thingamy

health care IT and messy objects

I've been busy building some "hospital demo" last few days.

Building was easy, two hours tops for a few flows and some reports, but pre-build think-over was a good and long one this time.

Building a working business model with thingamy is rather simple - recognise the objects that your organisation is supposed to increase the value of, then define the most effective, value-increasing sequence of tasks and events those objects goes through.

Add whatever reports and accounts you think is useful and you have your IT backbone to run it all.

No big deal with a bike factory - wheel sets, frames, gears goes through some work-flow and becomes a value added item, a bike.

Even a service company like an investment bank or a technical support firm or a media company - pretty much the same. Ideas and knowledge instead of frames and pedals.

But health care? Nah, here I stumble over something new: Messy, iffy, uncontrollable objects. Human beings on the loose.

Objects that does not "belong" anywhere, objects that cheekily wanders into any doctor's office or get carried into the nearest hospital after an accident without any regard to structured data capture. Annoying.

Where is that central data capture thingie from birth to hopefully a late death? Easier said than done. Still smacking of something designed by Ray Bradbury.

Then, yesterday I had a long discussion with Josh and Melanie in Maine who are tinkering with some very good ideas in the health care IT space - that got me thinking:

As President Bartlett would have said - "It's all about economy!"

And that's not a bad notion at all. Who pays for those costs? The "insurers": Governments, but increasingly the insurance companies (including the rather obscure concepts of HMOs, MCOs, etc.).

In the US the insurance companies have the biggest interest and thus the most extensive records - if they have to pay for a pill or a blood test or a surgery they bloody well see to it that they know exactly what happened, and better yet, what happened prior to it. Part of sound insurance business that.

In other parts of the world, here in Europe say, we often see the government being in the same "insurer" situation - and they do keep records.

Those are records created by pure fiscal reasons, not by some regulation. And in my world economy and bare interest beats laws and regulations any time in efficiency.

So why not flip the situation.

The fiscal stakeholders could run the health care systems including Patient Records. Software As A Service is not a new concept.

MD logs onto insurers site, finds his patient, sees complete Patient Records, adds his input, makes decisions, orders tests, medication whatnot, pharmacy or test facilities logs on same site, gets work order, fulfills prescription or test, MD sees results immediately. Next year another MD or hospital, again complete and real time records available. Etc.

Patient Record created by work-flow, patient costs captured in minutest detail and real time by work-flow, insurer information instantly available graciously supplied by the originator. All happy, all gain.

That would sort out my issues with the messy objects indeed.

I think I will build a hospital-IT-systems-redundant software-as-a-service demo for health insurance companies now :)

YKSIW

You Know Something Is Wrong...

With management theory when the Roman army established that ten subordinates per boss was the right number (decurions, centurions..), and now 2,000 years later, 100 years of management schools and 40,000 management handbooks in print we believe the right number is eight.

With management practice when those 40,000 management handbooks does not help much.

With management practice when it keeps alive a whole army of consultants that lives very well indeed and the results are barely noticeable over time.

With organisational hierarchies when millions read and enjoy Dilbert every day. Worse, that most of his work is based on reality.

With organisational hierarchies when society measures your success by "position" instead of what you created and did.

With organisational hierarchies when the worst thing you can do to your boss or your subordinate is to bypass him/her.

With tree structures when I forget where I put that file three weeks ago, and I do not even remember what the folder name was.

With modern enterprise software when the must-have-tool for the very best and biggest systems is not even a part of the system: Excel.

With modern enterprise software when reconciliation is still a major issue.

With modern enterprise IT systems and management practices when you spend hours on creating reports, pestering others to report and being pestered yourself.

With modern enterprise IT systems when middle managers tells you that they spend hours every week to "botch the system" or write snippets of code to survive with the monolithic and rigid top-to-bottom stuff.

With the whole system when about ten percent of what I pay for music or a book goes to the actual product; music and content.

With the whole system when on average I pay at least 50 percent for broadly defined information (think over what you pay for the actual product, it be a shirt, car or a good story) that could easily be replaced with cheap information and communication technology.

With the concept of marketing when you switch channels immediately when the advertising starts.

