Today I am celebrating a day of no meetings by working on several things on my to do list, including some blogging. And ironically I read this blog post with the image below from Seth Godin, one of my favorite marketers.

In the interests of being transparent, I would like to state that I think my blog post, Creativity, should have been broken up into a few paragraphs for easier readability.  I realized that after I posted it that I had puked one big paragraph of words into that post and didn't consider that the reader might not be able to quickly scan that post and is being asked to read it more carefully or not at all.  I am trying to be better about my paragraph length to promote content scanning.

I was at the annual meeting for my homeowners' association last night and I begin to think about open communication and transparency.

There a lot of complaints and questions about what's been going on with the leadership of the community.  There is only one meeting a year, the monthly board meetings have been either closed to the public or unadvertised.  The main source of communication has been phone or email from a web site that many homeowners didn't know about.

There have been issues with the former property manager and people in the community didn't know about that or the resignations from the board.  Consequently, many felt disenfranchised, and were distrustful of the board members and how the dues have been spent.

Watching all of this I realized that if communication had been kept in the open and homeowners informed of changes in the board and property management, their distrust would have been minimized.  And giving people a chance to speak during the previous year would have lessened the complaints in the meeting.  I believe that most people respond to open honest communication.  Explanations of community issues before this meeting would have lowered the level of hostility in the room.

How does this apply to health care?

Imagine if health care providers were open and honest all the time about what a patient is experiencing.  

You arrive on time for your doctor appointment but wait forty-five minutes to see the doctor.  Why did that happen?  The doctor may have had a complicated patient case come in and needed to spend more time with someone.  Or other patients’ lateness has caused the doctor to be running behind.  I read an article somewhere I can’t remember that stated that the main reason patients need to wait for their doctor is that other patients before have been late.  I don’t think most people know that.

Would knowing one of those situations help you be less frustrated with your doctor when you have to wait?

There are many other examples that can be imagined.  Ones that apply to hospital visits or even organization decisions.  The tools and technology for open communication are different depending on the situation.  In a hospital, talking to the patients individually would be more effective then later blogging about the event; for an organization blogging about a decision or event is more effective than individually talking to everyone interested.

I believe that open, honest communication in health care would reduce complaints and malpractice suits and allow the health care industry to spend more time treating patients.

Besides just creative and non-creative people, I think there are two types of creative people:  Those who think of lots of ideas and those who think of ideas that they can execute.  I believe that I am one of the latter.  I have at times thought that I am not a creative person, but I recently realized that I have thought of creative ideas, bringing together concepts, etc. and my ideas are ones that we can create or that we have created.  I build off of work that we have already done or have a vision that I work towards.  Just because I don't have lots of ideas (including some that can't be done), doesn't mean I'm not creative.  One of the benefits of the person who has lots of ideas is that they can inspire ideas in others.  I filter the ideas that I have and don't spend time working out ideas that can't be actualized.

Reading this article on NPR, Internet Health Records: Convenience at a Cost?,  prompted me to think more about Personal Health Records (PHRs) and Electronic Medical Records (EMRs).  In re-reading my previous post The Ideal Personal Health Record, I'm not sure that it was clear about my thoughts.

The other day in a meeting I described the relationship between the EMR and PHR this way:

Think of the PHR and the EMR as two separate entities sitting side by side.

The patient’s PHR can look at the patient’s EMR but is not allowed to change it.  The patient can add items from their EMR to their PHR.  Then they are able to modify that item only in their PHR to add additional details, etc.

The physician’s EMR about a patient can look at the patient’s PHR but can’t change it.  The physician can pull pieces of the patient’s PHR into the EMR as they feel it is appropriate because they are ultimately responsible for the accuracy of the EMR.  The physician is able to modify a patient’s EMR.

The two systems exist separately but are able to communicate with each other.

This system will only be able to work if the PHR is linked to a health care provider’s EMR.  The larger PHR systems like HealthVault and Google Health may be used to transmit data between PHRs so if a patient moves they can take their data with them.

I just finished reading John Maeda's "The Laws of Simplicity", and I was struck by an application of one of his laws this morning. I was loading my iPod with some music and I wanted to add my Time-Life "Living the Blues" series to listen to today. I usually load just my favorites from the ~25 CD series but today I wanted to also add the ones that were not ranked five stars. I wanted to listen to some variety and I realized that my favorites weren’t so favorite unless they are contrasted with songs that aren’t my favorites, just like Maeda’s fifth law, DIFFERENCES Simplicity and complexity need each other. Maybe this is the purpose of radio and something that we have lost in the iPod/iTunes/web 2.0-get-what-you-want-when-you-want-it era that we are in?

