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!