Future of Health IT: Trends and Scenarios

links for 2009-09-29

• Twitter API Wiki / FrontPage
  Twitter's RESTful API is documented in this wiki.
  (tags: social+media social+networks web2.0 api reference twitter microblogging)
• craigbellamy.net » Social Media vs the Dictator – Clay Shirky
  'Lessons learned. The social context of technological-use is as important as the technology itself (try telling that to the practical minded Dictator!)'
  (tags: social+media politics)

Agile Methodology and the Conversational Meta-Methodology: Part one

I'm involved in a project that uses an online Agile project management system. It's not a big project in terms of number of participants, but the personnel are distributed across four institutions in three different states, none closer than a hundred miles to any of the others. When it becomes manifest, it will be a major achievement in the world of biomedical research, and it may result in technologies with commercial potential, even though they will be delivered under an Open Source license.

As stated in the opening sentence, the project employs the Agile approach. It's the first time I've worked on a project branded as Agile. I'm capitalizing the word to distinguish it from the adjective "agile", because the methodology may be Agile, but that does not guarantee Agile projects are agile in practice.

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I should say up front, in case any reader knows the project of which I'm speaking (and I'm sure some will), the project is moving along nicely. It has its ups and downs as with any project, but it is on track to be successful.

My critique here is directed at how the Agile approach as we are practicing it is getting in the way of the project approaching its full potential, which potential is well beyond the contractual scope as originally defined. The limitations I'm describing here could easily cause a different project to fail, but that isn't happening on my project. I'm happy with it, but I could be happier.

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The problems I'm seeing with the Agile approach may relate to subtle misapplications of the Agile approach in projects involving distributed teams, and I suspect these are widespread in the industry. These problems stem from tacit cultural biases and preferences.

I say 'misapplications' because people I respect and admire are ardent Agile enthusiasts: for example, long-time friend and colleague from my commercial product development days, Rich Sheridan of Menlo Innovations. If Rich says it works for projects like mine, and he does, I know I have some learning to do. I'm still at odds with his viewpoint at present, but I know I'll probably be convinced.

An example of the kind of tacit cultural bias to which I'm referring is the tendency of software engineers to want someone else to talk to the end user. This is not at all due to laziness or indifference. Often shy and introspective by nature, most productive when left alone in silence, software designers and programmers often believe that the process works best when there is someone who can tell them what needs to be done, and then leave them alone to do it. There are often organizational policies that proscribe developer conversations with end users, and these factor into the equation as well.

This in turn is related to a more pervasive cultural bias, the assumption that intellectual constructs like the requirements or design for a product can have persistent, stable existence independent of the minds of the stakeholders (most importantly, the customers, sponsors, and implementers).If they did have that sort of stability, requirements could be written down and "thrown over the wall" as the saying goes.

Some projects must force this level of stability, for systems engineering reasons -- the software for the NASA Shuttle is an example -- but for most projects, requirements are fluid and dynamic, and worse, are never the same from one stakeholder's mind to another even at any specific point in time. Moreover, this fluidity is not limited to requirements analysis: the same can be said for detailed product design.

I'm not against creating requirements and design artifacts, whether in Agile user stories, in IEEE-standard formal documents, or UML models, as long as everyone who matters in the process understands that the documented version is always incomplete, always wrong, and never incomplete or wrong in the same way twice, i.e. at any two points in time during the life of the project.

In project management, the saying goes, Plans are nothing, but planning is everything"; I would paraphrase that here as "Requirements documents are nothing, but the requirements analysis process is everything."

To see the fallacy in the assumption of stable, documentable requirements, recall the cliched party game "Telephone". One person starts with a somewhat lengthy and usually gossipy anecdote, and whispers it into the next person's ear. That person whispers it into the next person's ear, and it proceeds in this sub-rosa serial fashion until the story has been told to everyone at the party. At the end, the last person recites out loud what the story has become in the series of translations, usually to the merriment of all present.