With the concept of marketing when you immediately go aggressive when some voice on the phone during dinner goes "Good evening Sir, I'm.... from the firm.... and I would like to offer you...".

With the concept of marketing when such callers and e-mailers have become today's poltergeists.

With all of the above when it relies on push instead of pull and we all know inherently what we detest (push) and what we love (pull).

With us all when we know this and still try to patch and tweak something that is so obviously wrong at it's core!

The time is ripe to right the wrong.

pushy buggers

Push, push and even more pestering "marketing" is everywhere.

Today's example is WebEx - which surprises me no end - they should be a bleeding edge web based new economy kind of thingie one would think. Note the slogan on their site - "Join the revolution!".

But no. Must be the one against Louis XVI they're talking about.

Did a trial once, not that bad, lag was pretty useless though, 10 to 20 seconds - but I suspect it would get better if I used their UK server.

Price was not so good either. Rather fuhgettabout it price for me. One hour would increase my annual "marketing budget" (typepad.com) with 50%.

Then all hell started - every time I even got close to the blasted thing I received some kind of pestering mail - questionnaire, "Am I happy with the services?", "We have a great offer for you!".

And then the marketdroids called, the modern version of poltergeists.

Latest today from one of their ladies in Holland wanting to know "how she could help me".

When I told her I was not happy about the lag (had to explain what I meant by "lag") she responded "No, that's not so, we're much better than everybody else!". Ah, good going, denial is much better than listening I guess.

So I told her I'm using VNC, free and no lag to talk about - her response? "Good for you. Good luck in the future. Click..."

Well run company that one... any short sellers out there? Give it a thought.

Anyway, found out a long time ago that not using WebEx is like a filter, I filter out many old fashioned closed thinking firms that would be a waste to talk to any way! Like WebEx themselves I would think...

I like filters.

to the mountain top and beyond!

Thanks to Thomas and Hamish and James (lurking in the background) we have now a bike ride for those of you tempted to the one must-do-once-in-lifetime ride in good company and for a good cause!

Mont Ventoux!

Only 1609 vertical meters in 21.1 km - average 7.63%, superb views and a dash of heavy breathing (the outdoorsy kind)!

And that for a good cause to boot.

More about it all here.

This is how it looks like just after start, looks easy eh?

...and a bit later it looks like this:

1.5 km before the top you will pass the Simpson memorial where cyclist leaves some memorabilia like punctured tubes and bottles. Simpson died here when racing uphill in 1963... so take it easy!

The profile looks like this:

And if you're not convinced yet that this is a definite, must do etc - here's a comparison to other well-known cols around:

	climbing m.	Km	%
Bourg d'Oisans - Alpe d'Huez	1141m.	13 km.	8.77 %
Luz St Sauveur - Col du Tourmalet	1405 m.	18 km.	7.80 %
Malaucène - Mont Ventoux	1579 m.	20.6 km.	7.67 %
Bédoin - Mont Ventoux	1609 m.	21.1 km.	7.63 %
St. Marie - Col du Tourmalet	1258 m.	17 km.	7.40 %
Jausiers - Cime de la Bonette	1622 m.	24 km.	6.76 %
Briançon - Col d'Izoard	1040 m.	21.5 km.	4.84 %
Briançon - Col du Galibier	1647 m.	35.5 km	4.64 %

As you can see there are some steeper ones, but Bedoin - Mont Ventoux has that nice combination of steepness and a looong way to enjoy it!

So join us now - go here.

Support car, video recording, photo opportunities supplied and water bottles filled up at need!

screenshots

Kingsley reminded me that some screenshots of the thingamy could be appreciated...

I agree, so here goes in the form of a little demo-stab. Quirky and all, for you who'd like rounded corners, pretty reports and AJAXy outputs please read my last post :)

For now it's all about getting the basics to work, more features/functions and prettyness will follow with end-user input as we start up some skunkworks/pilots.

When preparing for a demo I try to get an idea of "what's their strategy?" - or basically what value are they supposed to focus on creating.

