The Palawan Project

Next adventure: Palawan

Friends, my life in the States is over for now.

I'm relocating to the island province of Palawan, in the Philippines. Check out my new blog: Retirednoway.wordpress.com.

WHAT REALLY IS THE PROPER ROLE OF INFORMATION TECHNOLOGY?

This is my final entry. I’ve moved on to the next phase of my life. My days of managing IT infrastructure projects and implementing applications are over.

I wanted to share the gist of my experience in this post. Of the different aspects of IT consulting, I choose to discuss the proper role that Information Technology must play in an organization. In any organization.

Technology is merely a tool. It is managed by a part of the organization. And like any other part of the organization, IT’s mission is to support the organization’s mission.

How does it do this? By doing what it does best. And that, namely, is by improving the flow of information within the organization.

How does that help the organization? It helps because it enables people to make better decisions (or at least better-informed decisions) since they are able to access the right information at the right time.

Why is this particularly important? Today’s environment operates more rapidly than yesterday’s. Today’s environment also changes more rapidly than yesterday’s. Technology in the form of advances in communication and transportation is responsible for this. These factors, namely, faster (implementation) cycles and faster evolution (of the market), increase the need for faster decisions. And smart decision-makers who already face the pressure of making fast decisions will not handicap themselves with poor information. This is why IT is more important than ever.

HOW SPECIALISTS REACTED TO HEALTHCARE REFORM

HOW SPECIALISTS REACTED TO HEALTHCARE REFORM

The lighter side of physicians' reactions.

The American Medical Association has weighed in on the new Obama health care proposals.

Allergists voted to scratch it, but Dermatologists advised everyone not to make any rash moves.

Gastroenterologists had a gut feeling about it, but Neurologists thought the administration had a lot of nerve.

Obstetricians felt they were all laboring under a misconception. Ophthalmologists considered the idea shortsighted.

Pathologists yelled, “Over my dead body!” while Pediatricians said, “Oh, grow up!”

Psychiatrists thought the whole idea was madness, while Radiologists thought that they could see right through it.

Surgeons, however, washed their hands clean about the whole thing. Internists thought it was a bitter pill to swallow but Plastic Surgeons said, “This puts a whole new face on the matter.”

Podiatrists thought it was a step forward but Urologists were pissed off at the whole idea.

Anesthesiologists, meanwhile, thought the whole idea was a gas, while Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out and left the decision up to the assholes in Washington.

SHREDDING HARD DRIVES

Paper, we know, can be shredded, but why not hard drives? They contain important information and they are difficult and time-consuming to destroy.

These are samples of shredded hard drives. The contents of exactly one hard drive is in the box. The ziplock bag also contains the remains of exactly one hard drive. Thanks to MD of Michigan!

WHEN YOU TAKE OVER A STALLED PROJECT

Unless a good reason exists, I like to share my lessons learned. There’s no point in repeating mistakes that can be avoided if only someone had told me so. I believe that strongly. If a better way exists, wouldn’t you like to know about it? I would, so the four steps outlined below are a succinct summary of points that I’ve learned work and, even better, work reliably.

A project is stalled if it is drifting along and nobody is working on it. Somebody decided that it needed to be dealt with. Kill it or finish it.

The author is a practicing PMP (Project Management Professional). For more information, visit the Project Management Institute (PMI).

Here are the steps and their order. Following the steps do not guarantee that you will successfully turn it around. The steps, however, are best practices that have been tested and proven to work and work well.

1. Take stock of the project. Determine the current status of the project against the schedule (time) and budget ($). Analyze the results. It will guide you to the items that need attention. Why it it behind schedule? Was the cause a process or resource?

2. Develop a plan. It may be that the original plan just stalled because the sponsors ran out of money. Or perhaps the sponsors changed their mind. Find out. If funding can resume then you may just need to restart the original plan. Start imagining the solutions as you uncover the reasons that stopped the project. Be creative but pragmatic in developing the plan. Your developed plan, when ready, should be presented to the stakeholders or the parties that have a stake in the outcome of the project. The stakeholders are often the same ones of the original stalled project.

3. Reducing the scope of the work or the desired outcome is the easiest way to restart a stalled project. For example, should less work be performed? Can the result or outcome be reduced in quantity (five instead of 10) and/or quality (two instead of three layers)? The sponsors who provide the resources (like money) may be more inclined to resume if they learn that a lesser version of the outcome is possible.

4. New sponsorship must be found. This is critical. The sponsors may be new or of the original group. Do as much as you can to ensure that the new sponsors are committed to the project. You must get this commitment in the form of a Project Charter. It formally creates a project. A true charter will include a section that authorizes the expenditure of resources on the project and explains how it will be done. The charter is signed by the sponsors. It is a legal document.

Congratulations! The charter marks the start of the un-stalling. It marks the start of a new project lifecycle. After your team receive the charter, start the planning in earnest.

HOW CONFUSING IS THE NEW HEALTHCARE MODEL?

This is a high-level illustration of the relationships between the major entities in the Health Reform plan of the House Democrats. Although the illustration refers to the plan of the House Democrats, the illustration was created by Republican staffers. In other words, this is the Republican interpretation of their rival’s plan. This is similar but not identical to the plan contained in the Senate Bill that was unveiled today.

Click here to see a larger version. Click here to see the associated blog discussion.

PREPARING FOR AND TAKING THE PMP CERTIFICATION EXAM

The Project Management Professional (PMP) designation is one of today’s highly-sought and credible certification. It certifies that the person who possesses it has accumulated at least 4,500 hours of project experience—whether as a team member or project manager—within the past eight years. In addition, it certifies that the individual is sufficiently proficient with the best practices endorsed by the Project Management Institute. PMI is the dominant world body that oversees the profession.