I had the pleasure of listening to a lecture/conference call with Seth Godin yesterday talking about his book "Meatball Sundae."  I began to wonder how the health care industry fits into his model.  At first glance it seems like health care provides a meatball service, but there are unique aspects to it that work well as the whip cream, cherry and other toppings.  Health care and health care technology doesn’t seem to fit into his model.

The e-Business team has seen a lot of new media/new marketing trends that work really well in health care.  Patient blogs are one example that we have built.  Our SharingSite application allows patients to blog about their condition and treatment in or out of the hospital.  We are also using it to post our baby/nursery pictures.  This eliminates the phone calls to family and repeatedly telling relatives the same information by a patient or family member who is already stressed and busy.

Our discussion boards that we have really not promoted are gaining more and more usage because people want to talk about their health condition, ask questions and compare their experience to other patients.  This is a common patient behavior that used to (and still does to some extent) happen in person, but now you can go online and talk to many more people.

Patients also want to find out more about their health conditions so they are using online health information libraries along with just reading blogs, discussions boards, etc to find out as much as they can about their health issues.

I believe that health care is different, that it doesn't fit the Meatball Sundae model.  Maybe it has to do with all the regulations, etc. on our industry, or that we aren’t selling a product that users generally have a choice about purchasing or not.  But they do have a choice about where to purchase it.

I met with a vendor earlier this week and one of the services they are selling was Business Process Management (BPM).  I realized that the e-Business team has been doing this for several years now, before it was the new thing.  We have been building applications that are designed with the process in mind.  We build applications that improve process and workflow.  Our applications work within the process workflow already created.

On the other hand, IT in many organizations builds or buys an application and fits the process to it, or tries to.  One reason for project failure with applications and vendor product purchases is that they don't match the process previously developed in the organization.  The project fails because there is an attempt that doesn't succeed to change the process or the process isn't understood.

In our requirements gathering we review the current process and sometimes make suggestions to improve the process.  But then take the process requirements and build an application that meets the requirements and matches the predefined process.  I think that is a major factor in our success in this organization and outside it.

I believe this is especially true in the health care field.  The medical staff is very busy and there checks in place that need to be met to insure quality health care.  Processes have been created and in place for some time and it can be difficult to change them.  Health care technology systems generally don’t work together well and there are difficulties with interoperability.  Forcing a system into this environment without considering the work flows and processes already in place will ultimately fail.  Failure can mean a lack of usage of the system, a break down in work flow or issues with patient care.

In the latest issue of Wired (Alright, I'm still catching up on my reading.), there is a mention about an online article about Gary Gygax written before he passed away.  I was doing some reminiscing about the time I played Dungeons & Dragons (I actually played and preferred Advanced D & D.  I quit playing around the time that the 2nd edition came out, a long time ago.) and I realized that all that role playing in my teen years has helped or shaped my skills for my current position.  Yes, that’s right, playing D & D is like programming.

The rules can be compared to a programming language that a Dungeon Master creates a scenario with.  Just like a programmer writes an application from a set of rules or a programming language.  Other players play the scenario the Dungeon Master created with their characters or roles.  Users interact with an application attempting to perform a task and in usability terms have a role or a set of defining characteristics about their experience, etc.

My playing of AD & D in my teens has prepared me to be a productive member of society with a paying job (after a detour of several years).  Who would have thought?

If you liked this post, stay tuned for next time when I explain how an action film has the same structure as a musical!

(I had the chance to meet Gary Gygax when I went to a GenCon conference in Wisconsin.  My friend and I decided not to stand in line to meet him because we didn’t have anything to say to him other than I like your game, etc.  The same stuff that everyone else says to him.  And being "cool" teenagers we didn’t want to act like everyone else and look stupid.)

(I think I still have my dice I used to play AD & D with somewhere in my house.)

(Once you read the Wired article about Gygax, you'll realize that a 20-sided die is revolutionary. I first learned about probability and bell curves from this game.)

I just read an extremely interesting article in last month's Wired magazine, "Free! Why $0.00 Is the Future of Business."  (Yes, I am behind on my reading.) I started to think about how I could apply it to my work and projects.  We offer a free consumer health library and a free medication library for anyone to use.  I would be against any attempt to charge a subscription fee to get to those services.  When I was in graduate school I remember discussing the subscription model on the Internet as a business model that doesn't work.  I've seen that most organizations (especially newspapers) have tried this model and have moved to free online access to archives.

We offer these applications (and many others as part of the free myCommunity membership) as a service to our patients and hope that users who are not currently patients will consider these services when selecting a health care provider.  But these services are available to people outside of the Indianapolis area who may never be able to use our hospitals.  They are still allowed and encouraged to use our site. 

