healthy4u: agile computing

Vladimir Putin may be known for showing off his pectorals riding horses bare chested, but he also seems to have a substantial amount of gray matter between the ears. Our country, including the healthcare IT sector, could probably learn something from him: <blockquote><a href="http://online.wsj.com/article/SB10001424052748704415104576065641376054226.html"> A Walled Wide Web for Nervous Autocrats </a> Wall Street Journal Jan. 8, 2011 By EVGENY MOROZOV At the end of 2010, the "open-source" software movement, whose activists tend to be fringe academics and ponytailed computer geeks, found an unusual ally: the Russian government. Vladimir Putin signed a 20-page executive order requiring all public institutions in Russia to replace proprietary software, developed by companies like Microsoft and Adobe, with free open-source alternatives by 2015. The move will save billions of dollars in licensing fees, but Mr. Putin's motives are not strictly economic. In all likelihood, his real fear is that Russia's growing dependence on proprietary software, especially programs sold by foreign vendors, has immense implications for the country's national security. Free open-source software, by its nature, is unlikely to feature secret back doors that lead directly to Langley, Va. </blockquote>It's also less likely to feature a backdoor to a hacker's basement, or a lot of bugs ("glitches") that some health IT vendors and customer organizations allow to accumulate into the thousands before lifting a finger. This brings to mind the adage that "if you want something done right, do it yourself." <blockquote> ... For ordinary Internet users, there is one silver lining: The embrace of open-source technology by governments may result in more intuitive software applications, written by a more diverse set of developers. [Read the whole article at the link above - ed.] </blockquote>More intuitive IT applications could solve a lot of the current health IT problems, such as the <a href="http://www.tinyurl.com/hostileuserexper">mission hostile user experience</a> of many closed-source products from major vendors. Afrer major IT debacles including the <a href="http://www.huffingtonpost.com/stephen-soumerai/dont-repeat-the-uks-elect_b_790470.html">£13 billion abyss</a> of the National Programme for IT in the NHS (NPfIT), the UK also seems to be learning: <blockquote><a href="http://www.ehi.co.uk/news/EHI/6687/new_approach_urged_for_government_it">New approach urged for government IT</a> E-Health Insider <div style="padding-bottom: 10px;font-size:0.9em;">2 March 2011 Lyn Whitfield </div> <div style="margin-top: 3px; margin-bottom: 10px; float: right; margin-left: 15px;"> </div> A new report into government IT failures has warned that previous inquiries may have embedded problems by focusing on inappropriate ‘best practice’ instead of looking for alternative approaches. The report, from the Institute for Government, says “existing ‘best practice’ project models do not deal with the fundamental issues at the heart of government IT.”[As I've stated <a style="font-style: italic;" href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">here</a>, one has to consider the "worst practices" as well, the "thou shall not's." Typical Milquetoast, touchy-feely "best practices" models and their "sanitized accounts of successful projects" (cf. <a href="http://hcrenewal.blogspot.com/2009/12/healthcare-it-as-cybernetic-miracle.html">Greenhalgh</a><a href="http://hcrenewal.blogspot.com/2009/12/healthcare-it-as-cybernetic-miracle.html"> et al.</a>) avoid such inconvenient realities like the plague - ed.] It also argues that: “By implementing these same, flawed project techniques in an increasingly rigid fashion, these traditional solutions can act to exacerbate the problems further.” [This sounds familiar, typical of the inflexible, dogmatic business IT culture, descended from the punched-card programmable tabulator culture of the 1920's - see <a href="http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html">this link</a> - ed.] Instead, it calls for a new that focuses on using government’s huge buying power to get better deals for what it calls ‘platform' technologies – such as server capacity and PCs – while encouraging departments to adopt ‘agile’ methodologies to deliver systems to meet the particular challenges they face.... Andrew Adonis, Director of the Institute for Government said: “The billions spent on cancelled IT projects, such as ID cards and National Programme for IT in the NHS, demonstrate precisely why we need a much more flexible approach to government IT. ... The report cites the national programme as one ‘symptom of failure’ in government IT; the tendency for projects to run late and for departments to struggle to keep suppliers on board or hold them to their original delivery requirements as a result. </blockquote> <a href="http://en.wikipedia.org/wiki/Agile_software_development">Agile software development methodologies</a> have traditionally been anathema to the culture of IS departments involved in mercantile, manufacturing and management varieties of business computing. As I've written many times, however, those methodologies are essential in healthcare IT, such as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story">here</a> and <a href="http://hcrenewal.blogspot.com/2010/09/health-it-danger.html">here</a>. At the latter link I observed: <blockquote>... In fact, in my observations IT personnel are the true Luddites [as opposed to clinicians who are often accused of that reactionary characteristic- ed.], clinging to inappropriate, rigid business-IT views on the healthcare IT development and implementation process (vs. more appropriate and modern <a href="http://en.wikipedia.org/wiki/Extreme_Programming">agile methodologies</a>), holding unshakable, stereotypical views about physicians, and remaining unreasonably obstinate on clinician complaints about "clunky" health IT user experiences.</blockquote> Perhaps Mr. Putin and Mr. Adonis deserve a copy of the book "<a href="http://www.amazon.com/Medical-Informatics-Electronic-Collaboration-Innovation/dp/0763739251">Medical Informatics 20/20: Quality And Electronic Health Records Through Collaboration, Open Solutions, And Innovation</a>", Jan. 2007, by the <a href="http://www.ehealth.va.gov/EHEALTH/CPRS_Demo.asp">VistA</a> (open-source EMR) pioneers. The "Open Solutions" part of that title says it all. -- SS

Vladimir Putin and Common Sense on IT

Vladimir Putin may be known for showing off his pectorals riding horses bare chested, but he also seems to have a substantial amount of gray...

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