Hospital and Health Provider Web 2.0 Trends and Opportunities

We recently looked into ways that companies can leverage web 2.0 and monetize social networks.

We got a lot of questions regarding the applicability of these principles and methods to different industries and specifically for hospitals and other health providers. As organizations with a strong social purpose and educational / outreach focus, how can they remake themselves and their services to provide innovative and effective web-based information and health?

We envision the Hospital as the center of regional health, building a community of patients, caregivers and healthcare professionals that work online and offline providing care, support and prevention.

It is an overall shift in strategy that transforms the organization to be more Open, Collaborative, Transparent, Interactive, and Social.  Organizations that have successfully executed Web 2.0 initiatives:  share data and information securely and seamlessly with their health care partners, provide platforms for patients, doctors, and hospitals to collaborate on improving the effectiveness of services and communications, foster community patient support networks, and empower patients to gain access to the best health care services and providers.

There have been some interesting efforts but most providers are just in the initial experimentation mode. Ed Bennett maintains a great list on his blog of all the hospitals and their social activities. According to his findings, Twitter has just become the most popular social media channel among hospitals

Paul Levy, Beth Israel Deaconess CEO has been a trail blazer in his blog, sharing thoughts, ideals, goals, results and experiences, promoting true transparency. The hospital has recently launched the first web 2.0 oriented site with a special section dedicated to interactive features such as blogs, videos, podcasts chat etc.

St. Jude Children Research Hospital has close to 35,000 fans in their facebook group and have extensive social media program on their site. Cedars Sinai in LA is using YouTube for staff recruitment purposes.

These are great examples for a few health providers that seem to have a cohesive strategy for this new interactive age. For most hospitals, just being on facebook or Twitter without setting measurable goals and defining a strategy will not yield the anticipated results.

The following diagram shows the different areas where hospitals can consider collaboration and use of social media and interactivity:

 

Some of the interesting opportunities we are seeing for hospitals:

• Use of social media and communities to create an active health community around their health facilities that will involve patients, physicians and hospitals
• Enhance educational activities to include online courses and support groups
• Use blogs and actual access to quality and performance data to promote transparency and trust with the community
• Use advanced web analytics to capture interests and trends and improve content and services accordingly
• Build a stronger relationship with Affiliated Health Professionals and allow them to collaborate and exchange knowledge
• Reduce the customer support functions by moving self service functions to the web

Doublin’ Down in Hard Times

Hard times are definitely here.  By this time everybody in IT-land has done the obvious: frozen maintenance where possible, put off hardware and software upgrades, outsourced where possible, trimmed heads (contractors, consultants, staff), pushed BI/CPM/EPM analytics projects forward, and tuned up data and web resources.

Now is the time to think outside the bunker!

IT needs to consider what will need to be done to nurture the green shoots poking through the nuclear fallout. All of the talking heads and pundits see them ( glowing with radiation or whatever) and  the utmost must be done to make sure they survive and grow or we shall all sink into the abyss!

This is the time to double down in IT (poker speak).  It is not about heavily hyped Cloud Computing or the latest must-have tech gadget, but about something much more mundane and boring: improving the business process.  There, I’ve said it, what could possibly be more boring?  It doesn’t even plug-in.  In fact (shudder!), it may be partially manual.

Business process is what gets the job done (feeding our paychecks!).  Recessions are historically the perfect time to revise and streamline (supercharge ‘em!)  existing business processes because it allows the company to accelerate ahead of the pack coming out of the recession.  In addition, recession acts as something of a time-out for everybody (I only got beatings, no time-outs for me), like the yellow flag during a NASCAR race.  When the yellow flag is out, time to hit the pits for gas and tires.  Double down when it is slow to go faster when things speed up again, obviously the only thing to do.

How? is usually the question.  The best first step is to have existing business processes documented and reviewed.  Neither the staff involved driving the process at the moment nor the business analysts (internal or consultants) are that busy at the moment.  That means any economic or dollar cost of doubling will be minimized under the economic yellow flag.  The second step is to look for best practice, then glance ouside-the-box to maximize improvement.  The third step is to look for supporting technology to supercharge the newly streamlined business process (I knew I could get some IT in there to justify my miserable existance!).