In addition some applications like health information are becoming the standard for health care providers like ATMs are now a standard for banks to offer.  By paying attention to these services the health care organization can increase their reputation and trustworthiness, and secure a patient's attention.  Just like Chris Anderson writes:

"The word is externalities, a concept that holds that money is not the only scarcity in the world. Chief among the others are your time and respect, two factors that we've always known about but have only recently been able to measure properly. The "attention economy" and "reputation economy" are too fuzzy to merit an academic department, but there's something real at the heart of both."

We provide free services but also use free services.  We use Google Analytics as another source for web statistics, we use Feedburner to help manage our RSS feeds and we use Google Maps in our Find a Doctor application.  There is tons of free services available we could use but have chosen not to because they can be overwhelming to manage and get value from.

It makes me wonder what else we could offer for free that would return value through other avenues.

I love reading Wired for articles like this.  I read about The Long Tail some time before it became popular in this magazine.  Who knows, maybe this will be the next big idea?

As my desktop wallpaper on my laptop I have an image and a quote from this book, "The Laws of Simplicity" by John Maeda, that says "The simplest way to achieve simplicity is through thoughtful reduction."  Another Senior Web Developer co-worker has a poster with a quote from Leonardo Da Vinci which says "Simplicity is the ultimate sophistication."

Yesterday, I was going over some changes we are going to make to our Find a Doctor application.  We rebuilt it last year and relaunched it last summer with new features including a Google-like single search box, a compare physicians feature (like ebay and Lowes) and a much better underlying data structure.  We added complexity compared to the old application.  To accommodate some issues with adding the comparison feature and a javascript functionality to add physicians to the comparison list, we implemented a javascript that would cause the browser back button to not work.  Which is a major usability issue. 

This back button disabling also caused issues when a use clicked on a physician’s web site and then was unable to return to eCommunity.com and vice versa.  Also, the user was required to click the New Search link to start a new search and it was somehow possible to hit the back button to the search box page and enter a new search.  The results didn’t change because the old search parameters were stored in the session and the user didn’t click on the new search button.  More usability issues caused by the complexity.

The challenge was to leave in the complexity of the physician comparison functionality but remove the back button disabling and keep the search results state while the user was comparing doctors.  Thoughtful reduction.  We decided to change the application so that the physicians in the comparison list are stored in the session state and will remain in the list between searches.  The user will need to remove them from the list; they are not cleared out when a user clicks on the New Search button and performs another search.

The back button disabling was removed and the storing of the search parameters in the session was changed to be stored in viewstate.  We are removing the javascript that adds the physicians to the comparison list and are using a postback to accomplish this.  And adding more visibility to removing the physicians from the comparison list.  The user can use the back button freely and it fixes all the issues listed above.  We reduced the complexity of application by removing unnecessary accommodations made to add the new features and changing the application requirements so that it is easier and simpler to use and meets the user’s expectations of web usage.

I think good web application design consists of making complex functionality simple for the user.  I think it is telling that both of the Senior Web Developers at Community Health Network are inspired by quotes about simplicity.

Lately I’ve been hearing a lot about Personal Health Records (PHRs).  There’s been recent interest in PHRs and many big names getting into the PHR game:  Microsoft with HealthVault, Google, Revolution Health.

Like I’ve posted before think of PHRs like a bank. To be truly valuable a PHR needs to use the Electronic Medical Record (EMR) as a reference.  Can the big names do this?

The ideal PHR is editable by the patient.  The patient would be able to add new items or items from their EMR that they can reference.  They are able to share or not share items in the records that they feel is appropriate.  The items in the patient’s PHR are linked to a content library so that they patient can look up more information about their conditions or find drug interactions that may have been missed.  If a patient changes health networks or hospital organizations that record is able to be copied to another organization’s PHR.

I believe patients will use the one attached to their health network and then if they move the record needs to be portable to another organization.  Maybe this is the role of the big names?

I think my blog has been banned from Technorati.  It was in there and now it's not.  I tried to resubmit the url and it's still not in there.  I suspect it might be the way this blogging application works to create many categories with the same post in multiple categories that appear to be other blogs?  Anyone else have any ideas?

I didn't post any this week after posting at least twice a week for a month.  I'm not sure what happened.  I think my week was exceptionally busy and I really didn't have anything to say.  This experience is in stark contrast to my post about writing and blogging.  I’m not sure that anyone is reading this so I feel a lot like the crazy man yelling in the wilderness. I submitted my blog to Technorati and it was there for a little bit and now it's gone from the search.  I'm not sure what happened to remove this blog from Technorati's listings.

I was reading the latest issue of Entertainment Weekly and there was an article called "Oscars: Your Burning Questions Answered!"  One of the questions was what the word chuffed meant.  Colin Farrell said it introducing another star.  I was surprised that this question was in there because I knew the meaning of the word and have heard it frequently.

