Executive Advisory Program

Forget H1N1; focus on STS

Posted by: Jack Santos

There is a disease among us that I call STS – stock ticker syndrome.  I experience the symptoms at least once a day.  Usually it’s someone asking me if I saw their email, or me asking someone else.  And usually the response is : “No..I never got it…let me look…oh there it is….sorry”.  Or, alternatively, “No – never got it, must have gone into spam”  (usually it’s sitting in the inbox).

The real problem is that in our 21st century communication system that we have built, these tidbits of information fly in and out so fast it is easy to miss something – like watching a stock ticker.  At any given minute of any given hour of any given day, you can see the emails coming in at a regular pace.  And many people do just that – mesmerized by the pattern.

Our Gartner/Burton content and collaboration guys have a good recommendation for this: software that “pulls” relevant info forward, and pushes “irrelevant” info back.  The real issue becomes what is relevant and not.

Vendors are jumping into the fray – Facebook comes at it with a social networking bent,  Google, in its typical “throw mud on the wall and see what sticks” approach, has already introduced multiple attempts (like “Wave”) -- the latest is “Buzz” for Gmail. Even collaboration tools like SharePoint (or Lotus Notes) think they have a solution. Twitter comes at it from a different direction…make the tidbits smaller, but more numerous; so if you can’t beat STS, join it .

They fact is that it’s just life as we know it, and we’ll have to get used to high “miss” rates….which is worrisome.  I suppose the argument could be made that the only difference with pre-internet life is that now we know (or can find out) what we missed, whereas before we would have no clue, and no way to find out. I suppose so.  But this is a troubling side effect of the information society, and not something the just “unified communications” (whatever that marketing term means) can solve…..But it’s an issue we (as management) need to focus on.

Just delivering new ways of funneling more information, and no context or filtering, (like Buzz) won’t help…

Cloud-fuscation

Posted by: Jack Santos

Part of the Gartner/Burton integration plan calls for, of course, integration of benefit plans.  I have some particular insight here, since I have been on both sides of that equation – in health insurance IT, and as a health care provider CIO. 

Insurers have always been on the leading edge of technology usage – and that continues to be the case. There is extensive use of websites, online modeling, customer based data entry, and self help.  It’s cool stuff.

But it’s also an example of a nascent problem with “cloud computing” – or even its red-headed step child: e-business. 

As businesses have found that an internet-based delivery model solves many issues (and reduces many costs) they have gone at it with a vengeance. So has government – health plans are becoming increasingly complex (HSAs, HFSAs, CDHP are all in the alphabet soup), because a side effect of increasing automation is that it is (ostensibly) easier to develop more complex plans, and easier to deliver them.  Hence, like water flowing into an empty glass, the level of complexity rises.

The role of IT leaders is changing – no longer are we just the advocate of automation, we must be the advocate of appropriate and judicious automation – whether it’s through participation in business strategy, or government regulatory frameworks.  An excellent primer on this is “The Laws of Disruption – Harnessing the New Forces That Govern Life and Business in The Digital Age” by Larry Downes.

This issue is not unlike a situation I found myself in a few years ago.  After months of bake-offs, evaluations, vendor grilling, RFIs, RFPs, etc, we were about to make a major software decision, and were reviewing vendor contract terms (it was a 15-20MM dollar purchase).  Of course, the contract was internet accessible, PDF format;  And it was littered with hyperlinks to terms on web pages, references to commitments on web pages, and detailed product features on web pages.

I wouldn't sign it; they were reluctant to change it, and it almost cost the deal.

Besides the complexity of referencing material outside of the signed document, there was the issue of audit – clearly those web pages change frequently, almost at whim – with no clear audit trail of who/when/where/why.  God forbid we should get into an argument at a later date (inevitable) and both parties look at the terms – just to find they were written on beach sand that had been scoured by hundreds of successive tides of changes…..In the end, they dutifully printed out all of the referenced web pages, we reviewed them, and explicitly included them in the contract.

I submit this is an example of yet another potential unintended consequence of cloud computing; we are attracted by the dynamic and elastic aspects of cloud, but those same features can be detriments to a long term, sustainable business model. 

A potential way to deal with this may come out of design thinking and hybrid thinking approaches.  Gartner research is exploring that genre of ways to think about IT solutions, and the impact on business strategy…

When I had 20 different websites open from 5 different companies, and multiple time-sensitive modeling and data capture pages in process, it occurred to me that the benefits enrollment process is approaching lunacy-- not any one business’ fault, just a zeitgeist. I am not sure whether health care reform (if it ever happens) will worsen or improve this situation.  But issues around appropriate automation, user interface design, and silo integration are at the heart of what should be on an IT leader’s agenda for the coming years….and cloud computing will only add fuel to the fire…

Now if I can only get Fidelity to stop insisting that I only rely on web-based statements and alerts….