The telephone game metaphor in software development produces something like the ubiquitous "What the Customer Wanted" cartoons, an example of which is shown here, stolen from Allan Jardine's blog (click to open full-size in a new window):

 

The lesson of the Telephone game is that communication often happens without comprehension. When done well, projects using the Agile approach should be characterized by lots of communication.It is the ongoing conversation, not the artifacts, that ensure a successful project.

For that reason, when I listen to any software development methodology, I look for the points where meaningful conversations will occur. A 'meaningful conversation' in this context is a timely and thorough conversation about product and process that builds and continually refreshes a shared mental model of the vision, mission, and goals of the project -- a mental model that all participants acknowledge will evolve over time.

If these conversations occur throughout, involve all relevant stakeholders at their points of occurrence, and form the real basis for the collaborative work, the methodology will result in a successful project, barring the occurrence of any of the political, financial, and other disasters that can kill even the most promising efforts.

Rich Sheridan agrees with my premise that we were doing Agile development back in 1986 -- in fact, all the successful commercial projects we knew about used some methodology that would fit into the Agile paradigm. What we lacked was a trademarked brand wrapped around a coherent description of some incarnation of our "methodology". Rich learned that lesson well, and his group has registered a trademark for the term High-Tech Anthropology®. Menlo peddles a methodology, to put it crassly, but it's no con game -- what they teach you is eminently workable in practice, and I highly recommend their services.

That said, I think Rich would agree that their flavor of the Agile approach works as well as it does because it is an incarnation of what I will now name the Conversational Meta-Methodology, rather than as a result of any rote technique that they teach you. In fact, one of the things they will teach you is that all the rote techniques are intended to do is to work toward a shared mental model of the project as it evolves over time. It's the process, not the artifacts, that are the key to success.

To disclose my personal interest in this matter, I wrote a book back in 2002-2003 called Design Conversations: Envisioning Content-Rich Enterprise Systems. It's as much about requirements analysis as it is about design. I've gotten great feedback from many of the several dozen people who have read it (including a few who downloaded it to their Kindles), but it hasn't started a movement. Maybe it's time to trademark the Conversational Meta-Methodology^TM, write a manifesto, work up some curricula and a YouTube video or three, and found an institute of my own. :-)

I'll come back to this in a soon-to-be-written post and show how it relates to my current project.

links for 2009-09-25

• Technology Review: What's Augmented Reality's Killer App?
  'Augmented reality (AR), which involves superimposing virtual objects and information on top of the real world, may be coming to a phone near you. As mobile phones become packed with more sensors, better video capabilities, and faster processing power, many experts predict that AR will become increasingly common. But in a panel discussion today at EmTech@MIT in Cambridge, MA, panelists will admit that several obstacles still remain and that the "killer app" for augmented reality has yet to emerge.'
  (tags: virtual+reality augmented+reality hci)
• AIDS vaccines: Double, not quits | The Economist
  'SOME good news about AIDS. After more than two decades of research those labouring to find a vaccine against HIV, the virus that causes the disease, have found a method that might actually work.'
  (tags: biomedical+research)
• Kristin Tolle on biomedical initiatives at Microsoft Research | Jon Udell | Channel 10
  This is some 411 on Fone+ and the MS Research initiative looking at using the cell phone as a biomedical tool, especially in developing nations. Lots of research implications.
  (tags: biomedical+informatics ubicomp pervasive+computing)
• CancerGrid: Publications : Oxford University Computing Laboratory
  Interesting tangent on caBIG from Oxford, funded by Microsoft Research
  (tags: caBIG caDSR semantic+web biomedical+informatics)

Blumenthal: More research needed on health IT effectiveness - FierceHealthIT

From the FierceHealthIT newsletter:

Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records. To date, most of the research has focused on health IT in specific environments, such as a single hospital, physician office or integrated delivery network, but the stimulus will help put EHRs in new settings that haven't been studied.

