aaron c beals

boston.com had a recent article on the pushback from doctors in the US against the adoption of electronic health record (EHR) systems.

my favorite quote: “LeBow is reluctant to embrace a technology that he believes carries hidden costs, chief among them productivity losses while he and his staff master the system.”

classic short-term thinking — save money today even if it means losing money over the long run. granted, the doctor in question is 66 years old, so perhaps he’s got a reason to think about the short vs long term.

granted, there are questions about the return on investment (ROI) of electronic health record systems for doctors, especially if features like decision support are not built into the system. i argue that there are two issues here: first, many doctors are slow to adopt new technology. there are completely valid reasons for this — for example, they’re too busy saving lives to spend time learning flawed, nascent technologies. that said, their resistance to established technologies is unfortunate. second, the government has not clearly outlined the value for doctors. instead of doing this, they have set up a carrot-and-stick incentive model — a $44K payment actually encourages short-term thinking. the ROI is clearest for the government and insurance companies (benefits of cleaner reporting) — if the government is going to be in the business of pushing EHR’s down onto doctors and eventually patients, they need to make a clearer case.

as a technologist who is involved in the world of global health care, i know the value of a complete EHR system exists for all parties involved, but i’m not the one who needs convincing.

this is a story about testing, or the lack thereof.

for my ‘day job‘ (oddly named since i often find myself working on it at night), i manage a website that is used by thousands of health care professionals around the world. in order to keep things running smoothly on the site, we have a series of tests that we run every time we make a change to the code powering the site. these tests let us know that the code we have just written (often for a new feature) hasn’t broken the expected behavior of existing functionality.

these tests are Very Important. i cannot stress this enough. if you are a software engineer, a software QA engineer, and especially if you are a support engineer, i am preaching to the choir.

i’m not saying that our test suite is perfect. but we have one, and we add to it regularly. we do this because the penalty for failure to test can impact thousands of users and in the worse case, drive them away from using our site.

i also run my own site. for many years, i wrote the code behind the site myself, but over time, i started to realize that i was essentially building from scratch what the folks over at Wordpress had already implemented quite well. since they test their own code, i had no incentive to create a test suite for my site or my wife’s blog.

about 6 months ago, i upgraded Wordpress from the absurdly old 2.0.x to a more modern 2.7.x — an upgrade which went seamlessly and also allowed me to use their new one-click upgrade feature (i.e. no more unpacking tarballs and editing config files). however, the feature was DOA.

after some digging, i found that i needed to move to MySQL 5 in order to take advantage of the quick-upgrade feature. the data migration wasn’t painless due to the vagaries of our hosting provider, but after some massaging, i got things ported over. next, i found that an upgrade from PHP 4 to PHP 5 was required — luckily, i just had to add a line to the .htaccess file in the root directory. with a few other minor tweaks, we were good to go.

earlier this month, my wife tried to log in to the administration panel of a custom CMS she purchased a few years back. the login failed, as did the contact form submissions she had been receiving for a few months. i looked into the issue and found portions of the CMS code were not PHP 5 compatible (despite 5 being theoretically backwards-compatible with 4). turns out that adding the .htaccess file to the root directory, as my hosting provider had recommended, caused PHP 5 to be used in all subdirectories.

why didn’t i catch this earlier? well, i was making changes i thought only impacted our Wordpress installations. i had not touched other databases or code installations. since my wife’s wedding website appeared to work, i did not think to test features like the CMS admin panel or contact form.

why was it a big deal? if the issues had just impacted our blogs, it would not have been. however, the contact form on my wife’s wedding photography website is used to field questions by prospective clients. empty emails mean missed opportunities. the good news is that she’s putting her business on hold while we adjust to becoming parents, but this sort of mistake is still relatively costly.

would testing have helped? certainly testing of some sort (manual) would have helped. automated testing would have been harder to set up, since we had a bunch of different interfaces, but something like Selenium could have done the trick.

why don’t we have automated tests for our personal websites? discuss.

a recent post on WBUR’s CommonHealth blog, written by our executive director, Rebecca Weintraub:

http://commonhealth.wbur.org/guest-contributors/2009/12/life-saving-health-information-a-global-necessity/

i realize this presentation has been making its way around the web recently, but i’m just getting to it now. the folks over at Netflix (of whom i am a paying customer) put together a ‘little’ slide deck about their corporate culture.

the theme of the presentation is “freedom and responsibility”. given that these characteristics are two that i prize highly in a work environment, they started off on a good foot.

you should read the whole presentation (it doesn’t take that long), but here are the points that stood out to me (not that I agree with every word, but a lot of it rung true):

• “The real company values, as opposed to the nice-sounding values, are shown by who gets rewarded, promoted, or let go”
• “The Keeper Test Managers Use: ‘Which of my people, if they told me they were leaving in two months for a similar job at a peer company, would I fight hard to keep at Netflix?”
• “In procedural work, the best are 2x better than the average… In creative work, the best are 10x better than the average”
• The desire for process grows over time in a company not simply due to increasing complexity, but due to dilution of high-performance employees in the face of increasing complexity.
• The Netflix vacation policy is probably the most-quoted part of the presentation when it is referenced on the web, but I hope that people look past this (I think it’s a common-sense move I happen to strongly agree with) and see some of the other points in the deck.
• “Act in Netflix’ Best Interests” — the premise here is outstanding. I have always thought that the time and wages it takes to fill out and process lengthy expense reports is simply wasteful. If someone willingly abuses the system by acting in an irresponsible manner, fire them.
• “Managers: When one of your talented people does something dumb, don’t blame them. Instead, ask yourself what context you failed to set.”
• The compensation plan can’t be adequately summarized in one bullet, so check it out. Just outstanding.

interested in global health? we’re looking for an RA.

Jon Payne — who is doing some work with us here at the Global Health Delivery Project — has been working on outlining an ontology for the area of “Health IT”. the category is broad, so there are a large number of possible sub-categories, and increasingly so as federal money here in the US is put behind Health IT initiatives. head over to his blog and weigh in!

http://globalhealthdelivery.org/blog/?p=312

we have had the site up since late June, but with Jim Kim’s announcement, it’s official — GHDonline is here. as usual, there is much more on the horizon — new features, etc — but it’s a big accomplishment to get the site up in time for the IAS conference in Mexico City.

read Jim’s announcement about GHDonline
the GHDonline site

boston.com recently put together a list of workplace jargon collected from their readers… and frankly, while it amuses me, it also makes me sad. partially because it’s all so painfully true, partially because i find myself simultaneously using and hating these phrases, but mostly because the fact that so many people chimed in means that there’s really no escaping these inane phrases, no matter the workplace.