Adam and Eve’s Progeny Can Find Persistence with Apples

Posted by: Jack Santos

My apologies for the biblical allusions in the title, but reading rumors about the inevitable Apple Tablet brought me back to many years ago during a  dark, secret meeting deep in Apple labs.

I was sent as an emissary for a major Fortune 200 company, and Apple saw me as the techno-weenie to win over in order to keep a fairly lucrative contract for Macintoshes.  So they held no punches, pulled out the big guns, and showed me what then Apple Chief Technologist Dave Nagel felt was the hardware to end all hardware wars.  The crème de la crème, the “it’s not a desktop, it’s not a laptop, it’s not a handheld” answer to every techno geek’s dream.

It was the early 90s,  and it was “The Newton”.  Not just an apple from any tree, but one from within the Apple tree.  Even then, the prototyped envisioned always-on wireless capability, endless applications at the palm of your hand, ease of use at your fingertip (albeit with a stylus).

OK OK – they didn't get it right, and the Newton is on the dung heap of history. Sure, it was attempted during the Jobs hiatus – with Sculley in charge of all things visionary gone wrong.  But one thing you have to give the folks at Apple – they don’t give up.  I really think some of the visionary thinking and experimenting that went into the Newton is what has made the iPod, iPhone, and the impending tablet a commercial success.

A classic “If at first you don’t succeed…” story.  They didn’t succeed, they did try again, and the rest is history.  Stubbornness and persistence has gone a long way at Apple.  Right, Steve?

The Future of TV

Posted by: Jack Santos

Let me preface this post by stating that I don’t consider myself a videophile, or even an audiophile.  I have friends (like Mike Clapis, owner of Clapis Associates, or Dave Passmore, Research Director of our network strategies group) that would probably puke at what I have done with my flat screen TV.

But I just accomplished something with my home media setup that I can only say is what EVERYONE will be doing within 5 years.  This also explains, in tangible terms, the recent acquisition of NBC universal by Comcast.

You see, I HATE that I am paying Comcast over $100 a month for what amounts to about 5 hours a month of TV watching (but includes 24X7 internet usage).  I also have wireless 3G access which, though not as fast as 8Mb/sec Comcast, is good enough at 1-2 Mbs.  And I pay for Netflix, which now offers online viewing of movies.

When I first started thinking about doing this I was told by a lot of nay-sayers all these “the sun will get in your eyes” excuses for why it won’t work:

Not enough bandwidth

Downloads will take too long

Picture/video quality will be horrible

PC isn’t powerful enough

Playback will constantly stop/start for a variety of factors

It won’t be easy to use for the average Joe

Two years ago that may have all been true.  What a difference time makes.

This week I cut my cable, and hooked my flat screen monitor up to the internet via a PC.  And now my access to content (free and pay) is even greater than what I had available via Comcast and “on-demand”.  The real bennie is the easier user interface – windows based, point and click  (a pox on cable directories).   Much  of it through a consolidated video search engine: “clicker.com”.  Video quality for the most part is as good as snow free, ghost free old time broadcast quality, and in some cases approaches 720P HD quality; 1080 is on the way.  YouTube, others are pushing the envelope on quality.  There is very little herky-jerky stop/start stuff going on, and I can still have PC window sessions and other things going on in the background (try doing that with cable).

 

 

The last piece that fit was a remote control;  I experimented with wireless mice, presentation devices, and wireless keyboards with varying degrees of success.  Until Kevin Kampman (from our identity strategies group) said “Hey Jack – I think there’s a an app for that”.  And there was.  I am now using iMocon on my iPhone to control the mouse and specialty keys (everything short of a keyboard), and it works well.  Point and click on videos, and away we go.

I will admit I take advantage of the Netflix unlimited download movies deal (for $15/month).  Still beats $100. I can also plug in my iPhone (when not using it as a remote) to play music on the 5.1 speaker system, or watch videos.

Add to this Digital Video Recording functionality, and the inevitable entrepreneurial zeal that will go into new features and functions based on PCs and iPhones. This is the future.

It took 40 years to go from ubiquitous broadcast TV to ubiquitous cable, with a hundred fold increase in content. it will take less than 5 to go from cable to ubiquitous Internet TV, with a thousand-plus fold increase in content. 

