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A Hearty Bunch

August 3, 2009
by aguerra
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The open-source vanguard embodies traits the industry sorely needs

“I feel really strongly about it, Mark. And you know I don't push stories on you very often,” I said to HCI Contributing Editor Mark Hagland in our edit meeting a last month.

Hagland, a veteran healthcare IT editor with more than 20 years in the industry, is the kind of reporter who always comes up with great ideas, and the edit meeting cited above was no exception. At the meeting, he had suggested doing a story on CPOE, and where the industry stands with regard to that critical measure of digitization.

But I had been bitten by a different bug, and I needed to have the topic examined, so I asked Hagland to postpone his look at CPOE (you'll see it in the next issue) and dig his teeth into the status of open source technologies.

My interest was piqued by a talk with Steve Art, CIO of Lutheran Medical Center in Brooklyn, N.Y., (http://www.healthcare-informatics.com/steve_art) that left me so impressed I not only implored Hagland to investigate the possibilities of open source, but spent significant time ruminating about the interview.

In time, I realized why this interview stood out among the dozens of others - Art is one of the most determined and tenacious people I have ever talked to. He struck me as the kind of person who, once set on a course, would regard any obstacle as something which simply would be overcome, a minor nuisance that needed brushing away. The idea that anything could actually stop him, in his mind and mine, was impossible.

Why is this so stunning? Why is such determination so striking? I can only assume it is because we live in a world where it has become scarce, a world where someone explaining why something didn't happen is far more commonplace than someone explaining how it did.

This impression really jelled when I read Hagland's final copy, and saw him describe open-source CIOs as a “hearty bunch.” Healthcare, it seems to me, has ample room for the free VA open-source software which cost billions in taxpayer dollars to develop. But beyond that, healthcare today is crying out for hearty types, regardless of whether they use open source or Epic, Meditech or McKesson, Siemens or Cerner. Today, healthcare needs CIOs who will, by certified hook or crook, make sure their organizations qualify for HITECH funds. If CCHIT (or whoever) certifies the use of duct tape, hearty CIOs will figure out how it can help achieve meaningful use.

These are meaningful, historical and transformational times in healthcare, or as Malcolm Gladwell writes in “Outliers,” times of tremendous opportunity for those who have put in their 10,000 hours of practice. One hundred years from now, the HITECH provision in ARRA will be seen as the catalyst for an e-health revolution. Imagine - you are sitting in a captain's chair just as your engineer achieves warp speed capabilities. Most people wait all their lives for such a moment.

But that moment isn't welcomed by everyone. The non-hearty CIO who has been getting by on charm and superior C-suite maneuvering, perhaps even enchanting the board with fancy presentations, is in trouble. HITECH means push has come to shove, and those PowerPoints won't be able to explain why your organization didn't qualify for the funds - either CMS cuts the check, or it doesn't.

All in all, you and I are absolutely blessed to be a part of this industry at this time. But just being here doesn't guarantee success. We have to up our game by bringing you better information and a constant stream of valuable, high-quality content, both in print and online. And you had better get hearty. In the past, such an attribute may have been nice, but today, it's stakes to play.



I am having a hard time remembering the last CIO I've met who wasn't hearty. I looked up the Anyonym for help: introverted. halfhearted. frail. light.

I agree with your point that it's a necessary trait though, especially given the changes you elaborated.

Thanks for the comment Joe.

You know the type, you hopefully have one or two working for you. They are the people on your staff that you can hand a task with limited instructions, and you know they will complete it. It's not that those people don't encounter obstacles on the way, but they do not see those obstacles as the end of the assignment. They know the completion of the task is the measure of success, thus they press on.

Some people long to find a significant obstacle in their path, as, in their mind, this takes them off the hook.

That's another great point, Anthony.

That's exactly why clarity on two separate things is critical. One, clarity on goal, and two, clarity on "next step." When I see that the agreed upon next step is not happening at all, and they haven't renegotiated the "next step" deliverable, that's a management issue. That means that it's the duty of the superior to help the subordinate through it or out of their role or the company. The sort that you're describing. That person is probably both overwhelmed and having trouble focusing.

I think the fortitude or heartiness that you're describing is related but different. Heartiness is the single-pointed intention to deliver on the goal. The defined or obvious "next step" is subject to creativity, adaptation, or collaborative construction, instead of the retreat and escape described in the previous paragraph.

In any event, you are right. Heartiness is independently necessary to get past the inevitable obstacles.

thanks Joe. If it's possible to determine who is hearty and who is not during the interview process, we could create one heck of an organization. I think Tim Tolan's blogs have touched on this.