Having once dabbled in investment banking, M&A, here's a little off-the-top-of-my-head stab at that - in essence add knowledge about potential "targets" and their current "owners" and potential "acquirers". Then play around and match up and see if you get something that makes sense.

Then go out there with a well prepared pitch, try to get a mandate, capture costs, drive it forward etc. etc. Basically do the business.

Going for a ten minutes demo I restrict myself to a couple of flows and some simple reports just to give an idea - then show how it's done. Usually a demo like that takes me about one hour to dream up and plonk down.

First I go to the "builder" interface, the "root" of the system. Obviously a restricted area for the system users.

Here I start adding some "tags" that could add information to objects - like area, practice area, type of businesses, whatever. Not too many though as a start, more to "warm up" a slow brain in fact:

Then I pop over to the "Classes" to create the first few cookie-cutters for "objects" I'm going to use. The thinking is simple - a business is all about taking objects (parts, products, information snippets, human resources, etc.) and send them through a "sequence" (workflow) where value should be added or created - the essence of the business I think.

Here I have created a few:

The settings being like this for the "M&A idea" - here you can drag those "types" into the blue area for instant adding of properties, just change the title for it. That can be done at any time BTW, in essence changing the "database schema" at any time even when live.

Note also I'm using other classes as part of a class.

Then onto the "sequence" we'll put those "objects" through - the workflows. Here I have created a few, some of these can be used in other flows (map to and fro is easy) in order to save building time - I usually end up creating a small "library" of "operators", flows for reuse:

Here's "Create a M&A idea", including adding targets, owners and acquirers if needed. Again the colourful icons representing "instructions" can be dragged into the blue area, and/or around in it to build or change a workflow at any time.

Each instruction have quite a few settings to be set so the running of the workflow works like it was meant to do. The red hexagon is a "multiple choice" instructions with three different branches underneath, each with very different snippets of flows:

Then I "run" a few workflows to add some "data" so we can show how to "use" such:

I add a few reports-templates and give myself access to these in my Home area, like a display side-by-side of potential targets and acquirers as they exist in the system.

In this one I am using the Navigation tags to filter it down - highlighting "France" (multiple choices is allowed of course!) gave this (completely irrelevant data in here of course, just for illustration):

Also did a little "Accounting report" in the "builder" template-builder (mapping from report to actual events to give the right sums or whatever - completely opposite to usual accounting systems where account has to be chosen at data input) that looks like this:

Giving a report that looks like this:

Unless I apply some "historical browsing" onto it - note the bottom left setting.

Thingamy captures everything - changes - by whom, when, what, values, movements, absolutely everything and all from actual events. All with SOX, Basel II, Health systems requirements and whatever future regulations in mind, as well as thinking real-time + historical reports for whatever date and time might come in handy for all.

Combine some tags and historical browsing for instant display from same report of all "Unallocated costs at June 12 at 20:26 for French projects for Existing clients" - quite useful:

Much more to it of course, but have to keep the picture-book post a bit limited :)

thingamy potential vs. capability

Following a demo of thingamy, this is a question that easily comes to mind.

Potential is mostly easy to see, but with that comes the big question mark - what's the real capability?

Capability in my mind is about two things - direction and infrastructure - like roads. Is it the right path? Is it a dirt road or a three-lane motorway? Does it get you there most efficiently? Does it accommodate all kind of vehicles and traffic?

Here's where we are:

Thingamy is currently a dirt road.

We cannot take the bison futé of the French vacationers moving all at the same time. The big enterprise monolithic systems that has been around for some decennials are the four-lane ones.

But...

I humbly think we're have the right path, a very different and potentially much better path. We've been down most of the alternatives, machete in hand.

What does four lanes help if they end up in a dead end, or the wrong ocean? What costs are involved if the monolithic "roads" requires another lane?

I think our path will eventually take the people where they should go at a very low cost and quite snappy to boot.

Suspect that is the potential issue...

So, are we happy with being a dirt road?

Yes, we are. It was meant to be like that - while it is not meant to remain like that!

A single path was much easier to redirect than a large four-lane project from the outset. We have ripped our system apart and started all over again at least four times.

Out of that exercise we have a dirt road, directionally efficient.