The real proof in the pudding is that my non-tecchie wife is loving it, and finds it easier to use than vanilla cable; and the choices....

Gotta go, YouTube's calling…

 

 

The Golden Age of Computing

Posted by: Jack Santos

Occasionally I gain insight into where things are going such that it really excites me about the direction of our profession, and of the human race.  That happened today, with a briefing from IBM research.

We live in a world where heart transplants, ear implants, hip replacements are all routine.  Often the recipient is better for it coming out of the procedure than they were going in.

IBM didn’t say this, but what I gleamed was that within my children’s lifetime, we may not only be looking at our traditional organic transplants, but we’ll achieve stand alone compute capacities that will enable us to mimic the human brain.  Think brain replacements.  By 2020 we may see the mechanics in place, so sometime beyond that could see that kind of breakthrough.  Compute capacity today is already equivalent to cat-brain capacity (the IBM Dawn effort at Lawrence Livermore Labs).

Head trauma, Alzheimer's disease, memory enhancement, brain augmentation – all are areas that could see significant research benefit.  On a separate but related track are efforts like Google’s where access to information ubiquitously will only make this vision even more likely (or Frankenstein-ingly threatening).  I sometimes feel like an extension of the internet: answers to obscure questions come to me within 10 seconds by speakingto my iPhone.  The result is that I already mentally compartmentalize what I need to remember, and what I can conveniently forget, because of the ease of this access.  I am, as a biological entity, already being enhanced by compute technology – and the trend is accelerating.

2020…the new 2012, at least for IT. But not the end of the world, the beginning of a new one…

The Cell is going to POTS..or not

Posted by: Jack Santos

Everybody loves handheld (like iPhone) data and web access.  In fact, in a recent call with a very large west coast chip company, their IT’ers found it hard to believe that the trend was for senior execs to not take a laptop with them, and totally rely on a cell (Blackberry, iPhone) for access.

But that said, let’s just talk about POTS (plain old telephone service).

But wait, it isn't that plain anymore, especially on the iPhone.

Besides the normal AT&T service (enter a number, call, talk, hang up, see the minutes on my monthly AT&T bill)  I now have 2 other options that I typically use overseas:

Skype:

Find a WIFI signal, open the Skype app, dial a phone number, talk, hang up, get billed 3-30 cents a minute, based on country, anywhere in the world (pay with PayPal).

And now (as of Sept)

Vonage:

Find a WIFI signal, open the Vonage app, dial a phone number, talk, hang up, get billed 5-25 cents/minute, based on country; a minimum 35 cents monthly charge, even if not used)

   -or –

Get within 3G range, open the Vonage app, dial a phone number, talk, hang up, get billed the same Vonage rate as above plus use my AT&T minutes (i.e., its a double dip - the minutes show up on my monthly AT&T bill because the call gets routed to a Vonage access point phone number, and then forwarded to the number you dialed).

From a geek perspective – this is all really cool. And has great potential for reducing my overseas phone bill (which IMHO has always been a rip-off).

From a POTS perspective – can we (the telecom/software industry) make this anymore complicated?  I’ll bet we can…but I suppose freedom of choice always is more complicated..note  (in the US) the result of the original Bell system breakup, or energy deregulation.

Wait until we can use any third party VOIP technology over the traditional 3G/4G network (lots of behind the scenes fighting going on over that right now).  Something Paul Debeasi has been predicting for some time now (Paul is our mobility analyst). His blog is here. Paul has been doing research on mobility and cell phone policies and governance within organizations – an area seeing a lot of change lately, as evidenced by these options.  Makes for a lot of strategy options for the traditional carriers (to put a positive spin on it).

In the meantime, road warriors are loving it, and my EU travel phone bill is down by 80%.

More Pie for the Masses...

Posted by: Jack Santos

How many emails do you get daily?  I remember when my response of 50-100 per day would elicit a “yeah, right…do you get anything else done?”.

Sad to say, 50-100 per day is probably the low end of the norm for most people these days, and my work load has topped  over 150-200 a day…then add my personal email box of 50-100.

Our collaboration and content group has a lot to say on information overload. Craig Roth has for years talked about the concept of information pull, instead of push.  That is, set up a system so that you can easily get what interests you, rather than just get a torrent of unsolicited stuff that screams for attention.