In this post, I shall share some of the lessons I learned from preparing for and successfully passing the exam. For brevity, I shall omit many details (such as candidate requirements) that are easily found elsewhere.

Observations about the exam and testing facility:

Watch out for old nomenclature: several significant improvements were made in PMBOK-4 over PMBOK-3. Two processes, for instance, were deleted: Develop Preliminary Scope Statement and Plan Scope. To my surprise, I encountered two questions that involved the first deleted process. One question mentioned it in the body of the question. The other question provided it as one of the four possible answers to that question. Like many others, I was under the impression that PMI had completed the transition of nomenclature for several of the most important Earned Value (EV) measurement terms. The transition began in PMBOK-3. Since PMBOK-3 was the standard for five years, one would think that its successor, PMBOK-4, would complete the transition and refer to those important EV terms by their new names. I’m referring to these terms:

1. The new name of Planned Value (PV) instead of the old name of Budgeted Cost of Work Scheduled (BCWS).
2. The new name of Earned Value (EV) instead of Budgeted Cost of Work Performed (BCWP).
3. The new name of Actual Cost (AC) instead of Actual Cost of Work Performed (ACWP).

Well, to my surprise again, the old terms appeared in the exam. They had not been put to pasture yet!

The test uses an adaptive heuristic: I strongly suspect that the exam is adaptive. Expect the first 20 or so questions to probe your knowledge. If the testing algorithm detects incorrect answers in a certain area, expect more questions from that area to come your way. This is not my first certification exam. I took quite a few back in the 1990s. Back then, adaptive heuristics were already being applied. I had a study partner for this PMP. He took and passed it two weeks ago. He noted—with some annoyance—that he had to face a lot of questions about procurement and contracts. I did not. I’m fairly certain that the flood of procurement questions that he faced was not random at all. Rather, I suspect—as I told him—that he probably erred on several contract-related questions at the start of the exam. Those errors triggered the testing algorithm to dole out contract-related questions. The test designers did not adopt this heuristic in order to be mean. Rather, they want to ensure that the candidate will meet the minimum standard in all aspects of the knowledge being tested.

The testing facility: I took the exam at a Prometric center. You probably will as well. Do not bring a lot of things when you report to the facility. You will not be allowed to bring anything inside the testing room except your primary form of Identification (typically your Driver’s License). Pens, papers, mobile phones, watches, water bottles, and snacks cannot be brought inside. The testing facility I used had 20 seats (it was nearly full when I arrived). There were about 20 small lockers for personal belongings in the outside office. The Prometric staff will provide you with several sheets of scrap paper and two pencils. I asked for and received two sheets of tissue paper. They will require you to return everything including the tissue!

Perform a “brain dump.” As soon as you can, write down on the sheets of paper that were provided all of the formulas and tidbits that you memorized as part of the exam. While it is essential to understand the subject matter, some pieces need to be memorized. The latter is the purpose of the brain dump. The brain dump helps ensure that you don’t freeze over questions that require those memorized pieces during the exam simply because you could not retrieve these bits due to tension.

Do your best to calm down as soon as possible. Test center procedures were described in order to set your expectations. Take my study partner for example. To drink from his bottle of water, he had to sign out. To re-enter the testing room, he had to show his ID card and sign in. This protocol flustered my study partner. It hindered his ability to calm down and focus on the questions.

It will take several questions to get into the groove. All test questions follow a multiple-choice format. There are always four choices. The wording is tricky. Read the questions carefully. Read all of the answers even if you’re sure that you’ve already identified the answer. Ensure that you really comprehend the question. Assume nothing. Some questions are lengthy and end abruptly. Some end ambiguously and leave you perplexed. The four answer choices may give you a clue but it may take some time for your mind to pick up the theme of the question. When I was stumped, I selected my best guess and marked the question for later review. When I returned, most of the questions made sense. (Some of them never did though and all you can do is tell yourself that you tried.) My study partner said that most of his questions were situational. I think that only about 40% of mine were. Situational questions are challenging. The situation that is described may or may not be relevant to the real question. Either way, this type of question is more difficult because it will take up more time.

Today’s Prometric experience was better than the one I recall. First, the cubicle is larger and, thus, more comfortable. Second, the flat screen gives you more elbow space than the CRTs of old. Third, the typeface is easy on the eyes. I did dislike one thing. It was the red color of the scratch paper (which, by the way, consists of two large sheets that are folded in the middle, stapled, and, thus, is turned into a booklet). The pencil marks do not show up well against the red background.

At the end of the exam, you will receive an official test result. Ensure that it is embossed by the testing staff. Your proficiency level will be noted for each domain name. These domains are the five process groups of Initiating, Planning, Executing, Monitoring & Controlling, and Closing. The sixth domain is Professional & Social Responsibility.

The proficiency levels are rather vague but that may have been intentional. Your results are either Proficient, Moderately Proficient, or Below Proficient for each domain.

• “Proficient indicates that your performance is above the average level of knowledge in this domain.”
• “Moderately Proficient indicates that your performance is at the average level of knowledge in this domain.”
• “Below Proficient indicates that your performance is below the average level of knowledge in this domain.”

My experience: I was very pleased with my results. I attribute that to extensive preparation in addition to significant personal experience, of course. I knew it was going to end well because I was comfortably ahead of the schedule. I was 40 minutes ahead of schedule by the time I finished the last question. After taking a brief break, I spent the next 20 minutes reviewing the 17 questions that I had marked (for review) earlier. After the review I submitted it (still a good 15 minutes ahead of the four-hour mark). This experience took place two hours ago.