via www.fiercehealthit.com

It's amazing to have this kind of admission from the person at the epicenter of a multi-billion dollar effort to compel adoption of health IT "solutions". Given all the complaints about EMR systems getting in the way of providing healthcare (e.g., this guest post by Winslow W. Murdoch MD on the KevinMD blog), especially from primary care physicians who take part in the vast majority of patient-provider encounters. From the KevinMD post:

Currently, data can only be entered on a patient by patient basis. Unless the relevant medical decision making data is properly vetted and reviewed by the patient, with one on one help by a clinician, it becomes garbage in. An experienced primary care clinician who knows the patient best and has all medical information flowing through their office is the best person to input and screen new information important for medical decisions. They would also potentially shoulder the lion’s share of the burden of data input responsibility and therefore cost of implementing an EMR. These are the same practices that are the most financially insolvent, many on the brink of shutting down.

I am a great believer in health informatics, but I want to see it widely disseminated if and only if the systems enhance the quality of delivered healthcare and the productivity of providers. Key components of the vision I have in mind include, but are not limited to: intuitive and adaptable user interfaces for providers, suitable for real-time use in patient encounters; patient empowerment in maintaining the accuracy of health records; convenient (and billable) patient-provider electronic communications media; and perhaps most importantly, a holistic, episode-based approach to health records.

I am starting to get involved with an effort I believe has a lot of promise in realizing the potential of health IT, the Clinical Groupware Collaborative (CGC). Microsoft's Bill Crounse, MD recently posted on this subject in the Microsoft Healthblog (Learn more about “Clinical Groupware”); Microsoft is a charter member of the CGC. I'll post more about the CGC as events unfold.

links for 2009-09-21

• JavaScript InfoVis Toolkit - Demos
  Javascript toolkit for information visualization.
  (tags: information+science visualization javascript)

links for 2009-09-15

• Idea: The experience curve | The Economist
  'The experience curve is an idea developed by the Boston Consulting Group (BCG) in the mid-1960s. Working with a leading manufacturer of semiconductors, the consultants noticed that the company’s unit cost of manufacturing fell by about 25% for each doubling of the volume that it produced. This relationship they called the experience curve: the more experience a firm has in producing a particular product, the lower are its costs.'
  (tags: business entrepreneur scenario+planning)

links for 2009-09-14

• Bing Gets Visual Search Capability -- InformationWeek
  'Microsoft (NSDQ: MSFT) on Monday launched an enhancement to Bing that allows users of the search engine to find certain items by viewing images instead of sifting through pages of text-based Internet links. '
  (tags: hci search consumer+health+search)
• BAM - CTMS_Wiki
  'The Biomedical Research Business Architecture Modeling (BAM) activity is highly collaborative and leverages the knowledge of domain experts that participate in the caBIG® Clinical and Life Sciences Domains. The business stakeholder scope of the model spans the National Cancer Institute, Cooperative Groups, Cancer Centers, Community Clinical Oncology Programs (CCOP), and the broad biomedical research community. The objective of this effort is to identify the business use cases (activities), analyze the use cases and processes, and build a comprehensive business architecture model of the biomedical research domains. '
  (tags: biomedical+informatics biomedical+research clinical+research caBIG ctms)

links for 2009-09-11

• BBC NEWS | Technology | Smart sensors power interaction
  'Much of the conference was dedicated to the finer details of human-computer interaction, such as how web pages are organised for optimal information presentation or the practicalities of cataloguing the web's information using the "tags" familiar from social networking sites. '
  (tags: hci scenario+planning design)

links for 2009-09-10

• Researchers find a new way to attack the cloud
  Amazon and Microsoft have been pushing cloud-computing services as a low-cost way to outsource raw computing power, but the products may introduce new security problems that have yet to be fully explored, according to researchers at the University of California, San Diego, and the Massachusetts Institute of Technology.
  (tags: information+security cloud+computing)

links for 2009-09-06

• Video: Jeff Jarvis and the Future of Journalism part 1 | Media | guardian.co.uk
  Part one of Jeff Jarvis's seminar to the Guardian as part of the Future of Journalism series.
  (tags: news web2.0 Web3.0 journalism)