Wednesday, May 1, 2013

The Toad and the Snake


Over the weekend while working in the orchard, I found a small garter snake trying to eat an enormous toad, pictured above.

Did the toad not realize that by wriggling its feet, it could easily escape?   Was the toad unaware of the impending threat?  Might the toad have given up and thought that the end was inevitable?

Did the snake not realize that the toad was much larger than it could possibly digest?  Garter snakes have special jaw hinges that allow them to swallow things wider than their bodies.  Was the snake so optimistic about the benefits of an enormous meal that it was willing to discount the risks it faced in the swallowing process?  Might the garter snake have seized the opportunity because the conditions were right for eating the toad slowly over time?

As if often the case, I tried to find deeper meaning in this encounter with survival of the fittest.   On a daily basis, I examine my life, asking who I am, where I've been, and where I'm going.

In my early years as CIO, I did not know the risks I faced, what I had to lose, and who I might upset along the way.    I was the garter snake.   Out of this period came new advances in interoperability, patient portals, and clinical applications.    Everything was developed in a disruptive rapid cycle improvement fashion.

Today, might I have become the toad?

Have I become too risk adverse in a world of enhanced regulatory enforcement?  Have I evolved from the innovative rogue to the keeper of the status quo?  Have I become too attached to the customer relationships I've formed, the incumbent vendors I've chosen, and the strategy I have shepherded for 15 years?

In analyzing my behavior, I do not believe I've become the toad quite yet, but am I very sensitive to the warning signs.

In 1996, when I was faced with impossible tasks for which there was no technology, no standards, and no policy, the answer was simple - create them and if they failed, try again.

In 2013, with auditors reviewing my every project, government agencies scrutinizing my process maturity, and boards wanting to minimize risk, how can we reduce the barriers to innovation?

I do not have a complete answer, but I have an idea.

I would like to begin raising funds from inspired philanthropists, grateful BIDMC patients, and partner companies to create what I'll metaphorically call the New Organization for Transformative Outside-the-box Application Development  (NO TOAD)

Of course we'll continue innovating in all my operational BIDMC IT groups, but somehow NO TOAD has to be constructed and chartered to do work unconstrained by convention, risk adversity, or anxiety about the things that create overhead in 2013 and did not exist in 1996 such as

Project management offices
Application development methodology
Communication and milestone reporting
Operational oversight during workflow design and development
Business readiness
Policies, procedures and guidelines documentation
Training and education plans
Cutover planning
Functional/performance testing approach
End-to-end and user acceptance testing
System support plans
Infrastructure and controls
General and organizational controls
Physical and logical controls
Program change controls
Disaster recovery and business continuity plans

Is this possible?   I think so.

We'd create a large de-identified data set that could be openly used by developers without fear of violating HIPAA.

We'd isolate devices from the hospital network to enable freedom and experimentation with technology not allowed in a high security production environment.

Prototyped code would be reimplemented into production software using formal approaches only after it had proven its value.

By design (a separate LLC?) NO TOAD would be considered outside the scope of healthcare audit and regulatory burdens.

Projects would be audacious, aggressive, and agile.   Many would be expected to fail.   The culture would be high risk, high reward without concern for the limitations of current healthcare policies or technologies.

Lessons from Bell Labs, Steve Jobs' reality distortion field, and Google's 20% freethinking policy would guide the selection of ideas to pursue.

Over the past few months I've joined a number of BIDMC philanthropy activities, building awareness of the unique culture that is BIDMC and the amazing talented people that work there.

My challenge is now to incubate a true learning laboratory for BIDMC that can enable garter snakes who are not intimidated by the impossible tasks ahead.  Think of it as healthcare IT unchained.

If it works, I'll happily tell people that the entire idea was inspired by a concern that we've become prisoners of risk avoidance and a toad that decided the status quo was unchangeable.

NO TOAD.  An idea whose time has come.

And so the fundraising begins.

7 comments:

Ken Wells said...

You need a pay pal link to start taking donations. At the very least I would feel better if I knew I gave 20 bucks to this awesome idea.

Anonymous said...

Dr. Halamka, your eyes are wide open. Beautiful post. Appreciate everything you share.

James Deck said...

I could not agree with you more. Count me in for a contribution.

ToddRowlandMD said...

This is a great idea and interesting analogy.

Creating innovation zones is essential for collective progress.

If one of the major Harvard systems can't pull this off, we are all in trouble.

paul austin said...

Sign me up as a project engineer!

Anonymous said...

Sign me up as a project lead. Although you might also consider out of the box staffing ala open source.

Stephen Gordon Earle said...

Love to see some innovative applications that use relatively low-cost, commonly available technology (smart phones, tablets, etc.) to help improve the health of underserved populations, without having to worry about producing a generous ROI for investors.