I hope this helped. Good luck!

WAR ON TALENT TO BEGIN IN HEALTHCARE IT

My fingers are crossed. Your chances improve in rural areas. There are nearly 6,000 hospitals in the U.S. A third of them are in metropolitan areas. The 4,000 that are not have jobs that are going begging.

According to an article today in Healthcare IT News:

The government’s piece of the stimulus package aimed at boosting the adoption and use of healthcare information technology is expected to create 50,000 new jobs—maybe more.

A panel of healthcare IT experts who spoke Thursday at the 6th annual Connected Health Symposium in Boston agreed that 50,000 seems right. “The need for IT is going to explode,” said Andrew Vaz, national director of life sciences for Deloitte Consulting. He said companies like Oracle, SAP, IBM and Cerner are trying to position themselves to “win the war on talent,” both in the United States and offshore.

Read the rest here.

WHO TOPPED A RECENT STUDY OF THE BEST HOSPITAL SYSTEMS?

Thomson Reuters, a respected authority in industry analysis, just named Advocate Health Care, one of Chicago’s largest hospital systems, the best according to its latest study in quality and efficiency.

Why is this important? “Compared with the poorest performers, the best-performing hospitals had 25 percent fewer deaths, 19 percent fewer medical complications and 13 percent fewer patient safety incidents even though their patients were sicker and their average hospital stays were significantly shorter.”

I knew a senior physician executive from Advocate’s Lutheran General hospital who unexpectedly passed away last November. He was a fellow church member who represented the best of Advocate’s philosophy.

From Healthcare IT News:

Healthcare information technology played a role in hospitals that scored in the top 10 in Thomson Reuters’ new list for quality and efficiency.

New York-based Thomson Reuters, which bills itself as the global leader in electronic information services, released the study Monday, identifying the top 10 U.S. health systems based on their on clinical performance.

They are:

1. Advocate Health Care, Oak Brook, Ill.
2. Catholic Healthcare Partners, Cincinnati
3. Health Alliance of Greater Cincinnati, Cincinnati
4. HealthEast Care System, Saint Paul, Minn.
5. Henry Ford Health System, Detroit
6. Kettering Health Network, Dayton, Ohio
7. OhioHealth, Columbus, Ohio
8. Prime Healthcare Services, Victorville, Calif.
9. Trinity Health, Novi, Mich.
10. University Hospitals Health System, Cleveland

Researchers from the Thomson Reuters 100 Top Hospitals program analyzed the quality and efficiency of 252 health systems and found statistically significant differences in several key areas.

Compared with the poorest performers, the best-performing hospitals had 25 percent fewer deaths, 19 percent fewer medical complications and 13 percent fewer patient safety incidents even though their patients were sicker and their average hospital stays were significantly shorter.

BID OR DON’T BID?
I am seeding this useful flowchart from the public domain. It illustrates the structured process for arriving at a logical bid or no bid decision.



Right-click on the image and select “Open link in New Tab” or “Open link in New Window.” Switch to the tab or window that you just opened. Right-click on the image and select “Save Image As.”

HOW THOUGHTLESS DECISION-MAKING & SLOPPY HOUSEKEEPING NEARLY HIJACKED A HOSPITAL’S JCAHO

In 2005, twenty servers running a critical application at the busiest hospital in Illinois were consolidated into one physical server. Instead of reaping the benefits of consolidation, disaster struck. (Its name will go unmentioned but you’ll find it out if you read on.)

Hospital management anticipated the usual benefits that virtualization brings:

1. Easier administration. Caring for one server is easier than caring for 20.
2. Greater confidence in the IT infrastructure. The storage that accompanies virtualization is likely to be more reliable than the distributed storage of standalone servers. This reliability is a product of newer technology and a more efficient design.
3. Peace of mind. Virtualized storage complements or fits well with its business continuity features. VMware’s VMotion, for instance, empowers the human administrator to migrate virtual machines to backup servers in real time.

Unfortunately these benefits did not happen. They lost data and, for a time, they risked, first, losing JCAHO accreditation and, second, punitive action from CMS.

(Click here to learn why JCAHO accreditation is important to a hospital.)

How did this happen?

After the virtual environment was created, the IT staff added standard security controls to each new virtual server. This was fine as this is standard procedure. However, some of those virtual servers lay dormant. In fact, it appears that nearly a dozen servers were created for “testing” purposes. These were not removed after they had served their purpose. (I actually think that most of them were created for the novelty of it. How do you account for servers named “Tyrone” or “Michael Jordan?”) During the months that these servers lay dormant, Microsoft and the application vendor had issued patches. When these dormant servers were reactivated, they were not updated with those patches. The servers thus turned into potholes or, worse, security vulnerabilities waiting to be compromised. It didn’t take long for that to happen. Consequently, the hospital lost data.

We were brought in to sort out the mess.

LESSONS LEARNED

What did we take away from this incident?

First, virtual servers must be managed individually and managed from their creation to their removal.

Second, management of these servers consists of staying abreast of patches, installing them as needed and meticulously documenting the patches that were installed. These steps have to be done for the virtual environment, the guest operating system and the application. These steps are crucial especially because of staff turnover.