Small and medium businesses get the biggest bang for the buck (just picture trying to gas and change the tires on the Exxon Valdez at Daytona) with this strategy.  This process allows SMBs to leapfrog the best practice and technology research the Global 2000 have done and cut to the chase without the pioneer’s cost (damn those arrows in the backside hurt!).  Plus implementation is cheaper during recession ( I love to be on the buy-side).  The hardware, software, and integration guys have to keep busy so they cut prices to the bone.

The way forward is clear, IT only needs to lead the way, following is kind of boring anyway.

If you’re thinking of acquiring a software startup

IT due diligence on a software startup may seem unnecessary if the core product offering represents a significant new advancement.  It really can’t be overlooked, however, as there are many technology risks lurking within the product and within the company itself.

As far as the core technology offering(s), it’s important to conduct code reviews, architecture reviews, security audits, application performance assessments (especially in light of the projected growth in the business plan) and an assessment of the company’s software development lifecycle methodology.

There are other hidden risks, some of them far removed from the core product offering, that may impact your future acquisition’s ability to achieve its goals.  Many of them stem from the need to be both chief cook and bottle washer during the very earliest days of the company’s existence. Here are the top three:

1. Inappropriate software development practices: My favorite example here is a startup I was advising during its search for first round investors. They could not resist the urge to keep “improving” the code, so they never segmented or froze their brainchild into discrete releases. The night before I had scheduled a potential investor for a demo, they thought of four new “must-have” features to add, and were actually debugging during a demo that failed to execute.
2. Tendency to re-invent the wheel: Software entrepreneurs are often skeptical of packaged enterprise software to the extent that they will build their own backoffice, CRM, or other applications. The risk this imposes to potential investors is twofold: you are retaining dedicated staff to support those applications, and any migration off of these applications may be difficult because they are often built “on the side” without sufficient documentation.
3. Project management immaturity:  It’s unusual for a startup to hire real project managers very early on in their lifecycle. While PM discipline could certainly help them during the concept phase, it’s absolutely necessary as they are attempting their first deployments to clients.  Weaknesses in this area are easy to spot as you conduct due diligence interviews with their customers.

So even if the product has no competition in the market place, and you’re convinced it can sustain competitive advantage, please make sure you have qualified resources do some deep probing to help you understand where the hidden problems may lie.

Change: Opportunity or Agony

“Embracing change” is a common mantra. However, experiencing change is a certain reality. With it comes a series of choices for everyone involved. Perhaps, the game of Jenga(tm) demonstrates these choices. As you may know, Jenga consists of wooden blocks shaped like tiny beams. The game starts with the beams stacked tightly, three per layer, alternating them vertically and horizontally. The object is to manually dislodge any block from the tower and place it on a new layer at the very top; expanding the tower upwards until it topples from lack of support below or is blown by a strong gust of wind.

Like Jenga, a business also grows using its assets, strengths and opportunities to build customers and market share.

To continue comparing Jenga to running an enterprise, perhaps you could use two different perspectives. The player of the game is like the executives of the organization, moving around structural blocks to expand the organization. This executive has a 360 degree view of the tower with the ability to stress test the blocks before dedicating them for the move; and can scope the environment for threats to the construction such as a shaky playing table or strong winds.

The contrasting view is that of the employees impacted by the move within an organization; perhaps visualized as tiny ants clinging to the moved block. These individuals have an intimate knowledge of this specific block. They know each dent, scratch and slight change in color. They know how snugly it fits against the neighboring blocks (the nitty-gritties necessary to accomplish a job) and how it informally interacts with others. But this internal perspective lacks the comprehensive view. From within the safety of the tightly-built fortress, workers may not sense the unstable foundation or feel the gusts.

As a block is selected those associated with it can be hurled into significant change. One’s first reaction at the vibration may be to grab on as hard as possible to the comfort of the block. Despite the desperation, it takes very little time to see that the forces are overpowering and a significant change is imminent. At this point, there are really two broad choices: resist or cooperate.

The consequences of the first choice, resistance, can lead to demise. To explain this, let’s consider the two forms of resistance – denial and defiance.

Denying the seriousness of the changing forces will severely cripple the industry. Current examples of underestimating the impact of an impending change are seen with traditional media. After reluctance, newspapers, magazines, local broadcast television and radio eventually adopted the Internet. Through applying their respective traditional medium’s paradigm to the Internet forum, they used it as the broadcasting and publishing vehicle. Newspapers, for example, started by replicating their publication online and updating the sites daily after street publication. Internet users expecting more immediate news discontinued their subscriptions to the physical newspapers and started viewing news on new Internet news sites that refreshed content frequently.