One of the ways is to move some of that load to wikis or discussion groups.  The jury is still out for me on that, and my take on the use of wiki’s (for other than joint authoring, like with Wikipedia) is skeptical.  But some of the benefits of SharePoint discussion groups, or even wikis, are (as Craig pointed out):

• it enables simple subscription/unsubscription to the topic
• it maintains a historical record of how decisions were made for future justification
• it allows new employees to gain visibility to the whole thread
• it applies thread management like a tree structure
• it surfaces tribal knowledge so the corporation can maintain it (rather than this knowledge residing in our personal inboxes which are unsearchable and destroyed when we leave)

I guess so.

But it’s still yet another place to go, yet another place for MORE information, yet another place vying for your attention.  Add to that blogs, news feeds, Facebook,  Twitter…. well….its just piling on.  Where will it all lead?

We may be at a tipping point where the processes for managing information are far more valued than the delivery mechanisms.  One can only hope.  Lyn Robison (from our Data Management group) loves to rant about how business people put up with bad information from their IT departments.  No doubt. The sad thing is businesses want more. 

Like the old  shtick about the two senior citizens in the Catskills: “This  pie tastes awful!” says the first, to which the friend replies “ YES! and the pieces are too small!”

And so it goes with enterprise information…

The real world

 

 
  Posted by: Jack Santos

Just back from 2 weeks at sea; timing is everything – just missed a hurricane.  It gets interesting when life doesn’t include daily (if not hourly) interaction on the internet…and it was a welcome respite.  Which reminded me of this recent piece forwarded by a friend:

If Bud Abbott and Lou Costello were alive today, their infamous sketch "Who's on First?" might have turned out something like this:  

COSTELLO CALLS TO BUY A COMPUTER FROM ABBOTT      
ABBOTT:  Super Duper computer store. Can I help you? 
COSTELLO: Thanks. I'm setting up an office in my den and I'm thinking about buying a computer.
ABBOTT:  Mac?
COSTELLO: No, the name's Lou.
ABBOTT: Your computer?
COSTELLO: I don't own a computer.. I want to buy one.
ABBOTT:  Mac?
COSTELLO: I told you, my name's Lou.
ABBOTT: What about Windows?
COSTELLO: Why?  Will it get stuffy in here?
ABBOTT: Do you want a computer with Windows?
COSTELLO: I don't know. What will I see when I look at the windows? 
ABBOTT:  Wallpaper. 
COSTELLO: Never mind the windows. I need a computer and software... ABBOTT: Software for Windows?
COSTELLO: No. On the computer!  I need something I can use to write proposals, track expenses and run my business.  What do you have?
ABBOTT:  Office.
COSTELLO: Yeah, for my office. Can you recommend anything? 
ABBOTT: I just did. 
COSTELLO: You just did what?
ABBOTT: Recommend something.
COSTELLO: You recommended something?
ABBOTT:  Yes.
COSTELLO: For my office?
ABBOTT:  Yes.
COSTELLO: OK, what did you recommend for my office?
ABBOTT:  Office.
COSTELLO: Yes, for my office! 
ABBOTT: I recommend Office with Windows.
COSTELLO: I already have an office with windows! OK, let's just say I'm sitting at my computer and I want to type a proposal. What do I need?  
ABBOTT:  Word.
COSTELLO: What word?
ABBOTT: Word in Office.
COSTELLO: The only word in office is office.
ABBOTT: The Word in Office for Windows.
COSTELLO: Which word in office for windows? 
ABBOTT: The Word you get when you click the blue "W".
COSTELLO: I'm going to click your blue "W" if you don't start with some straight answers... What about financial bookkeeping? You have anything I can track my money with?
ABBOTT:  Money.
COSTELLO: That's right. What do you have?
ABBOTT:  Money.
COSTELLO: I need money to track my money?
ABBOTT: It comes bundled with your computer..
COSTELLO: What's bundled with my computer? 
ABBOTT:  Money.
COSTELLO: Money comes with my computer?
ABBOTT: Yes. No extra charge.
COSTELLO: I get a bundle of money with my computer? How much? 
ABBOTT: One copy.
COSTELLO: Isn't it illegal to copy money? 
ABBOTT: Microsoft gave us a license to copy Money.
COSTELLO: They can give you a license to copy money?
ABBOTT: Why not?  THEY OWN IT!
        (A few days later) 
ABBOTT: Super Duper computer store. Can I help you? 
COSTELLO: How do I turn my computer off?
ABBOTT: Click on "START"............