Finally, management of the virtualized data center should be handled by capable hands. The integrator may have configured the virtual environment properly when it was created. However, we all know that things change over time. Someone has to take ownership of staying abreast of these changes. In the hospital’s situation, the virtual environment unraveled in steps. Visualize these: (1) a new appliance was installed, (2) a new server was created, (3) a new application was implemented, and (4) Microsoft issued more security patches. All of these events most likely took place. Consequently, failing to update the relevant pieces or updating the pieces incorrectly would have caused problems. Note that there are two hurdles: (1) identify the pieces that need to be updated and (2) do the updates correctly. At the end, we discovered two network links that were dead ends. We think these links had prevented two or more virtual servers from communicating.

While that was a technical AHA!, the bigger picture shows the consequences of a thoughtless decision. The hospital had stopped paying maintenance fees to the integrator. It attempted to maintain the environment on its own. This was unwise since the IT staff did not have trained personnel. The VLAN’s configuration developed potholes and compromised security. This is how a combination of thoughtless decision-making and sloppy housekeeping nearly hijacked a hospital’s JCAHO accreditation and risked punitive action from CMS. (This was a major reason. During that period, the hospital was cited for numerous violations.)

SMALL BUSINESS STORAGE GROWS!

Over breakfast with another ex-EMCer, I learned that the storage demands of small businesses continue to grow—recession or not. We worked for EMC from 2000 to 2001. EMC, like many large companies, hold periodic conventions for its employees.

At the annual EMC World Congress (or whatever it was called then) for its global sales force, I recalled then-CEO, Mr. Michael Ruettgers, proclaim how mankind’s thirst for more storage would fuel EMC’s growth for the decades to come. Shortly after that, the dot-com bubble burst, a recession started, and spending in IT slowed. Today, investment in storage is apparently back on track.

What, we asked ourselves, was fueling the demand by small business for more storage demands? We identified three trends responsible for this.

First, most e-mails aren’t deleted. And many e-mails contain attachments. Second, many files are being saved even after their original purpose is over. And third, files have become larger. For small businesses, more documents are being scanned and stored in image or PDF format. PDF files are nearly as large as image files. Think of how much more widely images are circulated on the Internet, for example. Image files are vastly larger than a Microsoft Word document, for example. Movies (think YouTube) are even larger.

SOLUTIONS

There are several ways to help small businesses cope with this demand. One technology solution would be the VMotion capability of VMware. This capability is specifically designed to facilitate infrastructure growth. One benefit: it transforms the smaller configuration into a high-availability infrastructure.

The first trend we identified was e-mail proliferation. The best solution to this problem requires a combination of teaching best practices and using technology to rein in the e-mail monster. Most people don’t know how to shrink the sizes of their image files. Cameras typically produce photos in the multi-megabyte range. Music files are similar. A minute of song is about 750kb. Shrinking files of any kind before attaching them will reduce e-mail storage requirements tremendously. That’s the best practice part. File deduplication technology identifies and removes file duplicates. That’s the technology part but before we leave this topic, let me ask you: if a person attaches a file and sends that email to his co-workers, how many copies of that file attachment are created?

Storage appliances are another solution. NASs and even SANs have their place too. The former, as you can see from this selection, is especially well suited for smaller IT infrastructures.

Another way that small businesses can cope is through the adoption of an old strategy called Hierarchical Storage Management. HSM works this way: files are stored and archived in different kinds of media depending upon the business’ policy such as the file’s importance, its frequency of access, or any other. For example, in an architectural firm, all files that relate to a project are stored together, separately from the rest of the company’s files. HSM uses tiered storage. Files that are used regularly are kept on primary storage. Files that are accessed less often are transferred to secondary storage. Primary storage allows instant access. Secondary takes longer; the storage media has to be located and then mounted before the file can be retrieved. The key word is “policy.” The business should state its policy towards each type of file. E-mail goes here, image files stay there, and so forth. SearchStorage.com has a concise but comprehensive definition of HSM.

SUMMARY

During these tight economic times, small businesses require more storage. We think that’s because of three trends: (1) uncontrolled e-mails, (2) unnecessary storage of obsolete files, and (3) larger file sizes. We also thought of these solutions: (1) VMware’s Vmotion, (2) best practices, (3) file deduplication, (4) storage appliances, and (5) hierarchical storage management.


Image courtesy of Dell Ireland

TAG CLOUDS & TEXT CLOUDS

A cloud is a visual depiction of the word content of a website. The most frequent words are depicted. Additionally, each word in the cloud is emphasized according to its frequency. Numerous variations exist but this is the basic idea.

(You can enlarge any image by clicking on it. To return to this page, click on the back-arrow of your browser or press the Backspace key on your keyboard.)

In case you’re curious, here’s a succinct article about clouds. Click here.

ABOUT A DOCTOR’S PRIDE & RIDING A HORSE

I commented on an online BusinessWeek article entitled “Doctors’ Pride: A Hurdle to Digital Medicine.”

The article’s point was that healthcare organizations should not ignore emotions, specifically the professional pride of a key stakeholder, the physician, in its computerization drive.

The change from paper- and film-based records to digital-based ones is wrenching for most parties involved—the healthcare organization, the physicians and other caregivers, the financial intermediaries (insurance companies), and the government. The best seat in the house probably belongs to the patient who, for the most part, just needs to cooperate and be patient.

The change, in short, is revolutionary. A sea-change like this requires the change managers to factor in the emotional reactions of all stakeholders.

The article recounts the learning experience of one of America’s largest hospital networks. The network, a healthcare organization, forced 4,500 doctors who do business with its hospitals to install—at the doctor’s expense—a specific IT system in their respective offices. This would enable every doctor to communicate with the hospital network and, through the network, with other caregivers. There are several good reasons for this. To name just one, it would improve the coordination between physicians especially between physicians of different specialties.