The other form of resistance, defiance, could cause alienation with peers who tire of negative attitudes. Excessive defiant behavior could lead to dismissal from those who perceive it as obstructive.

In contrast, the option of cooperation, could lead to quite different outcomes. If the change is from competitive or industrial pressure, adapting to the changes’ new opportunities could put you in the driver’s seat. Those Internet sites that enabled the viewer to customize content offer an example of seizing the opportunity to lead the industry. In Jenga, a beam moved to the top is exposed to uncomfortable drafts, unfamiliar elements and added visibility. The gusts and vulnerability could be threatening. Also, the fall is farther if knocked off. However, the experiences gained are the essence of leadership.

Another recent example is the trend to stop travel expense. Geographically dispersed employees, trainers and consultants can overcome this obstacle by mastering the various technologies to be productive remotely. As organizations adopt these methods, the paradigms of phone etiquette, correspondence and meeting presentations will morph into new standards. Those of us who have adapted will benefit professionally.

Other gloomy headlines tout that many companies have fallen, or as in Jenga, the towers have toppled. Those who have fallen into the heap are left with the challenge to adapt to a new reality. After some brushing off, skills can be applied to participate in a new tower. Existing knowledge and tools will be augmented by wisdom for the next cycle of industrial changes.

As professionals, we need to recognize that external forces will cause us to make some hard decisions. To react with leadership, we should seek opportunities in the changes, communicate the realities and urge others to accept them.

Cloud Computing Trends: Thinking Ahead (Part 1)

The aim of this three part series is to gain insight into the capabilities of cloud computing, some of the major vendors involved, and assessment of their offerings.  This series will help you assess whether cloud computing makes sense for your organization today and how it can help or hurt you. The first part focuses on defining cloud computing and its various flavors, the second part focuses on offerings from some of the major players, and the third part talks about how it can be used today and possible future directions.

Today cloud computing and its sub-categories do not have precise definitions. Different groups and companies define them in different and overlapping ways. While it is hard to find a single useful definition of the term “cloud computing” it is somewhat easier to dissect some of its better known sub-categories such as:

• SaaS (software as a service)
• PaaS (platform as a service)
• IaaS (infrastructure as a service)
• HaaS (hardware as a service)

Among these categories SaaS is the most well known, since it has been around for a while, and enjoys a well established reputation as a solid way of providing enterprise quality business software and services. Well known examples include: SalesForce.com, Google Apps, SAP, etc. HaaS is the older term used to describe IaaS and is typically considered synonymous with IaaS.  Compared to SaaS, PaaS and IaaS are relatively new, less understood, and less used today. In this series we will mostly focus on PaaS on IaaS as the up and coming forms of cloud computing for the enterprise.

The aim of IaaS is to abstract away the hardware (network, servers, etc.) and allow applications to run virtual instances of servers without ever touching a piece of hardware. PaaS takes the abstraction further eliminates the need to worry about the operating system and other foundational software. If the aim of virtualization is to make a single large computer appear as multiple small dedicated computers, one of the aims of PaaS is to make multiple computers appear as one and make it simple to scale from a single server to many. PaaS aims to abstract away the complexity of the platform and allow your application to automatically scale as the load grows without worrying about adding more servers, disks, or bandwidth. PaaS presents significant benefits for companies that are poised for aggressive organic growth or growth by acquisition.

Cloud Computing: Abstraction Layers

So which category/abstraction level (IaaS, Paas, SaaS) of the cloud is right for you? The answer to this question depends on many factors such as: what kind of applications your organization runs on (proprietary vs. commodity), the development stage of these applications (legacy vs. newly developed), time and cost of deployment (immediate/low, long/high), scalability requirements (low vs. high), and vendor lock-in (low vs. high). PaaS is highly suited for applications that inherently have seasonal or highly variable demand and thus require high degree of scalability.  However, PaaS may require a major rewrite or redesign of the application to fit the vendor’s framework and as a result it may cost more and cause vendor lock-in. IaaS is great if your application’s scalability needs are predictable and can be fully satisfied with a single instance. SaaS has been a tried and true way of getting access to software and services that follow industry standards. If you are looking for a good CRM, HR management, or leads management system, etc. your best bet is to go with a SaaS vendor. The relative strengths and weaknesses of these categories are summarized in the following table.