And we have cleared the brush, designed the bridges and filled the ditches in order to be ready for paving at a snap. Designed for easy adding without limits to four, six, eight or any number of lanes.

With at least four rewrites we had the opportunity to halve the lines of code every time, to re-factor and organise - so now we are out there to learn more about the paving and number of lanes requirements.

We have built the basics so that we can add a function or "feature" within hours - two, four, six, eight lanes? We're ready.

Paving comes last, neat UIs and AJAXy finesses will have to follow the lane decisions.

All potential but well poised to quickly add capability is better than all capability and little potential left... very humbly suggested of course ;)

And yes, that is why we want to start with pilot projects, trial installs and skunk works so we can set the number of lanes and quickly add the capabilities required.

redundant hierarchies

Of all questions I get, this is my favourite : "Could we use thingamy to change the organisation?"

To which I enthusiastically answer: "But of course, thingamy can even replace the organisational hierarchy!"

The organisational hierarchy's purpose is to organise the processes, the work flows and distribute work orders one way and reports the other.

In other words, implement a structured use of resources, i.e. deliver the Business Model.

That is what the thingamy is designed to do: Organise the processes, design and deliver the Business Model, create value in short.

Thus it requires no organisational hierarchy.

That's why my business card has this precise Hugh drawing:

With "avoid the whole blasted thing" on the flip side :)

thingamy moving forward

(Did the hat help?)

I just recently started to meet up with actual potential end-users of the thingamy...

Highly enjoyable as I mutter "at last, at last!" :)

Thingamy does not give it's best as an "application builder" nor as a "mapping tool" for current organisational hierarchies - so I focus on what it does best; business model building, value creation.

To that purpose my homework consists of trawling online resources for strategy statements from the potential end-user (strategy being what value to deliver to what customers and how to be different).

Of course, "strategic goals" and "vision statements" comes in many forms, some slightly iffy thus leaving me some guesswork...

But it's not that difficult:

• A tech support department creates more value if it can capture and reuse as much as possible of its problem-solution pairs, build more knowledge about customers, technology, rules and regulations and make it easy to find and match and play with it all. Then efficiently fulfil the needs of the customer when it arises with minimum resource use.
• A financial institution (of all colours and stripes) must build knowledge about products, customers, rules and regulations - then play with the knowledge and create new and interesting products and/or solutions. Then efficiently execute.
• A media company must (again) build knowledge of all kind of customers, of technologies, of rules and regulations, about suppliers and resources - the play around with the knowledge to create ideas with no limits, then flip to actual products. Executing efficiently at the end of course.
• A production company - same thing all over again, just with some twists.

Whatever the industry or part of firm it is - creating value boils down to:

• Easy amassing of knowledge.
• Easy browsing and matching and playing with the knowledge to enhance ideas/solution/product creations.

Then some "keeping some of the value creation for yourself" - a main part of the business model:

• Efficient fulfilment of specific requests/productions/deliveries.

Add the interaction and overall glue - no small part:

• Transparency and accountability for all - internal and external.

That makes it easy for me, I have a stab at translating such into "objects" (stuff, info, ideas), "sequences" (workflows) and "reports" that in the right combination could enhance the value creation.

Which constitutes a demo that can be run, delivering work orders, interfaces with info and fields to fill in and some reports to play with (restricting myself to a couple of flows and some pertinent reports, all within an hour of demo building).

It works, specific "application needs" or "problems" to be solved are quickly forgotten - after all value creation is more fun, and with luck it often makes some problems and application needs evaporate.

Add that it illustrates something else that makes a trial install/skunkwork project simpler: No top-down, no waterfall method, no method at all, just think "value creation" and start somewhere banal and build from there - viral, Trojan horse. Easy :)

Now to the next, and even more interesting part - help out so the trials/skunkworks creates some real value for the potential end-users, real tangible easy to measure value. Then the real fun starts!

what the heck is that thingamy? #2

With our stuff getting into the last stretch towards being "finished" I'm now in the fortunate situation of discussing run-your-business stuff with real, live, actual end-users who have some experience using the large monolithic enterprise thingies.