Of Garages and Hospitals: The Mechanics of High Tech Healthcare

Posted by: Jack Santos

Those of you that know me or my background know of my healthcare IT pedigree – on both the insurance and the provider side.   Keep that in mind when reading this post, because  my comments can be easily misconstrued. 

One of the key concerns for healthcare IT advocates (and detractors) is the  automation of healthcare; kind of a care assembly line.  This has certainly been a concern of some watchers of the debate going on at Capitol Hill.

This concern manifests itself with alerts and reminders in an Electronic Medical Record system, leading to complacency on the part of the clinician.   I recently saw a similar phenomena happen when I took in my brand new 2009 car to the dealer for a perceived warranty issue.

Mechanics courses now focus heavily of use of computer based diagnostic testequipment.  By connecting to the car’s on-board computer (OBC) system, a mechanic can measure and detect all sorts of things – alerts on component failures, out of spec operation, even speed and acceleration statistics (which would be a boon for auto insurers and rate determination – but that is for another post).

In my case, my cruise control on my new car was working erratically – sometimes over 30 MPH, sometimes under 40, sometimes never.  After three trips to the shop, and numerous on-line lookups by mechanics for similar service recalls or problem reports (each time downloading codes from the OBC and diligently following alerts and repair protocols) they determined that the problem was an obscure part that rarely fails, especially in so new a car: an electronic brake light switch.  It would take a month to get a new one from the factory.

What the mechanics failed to do in this entire diagnostic process was to actually LOOK at the patient (in this case, my car).  Even a rudimentary look would have revealed that an after-market hitch harness for brake lights had been installed (by yours truly).  The manufacturer of the hitch harness had incorrectly listed this make and model as compatible.  The electronics in the harness (which was supposed to just extend the brake light signal to a trailer) interfered with multiple things in the car – including the cruise control.  I removed the harness – and problem solved.

This automotive story is a perfect example of what I would call process automation complacency.  Complacency that would be the result of relying totally on pretty (although busy) computer interfaces (like the one above), automated alerts, reminders, computer based knowledge bases – at the expense of rudimentary human-based diagnostics, or even common sense.

In this automotive case, the results were just annoying; in the case of back office processes, it could be an impact to the bottom line, or even financial reporting.  But in healthcare -  it could be a life lost.

Should that derail the Electronic Medical Record juggernaut?  I think not.  But it should make computer professionals, and healthcare executives, sensitive to  all the other aspects of a healthcare delivery system – including training,  and the cultural/sociological implications.  Cars can be replaced – human lives cannot.

NO Bars, NO Service

Posted by: Jack Santos

  A recent snafu with my cell phone roaming plan really brought home what it’s like to be one of the bandwidth have-nots.

Unfortunately, AT&T has a policy of not automatically transferring  features when you get a new phone.  So I ended up in a London hotel room, waiting for my cell to ring with directions to a meeting and…no bars, no service. My international calling plan was non-existent.

No problem. Call AT&T.  No service meant no 3G. No 3G on my laptop too.  Pull out the old, trusted fallback – the AT&T business calling card for international calling. 

Well my old trusted fallback was so old (2 years!) that no number on it was working (they were all disconnected and not forwarded).

Can’t call 1-800-CALL-ATT.  NO international access to US 800 numbers.

OK, frustration building (what was that about no bars?). Call the hotel concierge (help!). Here’s the AT&T international number, they say.  That, too, is out of service.

So I am in a foreign country (at least I speak the language), but no way to communicate to my carrier, with a phone and PC I can’t make calls with, and awaiting an incoming business call.  Not even Skype can bail me out at this stage (no WIFI in the hotel). What to do?

It occurred to me that for just a brief moment (or maybe an hour), I was in the land of the technology have-nots.  Off-net, no way to plug into the ether, starved, lonely, looking for attention, with nowhere to turn.

Kind of like an inhabitant of Vatican City, which according to Wolfram Alpha is last on the list of places with internet users – 90,000  (versus the US at 223M; by the way – China just passed the US with 253M users).

It also shows how much wireless is overtaking regular landlines – to the point of the atrophy of phone numbers for landline calls.  Or the inability to get number information, especially without internet access (an interesting conundrum).

So, you may ask, did I finally get “on-net”?   Yes – thru the British Telco operator, who connected me to a landline AT&T operator, who connected me to a wireless AT&T service number, who turned everything on in seconds. Problem solved.

Burton Group mobility analyst Paul DeBeasi has forecasted how wireless will overtake landline in all its forms (his posts here).  That time seems to have come. But our need for landline (and human-based service) just keeps on hanging on.