Technology has sped up the pace of life. Technology brings about change—change in workflows and processes—and, as noted in one of my blog entries (click here), persuading people to change their habits is not an easy task. Even rational reasons will fail. Note how difficult it is for people who live an unhealthy lifestyle to change. Sedentary people typically find it difficult to make working out at the gym a habit. Overweight people typically find it difficult to control their eating.

A Doctor’s Pride

At any rate, the article’s subtitle says it all. “A forerunner in New England found that some physicians would sooner cut ties than see their elite status threatened.” The first comment to this article was written by a doctor.

dan1138
Apr 24, 2009 8:37 PM GMT

As a doctor I find this to be a truly ignorant article. We work in teams all of the time. If doctors are reluctant to give up final authority, it’s because we have ultimate responsibility as well- spelled LAWSUIT. In the case cited, how would like to have a $25,000 system shoved down your throat, even if it negates all the work you’ve done with another system or forces you to change your- day-to-day practice ? I’d tell ’em to get lost, too.

I submitted the following comment in response.

Alex Pronove
Apr 25, 2009 11:18 PM GMT

It appears that the second comment, made by dan1138, justifies the title of this article. The dismissive tone suggests that he wrote it with emotions rather than cognitive reasoning in his mind. A major point of the article is teamwork, as in the example of a diabetic in the penultimate paragraph. Teamwork should improve the outcome and, consequently, reduce the likelihood or severity of dan1138’s concern (spelled LAWSUIT). His attitude seems to reflect hurt pride indeed.

ITIL

ITIL stands for the Information Technology Infrastructure Library. ITIL is a compilation of what businesses call “best practices.” I reviewed ITIL in another blog entry (click here). In it, I remarked at how it pleasantly surprised me. One surprise: don’t be misled by its roots in Information Technology. ITIL’s best practices are applicable to many situations in different fields.

Change Management

One vital piece of ITIL’s framework is change management. That’s correct—change management. Today, change—whether it’s in our work or personal space—comes so frequently and, sometimes, so strongly that a discipline emerged simply to understand and manage it. Change management is the field focused on controlling the risk and minimizing the adverse impact of change. The goal of change management is to facilitate the target’s adoption of the change. Adopt and adapt, you might say.

This is an appropriate definition of change management:

Change management is a systematic approach to dealing with change, both from the perspective of an organization and on the individual level. Change management has at least three different aspects: adapting to change, controlling change, and effecting change. A proactive approach to dealing with change is at the core of all three aspects. For an organization, change management means defining and implementing procedures and/or technologies to deal with changes in the business environment and to profit from changing opportunities.

Successful adaptation to change is as crucial within an organization as it is in the natural world. Just like plants and animals, organizations and the individuals in them inevitably encounter changing conditions that they are powerless to control. The more effectively you deal with change, the more likely you are to thrive. Adaptation might involve establishing a structured methodology for responding to changes in the business environment (such as a fluctuation in the economy, or a threat from a competitor) or establishing coping mechanisms for responding to changes in the workplace (such as new policies, or technologies).

Terry Paulson, the author of Paulson on Change, quotes an uncle’s advice: “It’s easiest to ride a horse in the direction it is going.” In other words, don’t struggle against change; learn to use it to your advantage.

Ride that Horse!

If the healthcare sector is a horse, then the American Recovery and Reinvestment Act of 2009 (Recovery Act) that was signed into law by President Obama two months ago gave it a big kick. According to the Department of Education:

“The act is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century. The act is an extraordinary response to a crisis unlike any since the Great Depression, and includes measures to modernize our nation’s infrastructure, enhance energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief, and protect those in greatest need.”

Returning to the original article, “Doctors’ Pride: A Hurdle to Digital Medicine,” I appreciated it more for reporting on the lesson that was learned from the change experience than anything else. As the author’s concluding paragraph notes:

No studies have yet been published to determine whether Partners (the hospital network) has saved any money since going digital. Nor has the network determined whether care has improved. But it now has the data to carry out those studies, and it plans to do so soon.

Now I call that horse riding—in the right direction!

TRACKING THE PERFORMANCE OF INDIVIDUAL CALL CENTERS

The Business Processing Association of the Philippines (BPAP) is the umbrella organization for the fastest-growing industry in the Philippines: offshoring and outsourcing (O&O). According to its website, in OFFSHORING & OUTSOURCING PHILIPPINES: ROADMAP 2010:

BPAP believes it is possible for the Philippines to increase its share of the global market from 5 percent in 2006 to 10 percent in 2010. This will mean the Philippine industry will earn revenues of about USD13 billion and directly employ close to one million people by the end of 2010.

Call centers account for the majority of O&O firms. How can the performance of individual call centers be objectively tracked? And why does it matter?

Well, a recent article in The New York Times reported the emergence of a new class of software that can do just that. “It can monitor workers who, conveniently, do most of their work on computers. It can also measure their efforts and direct work to those who do it best.”

To quote:

LiveOps, a rapidly growing company in Santa Clara, Calif., that operates virtual call centers — agents working from home across the country — has also found that software can perform other management tasks. How it uses that software points to the direction in which technology is taking the workplace.

Founded in 2000, LiveOps fields some 20,000 “home agents,” all independent contractors who take orders for products advertised on late-night TV, sell insurance or transcribe recordings for other companies. The agents even take pizza orders. If there is a storm in a particular city and pizza orders surge because no one is going out, calls to the pizza store are routed to LiveOps agents thousands of miles away. (The delivery boy still has to brave the rain and the wind. Software hasn’t solved that problem.)

