What keeps me up at night - FY10 edition

Life as a CIO is never boring.

In Sunday's Boston Globe, Microsoft CEO Steve Ballmer said “What’s the old movie line from ‘Annie Hall’? Relationships are like sharks; they move forward, or they die. Well, technology companies either move forward, too, or they die. They become less relevant.”

No matter what an IT organization has accomplished in the past, what matters is daily infrastructure performance and the ability to constantly improve applications. I call this problem "changing the wings on 747 while its flying". Rapid change and complete stability must be achieved at the same time.

Here are the change management issues keeping me up at night in my various organizations.

BIDMC

Intranet - we're introducing a new intranet organized around social media concepts : tag clouds, blogs, and new media. Creating the security infrastructure to provide data confidentiality while at the same time encouraging use of social media anywhere on any browser is a delicate balance. We're looking at several new security appliances to help with this effort and I'll share the details in a future blog. Also, changing an intranet is one of the hardest projects that an institution can do, since so many people use it for their work every day. Even if the change is for the better, it's still a change. Balancing new functionality with ease of use and rapid adoption is challenging.

Enterprise Image Management - as storage needs increase and image exchange becomes a requirement throughout the organization and with our business associates, IT is becoming the focal point for image storage and life cycle management of all modalities. The days of local DVDs and departmental storage are gone. Using a combination of EMC products, IT is hosting short term cache, long term archiving, backup, and disaster recovery. Our projects over the next year will serve radiology, cardiology, and likely several other ologies that are seeking assistance. The challenge is building an infrastructure that is scalable, affordable and maintainable. We're using cutting edge products and technologies. There is always risk in implementing a new service based on highly innovative products.

EHR rollouts for meaningful use - I've described our EHR rollout efforts in several previous blogs, which are summarized in this document. We've solved the technology issues, but motivating clinicians to rapidly adopt EHRs is hard. Stimulus dollars help, but sometimes they are not enough, such as for specialists or "concierge medicine" PCPs. As a leadership team, the EHR steering committee needs to provide carrots and sticks to stimulate change.

Business Intelligence - I've written about the need to look beyond data and find information, knowledge and wisdom. We need to provide our stakeholders with innovative access to knowledge in our clinical and administrative systems using tools that are self service and do not require programming/IT expertise. The challenge is how to enable tools that anyone can use without requiring expert knowledge of the data itself - how it was gathered, who entered it, how accurate it is etc.

Interoperability - BIDMC strives to be one of the most interconnected healthcare organizations in the country. We have new projects that ensure we achieve meaningful use data exchanges in 2011 and beyond such as a exchanging quality metrics with the Massachusetts eHealth Collaborative Quality Data Center, exchanging clinical summaries with community EHRs, and enhancing our public health reporting using HITSP standards, all with the NEHEN gateway. This effort requires that we adopt new standards, enforce controlled vocabularies as the data is entered and appropriately address privacy/security concerns for data moving between organizations.

Harvard Medical School

High Performance Computing - The demand for computing is increasing exponentially and our challenge is not real estate but power/cooling. Over the next year, we need to substantially increase our electrical capacity and we're considering many options including a data center near hydroelectric power.

Storage - the research community at Harvard Medical School demands high performance, highly reliable storage at a low price. We've been able to offer high quality NAS with replication, attached to our high performance computing cluster for .67/gigabyte per year. Our challenge is to keep up with demand, always ensuring we have enough storage, but not over provisioning.

Content Management - Last year, I worked with BIDMC Corporate Communications to move BIDMC's web content to a commercial content management system with delegated content management. In FY10, we'll need to do the same with Harvard medical school including administrative websites, research websites, and departmental content. The stakeholders at Harvard Medical School are very diverse so the challenge will be selecting an information architecture and navigation approach that works for everyone.

Social Networking for research - Over the past year, we've worked as part of the Clinical and Translational Science Awards (CTSA) to build transparent access to researchers with active and passive social networking techniques. Expanding this work requires that we build trust among all our collaborating institutions and encourage transparency with the sharing of personal intellectual property. The more you share about your thinking, the better the social networking.

Governance - I'm a strong believer in IT governance. At HMS, I've always had good input from research, administrative, and educational stakeholders but this year I've worked with the Administrative Dean to launch an overall IT Governance Committee to ensure the needs of all stakeholders are balanced. Governance takes a great deal of time and energy, but it does mitigate surprises such as delayed projects, budget variances, and misaligned priorities.

NEHEN/State activities - The Office of the National Coordinator is distributing $600 million in Federal funds for health information exchange. In my role as chair of NEHEN, I want to be sure our state has a good strategic plan and stakeholder alignment to create health information exchange in support of meaningful use goals. As with many of my other projects, this work requires a huge commitment to governance and working with highly innovative technologies and emerging standards. It's all high risk.

HITSP/HITSC/Federal activities - The Standards Harmonization work at HITSP and the Implementation/Adoption work at the Healthcare IT Standards Committee requires constant communication, balancing of stakeholder interests, and embracing innovation. Like any Washington task, achieving consensus among all the various points of view requires patience, an open mind, and a steady hand. I'm learning every day how best to serve the country as a facilitator and communicator. The task is never easy.

Personal - On the personal side, my daughter is 16 and we've begun college planning. Applying to college these days is much different than in my youth. I'm convinced that if I applied now to the schools I attended (Stanford, UCSF, UC Berkeley, UCLA, Harvard, and MIT), I would not be admitted!

My parents recently retired and we helped move them to a new house where the living is easy and maintenance free. My wife and I have begun to think about our retirement 20 years from now.

My 2009 work schedule has reduced my outdoor activities a bit, so I've had less climbing and hiking opportunities. This winter, I'm committed to getting back on trail in the 4000 footers of New Hampshire

My flute playing has taken a backseat to Washington travel. This winter I'm committed to playing the Japanese flute at least 3 times per week.

Thus, overall my challenges are keeping customers happy, managing the risks of change, embracing innovation, and keeping my family/personal life balanced with a worklife that has no downtime.

That's what keeps me awake a night. It's a lifestyle, not a job, and I enjoy every minute.