Then I realized that I knew what it meant because I am an anglophile and watch a lot of British television.  Also, it occurred to me that I have had a similar experience in talking with my family doctors who sometimes seem to be speaking a different language.  The trick is to share complex medical concepts and terminology in a way the a layperson can understand.  I have found myself doing this with technology terms.  A layperson can understand information technology concepts if they are explained in a non-technical manner.

I hope that our consumer health library explains complex medical concepts in a layperson's terms.  I believe that it does but since I work in health care, I know that I'm not the typical user.

The past few days I have submitted my blog to Yahoo, Google and Technorati.  I haven't appeared in Yahoo or Google yet, but I just submitted to the Google Blog Search today.  It should be indexed soon I think.

I was extremely impressed with Technorati.  When I submitted by blog it was instantly indexed (or so it seemed) and ranked.  My authority ranking instantly went up to 8.  I have an ranking of 8!  I liked that Technorati immediately visited my blog and indexed it.  My expectation was that it would be indexed in a week or two, the expectation set by Yahoo and Google.

Forget Google.  Howard Waldrop is the original mash-up artist.  And has been for thirty years.

Waldrop is considered a science fiction writer.  He frequently writes alternate history stories including one in which Eisenhower and Elvis had each other's careers ("Ike at the Mike") and another one where the last dodo is tracked down only to discover that it was eaten by a family in the south ("The Ugly Chickens").  He brings together characters and events in an usual fashion.  "God's Hooks" is about John Walton meeting John Bunyan and fishing for the Leviathan from Bunyan's writing (obscure English Lit reference alert!).  He wrote a story about The Marx Brothers and Laurel and Hardy ("Save a Place in the Lifeboat for Me") and one with Mickey Mouse, Goofy and Donald Duck robots ("Heirs of the Perisphere").

One of my favorites is "Night of the Cooters" which stars a character who is an homage to Slim Pickens who battles the martians from "The War of the Worlds."

Oh and the title of this entry comes from "Thirty Minutes Over Broadway."

Bet you can't wait to see my post on Philip K. Dick and the metaphysics of HTML code.

I can't find where I read it but I remember reading a discussion, I think it was in Wired Magazine, about how the presidential candidates were using the Web and Web 2.0 technologies.  I remember a chart of the candidates and what they were using.  And one of them, Edwards I think, said something like blogs, wikis, rss, Twitter..too..much...Web 2.0 (I always imagine this with the voice of the best Captain Kirk impression).

I like Web 2.0 technologies and they can be useful in health care if applied intelligently to problems, but they can be abused.  Just like Flash was abused in the 90's, a site can have an overload of these applications and overwhelm the user.  We try to use them where appropriate to solve business problems.  One of the best examples is the Google Maps mash-up we incorporated into our find a doctor application.  It displays a map of the office locations in a physician profile.

I love Tivo!  My old satellite receiver that came with Tivo recently died and we got one from the company that had its own DVR software.  It can't compare to Tivo so my wife and I bought another Tivo box also.  With the new version of Tivo, you can connect to your wireless network if you buy a special USB wireless card for it.  Not only do you not need a phone line to update the guide, you can download your programs to a computer.  I have wanted to do this since we first got a DVR.  I love old movies and I can burn copies of them to watch later and not constantly keep them on the DVR like I was doing before much to my wife's consternation.  She was a secret deleter of my recordings.

Tivo is the epitome of one of the new trends happening now.  I'm not the first or the hundredth person to discuss this trend of the user/consumer being in control of the mass media messages.  They can skip commercials and watch their shows whenever they like.  There is no primetime anymore; it's all the time.  IPod and other mp3 players are replacing radio which has become bland, boring and repetitious.  The more this trend happens, the more companies operating under the old paradigm try to reach out and make the old methods work again.  They try to force old marketing ideas on a new marketing arena just like dinosaurs trying to feed themselves after the meteor hit.  Eventually new marketing methods will prevail.

It's probably obvious to a lot of bloggers but cut me a little slack:  The more you blog the easier it is to keep blogging.  It's just like the older adage for writers that the more you write the easier it is.  And to be a writer all you need to do it write!  All you need to do to be a blogger is to blog!

In my salad days, I wanted to be a fiction writer.  I did some writing but I realized that while I wanted to be a writer, I didn't have enough passion for it.  I didn't write enough.  I didn't stay up late working on a story.  I did finish a few stories but never tried very hard to get them published.

I think I'm on the downhill side for this blog.  It's become easier to add entries.  I also think I was trying to write my entries too long so it would take me longer to complete one.  Now I dash off something short and post it.  And I can add to the discussion later.