The software moves a company beyond simple cost-cutting. Mr. Webb says greater efficiencies can be found because the company’s software measures the results from each agent according to criteria determined by the client.

If a client wants agents to persuade callers to buy additional products, the software tracks that — and then directs calls to the agents who do it best. Those agents prosper.

What about the agents who aren’t so good? “No one gets fired,” Mr. Webb said. “They just don’t get work.”

Software becomes a passive-aggressive manager.

He thinks the concept can be expanded to any line of work — like health care, retailing, publishing and law — where the output can be measured.

The BPAP would do well to note this development. It could be used to determine best of breed, foster competition, and, by doing so, raise the bar. The industry, as a whole, becomes more competitive. It takes a step towards maturity. The results can then be used in BPAP’s marketing. This technique should be part of the strategy to sustain the competitiveness of the outsourcing and offshoring industry.

MEDICAL SCHOOL FOR FREE?
That’s the article's title: How to Go to Medical School for Free

This is quite an opportunity. Previously, I had explored the salary range of different medical specialties in two entries: HOW MUCH DO PHYSICIANS EARN? and the recession-resistance index (!) of a profession in healthcare in A HEALTHCARE-RELATED CAREER OR NOT? THINKING DEFENSIVELY....

To me, this article indicates the seriousness of the problem with the healthcare system in America. Healthcare currently accounts for 16 to 17 percent of the Gross Domestic Product (GDP) of the United States. It is the single largest component of the economy.

A related article by the same author discussed how medical school has become less expensive for some.

One of the better deals, in my opinion, is serving in the US military if you can.

At any rate, I can see demand and supply meeting each other within the next 15 to 20 years. Until then, demand far exceeds supply which means that healthcare professions have an above-average rating in terms of compensation and security.

The flip side of the equation is work and study. Since demand exceeds supply, be prepared to study and work a lot and continuously. Medical school is not a walk in the park either. As this other article indicates, medical students are more depressed than the general population. Doctor, heal thy self!

CITY HOSPITAL No. 17
The paradox of US healthcare & photos of a community hospital in post-Soviet Ukraine

There’s a paradox that illustrates why the healthcare system in the US needs to be reformed.

You may or may not know that the US spends more for healthcare than any other country in the world. That's significant. But it can be like visualizing a trillion; how large is that number?

How do we make that fact meaningful?

Well can we agree that a relationship exists between the amount spent on healthcare and life expectancy? In other words, can we expect that spending more for health and medical care will prolong the average life expectancy? If we agree, then we should expect that, up to a certain limit, more money spent on healthcare should prolong life expectancy.

Let’s see if the facts support that hypothesis. Compare the following countries. The data came from the World Health Organization (WHO). This is the agency of the United Nations whose mission is to “provide leadership on global health matters, shape the health research agenda, set norms and standards, articulate evidence-based policy options, provide technical support to countries and monitor and assess health trends.” I used the latest figures (2001 and 2002) available on their website [1].

United States
Per-capita expenditure = $4,887
Life expectancy, Male = 75 years old
Life expectancy, Female = 80 years old

Switzerland
Per-capita expenditure = $3,322
Life expectancy, Male = 78 years old
Life expectancy, Female = 83 years old

Cuba
Per-capita expenditure = $229
Life expectancy = 75 years old
Life expectancy, Female = 79 years old

Ukraine
Per-capita expenditure = $176
Life expectancy = 62 years old
Life expectancy, Female = 73 years old


Let’s take a moment to review these numbers.

The US spent nearly $4,900 per person in 2001 for healthcare. Switzerland, the next big-spender, spent $3,300. Yet the average life expectancy of an American man (75) is less than his Swiss counterpart. The same holds true for American women (80) and her Swiss counterpart (83). It appears that the additional $1,600 did not prolong American lives.

Incidentally, that per-capita figure, $4,900 (per individual in 2001) represents the total expenditure on healthcare by both the government and private sector (i.e., companies and individuals).

Let’s take Cuba now. Cuba was chosen for comparison and contrast. For comparison, note that its men live as long as American men. Its women live only one year less than American women. And for contrast, note how little was spent by Cubans for healthcare? Only $229! That’s $4,700 less than Americans spent and the life expectancy for both countries is very similar!

Now let’s move to Ukraine.

Ukraine spent only $176 per head and that’s less than Cuba. Its men have a life expectancy of only 62 years and its women, 73 years. Ahhh… Now we see a correlation. Less money spent shortens life expectancy.

The facts above support the notion that extra expenditure on healthcare does not extend life expectancy. So why is the US spending so much and what can be done to reform the system?

The solution is complicated and I’d like to cover that in another blog entry but for now, let me show you a typical Ukrainian community hospital.

These photos show the facade of City Hospital No. 17 in Dnipropetrovsk.

Dnipro (“Dnepro” in Russian) is the third largest city in the Ukraine. It has a number of interesting secrets. For example, the first artificial satellite, Sputnik, was developed in this city [2]. In fact, the manufacturing facility that actually developed it, Yuzhmash, became the heart of the Soviet space and missile programs [3].

Yuzhmash owns an Olympic-standard swimming pool complex beside it. Before you’re allowed to swim in it, you have to get a medical note that declares that you don’t have any skin-related diseases [4]. And you can get one at Hospital No. 17.

REFERENCES:

[1] Per capita total expenditure on health at international dollar rate & Life expectancy at birth. Retrieved January 24, 2009 from the WHO website at http://www.who.int/whr/2004/annex/country/.

