Green

Although being a CIO is my passion and my lifestyle, there may come a time when I want a less operational role, a focus on the simple pleasures of living, and to apply my energy on leaving an environmentally responsible legacy for my daughter. She will inherit the earth I leave her.

The engineer in me wants to pursue a low impact, off grid, eco-friendly life using all the tools and technologies available. Here's my list of Dreaming of Green lifestyle ideas

1. Pick a location with temperatures that vary between 20F and 80F to minimize the need for heating and cooling energy sources. My early research suggests that Portland, Oregon is a good choice for its mild climate, bicycle paths, vegan restaurants, and environmentally enlightened culture.
2. Live in a home under 1000 square feet. That should be more than enough for 2 people and their stuff.
3. Build with sustainable materials such as rammed earth walls, bamboo flooring, and a living roof.
4. Use geothermal heat pumps to heat and cool the house using the fact that the earth maintains a constant temperature across the seasons. Radiant floor heating is another technique that can be used that is more energy efficient and forced air or radiators. Wood pellet stoves use renewable fuels and are energy efficient.
5. Use photovoltaic solar panels, hydroelectric energy and windpower to generate electricity for the home.
6. Use minimal electrical appliances and choose devices that have minimal use of resistive heating elements.
7. Use natural light and compact fluorescent bulbs for illumination.
8. Wear sustainable clothing made from linen, hemp, and rayon. Avoid leather and any animal products.
9. Use an on demand water heater to eliminate the energy needed to keep a tank of water hot.
10. Use the Japanese technique of washing with minimal water outside the tub, then soaking inside the tub, changing the water every few days.
11. Recapture sink wastewater via grey water recycling for plants.
12. Use composting toilets.
13. Eliminate junk mail and strive to purchase items with minimal packaging.
14. Be vegan. Eat local/regional foods. Grow your own when possible. Compost your biodegradable garbage. Recycle everything you can. In Wellesley, Massachusetts, we recycle over 85% of our solid waste.
15. Use public transportation, hybrid vehicles, bicycles and walking to get around.

Thus far, I've done as many of these as I can in Massachusetts, including many IT related efforts described in my previous blog entries Kill a Watt, Some Like it Hot, and A Green Approach to Storage.

I look forward to the opportunity, in retirement, to make green living my lifestyle and my job. I know that I'll never truly eliminate my impact on the environment, but the journey to minimize it will be very rewarding.