What I hear a lot, followed by shaking of heads, are these three key terms:

Excel
Reconciliation
Reports, now please

Excel as in "I want my little special report so give me export of data into Excel". Producing "loose cannon balls" of manipulated, re-manipulated and time-sequestered data that leads to both humorous presentations (oops, same data, different assumptions... the graphs look a bit different don't they?) and the well known nightmare of:

Reconciliation. Take one spoon of data from accounting (gawd knows if all invoices have arrived), one dash ad-hoc report and four different spreadsheets that supposedly started with same set of data but which now are different. Result? Well, something iffy at best.

Reports. Well, if data sets are wandering, raw data dependent on snail-mail and multiple data sets each claiming to represent real life - what else than desperate calls at seven in the morning for reports by ten can be expected. Pestered from above, pester down, mess up your days.

On Red Team (changed colour this time) we have the well known monolithic enterprise software whose owners are big sponsors of the yachting industry (at least I can try earning some off them here).

And on the Blue Team we have as always the weed in the garden, thingamy.

Let's compare:

	Red Team	Blue Team
"My own special report" ability:	Export to Excel, apply logic at will, loose integrity and timeliness of data.	Create template easily once and for all, create your special report forever by push of button. Never loose integrity or value of raw data.
Reconciliation:	Required. Made difficult by said use of Excel, lateness of invoices etc. End result never exact.	Not required. One real world data is represented real-time by one data object in the system. Data captured by real world actions in real time. End of story.
Reports now! please:	Call, mail, request, cross fingers that nobody has to be dragged out of bed in California (heh, who cares, you're the boss)	Push button. Real time, now, any type, true now. Accessible by anybody, end of pestering, leave you to focus on task at hand.

I like learning about the "competition" :)

reboot & cycling

Yet another great couple of days in Copenhagen - no doubt about it, Reboot rocks!

So, Thomas, Nikolaj and the whole Reboot crew - thanks again for a wonderful two days!

Have to admit that I was not as good as I should have been to listen in on all the amazing presentations and workshops supplied, ended up spending much time in the garden, in the bar, talking with old and new friends about all that matters etc.

Half the fun, half the reason to be there is in fact to see old friends and at last see some newly found friends face to face and then again meet even more amazingly nice and smart people.

Then it's simply about being entertained (and inspired, same thing!) by provocative ideas, inspiring ideas and of course the odd plain falling-off-my-chair-laughing presentations (no doubt the Renaissance man requires a honorary mention there!).

Two days of laughter, two days of great discussions, two days of utterly great people - my thanks to you all, too many to mention in one post!

Got home safely, although I managed to delay my flight - being the kind of chap that I usually sneer at, "heh, don't he know how to find the gate on time or what... hmpf".

Brain firing on about one-and-a-half cylinder combined with this new "code sharing" nonsense (my ticket said LX 4556 while the boards said SK 603, then sometimes UA 8767 or LX 4556 while another LX for Zurich were to leave 15 minutes later) put me at gate A14, iPod blaring when I heard beyond the Eels something like "Will Mr. Sigurd Rinde come to gate C23... NOW!". Oops, those who's been to Copenhagen airport knows the distance between those points... on a crowded Sunday... with some heavy luggage... me felt pretty stupid knocking over old ladies and scaring Danish kids on my way :)

Back on the coast I had the pleasure of rigging Sarah Blow up with one of my old bikes then letting her lead up some nice hilly rides in our backcountry!
What else not to love, met Sarah on the London Girl Geek Dinner, then she's off to Nice for a conference, needs a bike (and I have about ten of'em) so I suddenly have a new cycling buddy... a side effect of blogging that should be a theme for next Les Blogs ;)

Sarah is getting ready for a London-Brighton charity ride so we decided 750 meters elevation and about 3 hours leisurely ride was the thing to do. And I can say that she will survive nicely such flat rides from London...

Here's Sarah in my garden after lunch giving Albert (my youngest one) swimming tips, she does not look much exhausted does she? (She'll be using the bike for the rest of the week though!)

Bonus for the cycling geeks, the readout (my pulse though)... as you can see, pretty much unhurried but still a good start for Sarah :)