[2] Sputnik, the world’s first artificial satellite. Retrieved January 21, 2009 from the NASA website at http://history.nasa.gov/sputnik/.

[3] The product line (!) of the State Enterprise called “Production Association Southern Machine-Building Plant named after A. M. Makarov.” Retrieved from the Yuzhmash website at http://www.yuzhmash.com/index_en.htm. Also Wikipedia’s entry notes that:
The company has been the key missile producer for Soviet ICBM and space exploration programs. Yuzhmash launch systems included:
• the R-5M - the Soviet Union's first nuclear armed missile
• the R-12 Dvina theatre ballistic missile
• the R-14 Chusovaya theatre ballistic missile
• the R-16 - the first Soviet ICBM
• the R-36 ICBM (converted to Dnepr rocket)

[4] The medical note is called a "spravka." Refer to this entry from a Christian medical missionary's blog.

A HEALTHCARE-RELATED CAREER OR NOT? THINKING DEFENSIVELY...

The current economic and financial crisis made me think about careers. If I were a high school or college student should I consider a healthcare-related career? And if not, what other industries look promising?

Four reasons come to mind:

First, a career in healthcare is recession-resistant. For at least the next 15 to 20 years, as baby boomers age, the demand for physicians, nurses, and all the other allied healthcare professions will be strong.

Second, this is a rewarding career if you enjoy the feeling of satisfaction when you help someone.

Third, all healthcare professions pay well. Physicians are typically at the top of the pyramid. They earn the most money but they also work the hardest and they have to commit to a lifetime of learning. As with most things, your compensation is proportionate to your skills and ambition.

Fourth, healthcare offers many choices.

WHAT RECESSION-RESISTANT MEANS & WHY IT'S IMPORTANT

The following chart, created by a prestigious consulting firm, shows how different industries have performed during recessions. Any industry connected with those activities that show an increase in spending is more resistant to recession than average.

(You can enlarge the image by clicking on it. To return to this page, click on the left arrow of your browser or press the “Backspace” button on your keyboard.)

These are the five activities that show a spending increase during tough times:

1. Education
2. Reading
3. Personal Insurance
4. Healthcare
5. Food at home (as opposed to dining out)

A recession-resistant job is important because it provides you with that extra margin of security during tough times.



MORE INFORMATION

Office of Science Education (OSE)

The OSE is a section of the National Institute of Health. This links you to an excellent base for exploring various science-based careers.

The webpage offers a well-designed career finder tool. It sifts through 128 possibilities and creates a list of jobs for you to explore based on your interests and skills. This is a comprehensive tool that isn’t limited to healthcare professions.

1. Architecture & Engineering
2. Arts, Design, Entertainment, Sports, & Media
3. Business & Financial Operations
4. Community & Social Services
5. Computer & Mathematical
6. Education, Training, & Library
7. Healthcare Practitioners & Technical
8. Healthcare Support
9. Installation, Maintenance, & Repair
10. Legal
11. Life, Physical, & Social Science
12. Management
13. Office & Administrative Support
14. Personal Care & Service
15. Production
16. Sales & Related
17. Transportation & Material Moving

Health Professions Network

This is a group of health care professionals who represent the diverse specialties of allied health professions, including provider organizations, educators, accreditors, credentialing agencies and administrators. Jump directly to this specific page: Students Interested in Health Care Careers.

Their website contains a comprehensive list of links to healthcare-related organizations at this page.

National Association of Advisors for the Health Professions

The is an organization of over 900 health professions advisors at colleges and universities throughout the United States. Their website also contains a comprehensive list of links to healthcare-related organizations at this page.

Health Opportunities for Today and Tomorrow (MHOTT)

This site is aimed at high school students. Although the site was created and is maintained by the Michigan Health Council, its information is useful for any high school student.

The last site, Health Occupations Students of America (HOSA), belongs to a national student organization endorsed by the U.S. Department of Education. (That means financial aid!) HOSA's goals are to promote career opportunities in healthcare and, in doing so, enhance the delivery of quality healthcare to all people.

Since the site is endorsed by the U.S. Department of Education, it also links to other websites focused on other industries. This will link you to Career Voyages, a site for these industries:

1. Advanced Manufacturing
2. Aerospace
3. Automotive
4. Business
5. Construction
6. Education
7. Energy
8. Financial Services
9. Health Care
10. Homeland Security
11. Hospitality
12. Information Technology
13. Retail
14. Transportation

This site has a section for people changing careers. Quoting from this page:

In today’s world, there are never any guarantees, but some careful planning may help ensure that you make choices that can give you more security for your future.

If you have already been in the workforce for some time, you probably already know that it is always changing. You know how important it is to know what’s around the bend. Career Voyages is here to try and help you do that.

Those industries above were chosen since they are expected to either need the most employees or are evolving and creating new jobs.

In short, these industries were selected for three reasons:

1. they are projected to add substantial numbers of new jobs to the economy or affect the growth of other industries;
2. they are existing or emerging businesses being transformed by technology and innovation requiring new skills from workers;
3. they are economically vital to the overall health of the American economy.

Go ahead and explore.

Invest in your future by spending some time planning for it. Makes sense, right?

Good luck!

MAJOR SECURITY FLAW JUST DISCOVERED IN INTERNET EXPLORER (IE)

Users are urged to switch immediately! The problem was discovered about 36 hours ago. The flaw allows thieves to steal your password. I work with information technology and my password has been stolen before. It’s a huge hassle to say the least since I had to estimate the severity of the damage after several of my passwords were stolen. May I recommend a free application that has done a great job of protecting me since then? The application (or program) is called “Spybot.” There’s a link to it at the end of this posting.

This post was updated on Dec. 17.

The security flaw allows hackers to steal passwords. Some 10,000 websites have code that can exploit the flaw.

Here are links to several stories:

Microsoft: Microsoft Security Advisory (961051)

Microsoft is continuing its investigation of public reports of attacks against a new vulnerability in (the web browser) Internet Explorer. Blah, blah, blah... (It continues in very sterile language. The other links state the severity and urgency of the problem in plain language.)

BBC News: Serious security flaw found in IE

Users of Microsoft’s Internet Explorer are being urged by experts to switch to a rival until a serious security flaw has been fixed.

The flaw in Microsoft’s Internet Explorer could allow criminals to take control of people’s computers and steal their passwords, internet experts say.

Microsoft urged people to be vigilant while it investigated and prepared an emergency patch to resolve it.

Computerworld: Microsoft preps emergency IE patch for Wednesday release

December 16, 2008 (Computerworld) Microsoft Corp. announced today that it will issue an emergency patch tomorrow to quash a critical Internet Explorer bug that attackers have been exploiting for more than a week.

The advance warning came less than a week after Microsoft acknowledged that exploit code had gone public and was being used by hackers to hijack Windows PCs running IE.

Microsoft will deliver the out-of-cycle patch Wednesday at 1 p.m. Eastern time via its normal update mechanisms, including Windows Update, Microsoft Update and Windows Server Update Services.

The update will be pegged “critical,” the most serious ranking in Microsoft's four-step scoring system.

Even as it declared that it would release an emergency fix, Microsoft continued to downplay the threat. “At this time, we are aware only of attacks that attempt to use this vulnerability against Windows Internet Explorer 7,” said company spokesman Christopher Budd in an e-mail today.

Initially, Microsoft and other security companies believed that only IE7 was vulnerable to attack, but on review, the company confirmed that all versions of its browser, including IE5.01, IE6 and IE8 Beta 2, contain the bug.

Last weekend, Microsoft researchers said that they had seen a “huge increase” in attacks, and that some were originating from legitimate Web sites. Another researcher added that about 6,000 infected sites were serving up exploits that target the IE vulnerability.

Also today, Microsoft confirmed that attacks could be launched through Outlook Express, a free e-mail client bundled with Windows XP. Because Outlook Express renders HTML-based messages using IE’s engine, attackers could exploit the bug by getting users to open or view malicious messages.

New York Times: Microsoft Issuing Emergency Fix for Browser Flaw

REDMOND, Wash. (AP) -- Microsoft Corp. is taking the unusual step of issuing an emergency fix for a security hole in its Internet Explorer software that has exposed millions of users to having their computers taken over by hackers.

The “zero-day” vulnerability, which came to light last week, allows criminals to take over victims’ machines simply by steering them to infected Web sites; users don’t have to download anything for their computers to get infected, which makes the flaw in Internet Explorer’s programming code so dangerous. Internet Explorer is the world’s most widely used Web browser.

Microsoft said it plans to ship a security update, rated “critical,” for the browser on Wednesday. People with the Windows Update feature activated on their computers will get the patch automatically.

Thousands of Web sites already have been compromised by criminals looking to exploit the flaw. The bad guys have loaded malicious code onto those sites that automatically infect visitors’ machines if they’re using Internet Explorer and haven’t employed a complicated series of workarounds that Microsoft has suggested.

Microsoft said it has seen attacks targeting the flaw only in Internet Explorer 7, the most widely used version, but has cautioned that all other current editions of the browser are vulnerable.

Microsoft rarely issues security fixes for its software outside of its regular monthly updates. The company last did it in October, and a year and half before that.

Cnet: Critical IE 7 exploit making the rounds

Microsoft issued a critical security warning Tuesday that a malicious exploit is making the rounds and attacking vulnerabilities in Internet Explorer 7.

The risk is believed to be widespread, given that IE 7 is the latest version of Microsoft’s browser and is bundled with XP service pack 3 and also Vista, said Dave Marcus, director of security research and communications for McAfee's Avert Labs.

The AZN Trojan, which has been making the rounds since the first week of December, has the potential of infecting users’ system with a Trojan horse, or “downloaders” that can download other forms of malware onto a user’s system.

Microsoft announced it will release a security patch Wednesday via its automatic update system to patch users computers.

Users can potentially get infected two ways, Marcus said. One is to visit a malicious Web site that already has the malware installed on the site, or visit a legitimate site, in which the attacker has inserted the malicious script to run in the background, leaving visitors unaware their systems have been compromised.

“A lot of Web sites are pushing out this exploit,” Marcus noted. Some of the infected sites include Web sites that offer free wallpaper for mobile phones to sites that feature property to product-related sites.

Microsoft is encouraging users to update their systems once the patch is released Wednesday at 10 a.m. PDT.

A SUGGESTION

If you still use IE, stop using it until you learn that it’s safe once again. On the other hand, why not just switch to another web browser? It wouldn’t be a bad idea to make any of these other browsers your primary browser and use IE only as your secondary browser.

These browsers are listed in order of popularity. All of them are safer, relatively speaking, than Internet Explorer. Another bonus: all of them work faster than IE.

1. Firefox
2. Opera
3. Google Chrome
4. Apple Safari

Earlier, I mentioned my bad experience with stolen passwords. I looked around for an anti-spyware program and found Spybot. I recommend Spybot. I find it so useful that I donate to it. The application is free and it serves me well.