	App Type Prop. vs. Commodity	Scalability	Vendor Lock-in	Development Stage	Time & Cost (of deployment)
IaaS	Proprietary	Low	Low	Late/Legacy	Low
PaaS	Proprietary	High	High	Early	High
SaaS	Commodity	High	High	NA	Low

Cloud Computing: Category Comparison

Practical Project Management

In times like this every PMP needs a healthy dose of a new and improved PMP, that is, project management practicality. As the recession lingers, those of us who drive the success of projects, programs, and any corporate initiative are going to have to find new ways of doing more with less.  Here are seven practical tips for cutting corners without sacrificing project success.

1. Curtail time-consuming interviews for requirements-gathering. There are several easy ways to cut the effort required to gather information from subject matter experts:

• Group them by functional area (when appropriate) and avoid interviewing single stakeholders.
  
• Use structured information gathering templates and require that they take a pass through them and begin filling in the required information before the meeting. The keyword here is structured. I prefer Excel templates with restricted ranges of responses, rigidly enforced with data validation limiting those responses to list.  STructure the information you need into columns, apply data validation, and put explanatory notes as a cell comment in the column headers.

2. Make your meetings more productive.

• Know your goals. Have an agenda and be ruthless about sticking to it.
• Limit the attendees to those people with decision-making authority
  and real subject matter expertise. Bigger meetings cost more and waste more time.
• Appoint a live note-taker. The note-taker should type the notes live during the meeting and send them out before the end of the day. Transcribing from written notes is wasted effort.

3. Restructure your project team. Combine roles and responsibilities, because fewer roles mean fewer handoffs. It’s better to have a smaller team running above 100% utilization than a larger team at or under 100% utilization.

4. Carefully define the scope of your analysis/requirements gathering effort. Don’t waste time documenting standard business processes in excessive detail; concentrate on the areas that have unique and/or critical requirements.

5. Hold the line on customizations. They add cost to the current project, and will complicate upgrade and migration projects down the road.

6. Request a mini-business case for custom reports. Every custom report should have a place in the spec that describes the business action that the report enables, as well as a list of alternative sources for the requested information if the custom report is not available. This will help the project sponsor make an informed decision when approving the custom report request.

7. Make project status more transparent. To reiterate an earlier post on PMOs: A well-defined, user-friendly, and well-maintained project portal site can cut down on the need for lengthy status meetings. Milestone status, next week’s key tasks, and open action items can be posted to the portal site. A weekly meeting can be used for exception-based reporting on lagging milestones and critical issues, allowing the project sponsor and key stakeholders to participate in resolution during the meeting.

Budgeting from the trenches

Have you ever noticed how text books understate the budgeting process? They tend to gloss over the topic as four steps:

1. Determine revenues
2. Forecast expenses
3. Adjust
4. Communicate

Some text books suggest that that the process has iterations. This general outline of the process rings true, but its oversimplification makes the budgeting process sections meaningless when it comes time to map one out. I have found that undertaking the budgeting challenge is different between organizations. The process design is similar to perhaps how Generals draw up battle plans. The available personnel, supplies and equipment are assessed and the desired outcome is clear. However, the details of the approach are dependent on the specific terrain and rely on the latest tools and information. For this reason, organizations tend to see its budgeting strategy as unique.

Strategy is a fair term to use in budgeting as its outcome has a great deal at stake. Every staff member submitting input for calculations or making a request for funds has credibility on the line. Without complete information the profitability of a product, service, region or division is at jeopardy. And, day-to-day performance of the organization can be besieged from the pressure and time consumption when gathering intelligence from the field.

There is a point where this analogy between a battle plan and a budgeting process falls apart: That is, a battle will end and budgeting does not. A budget plan will play itself over and over. This exposes a point of vulnerability in the budgeting process as it was designed for a set of conditions that most likely has changed. It may no longer be sufficient to budget annually. Reporting requirements may change. Consolidations in the industry confuse the financial results. Or, new competitors, products, clients, regions and staff render the plan obsolete. When there is such a difference between the framework and reality, the budgeting framework cannot be trusted for strategic forecasting.

In the wake of the global financial crisis as organizations seek to maximize cash reserves, evaluate expenses and eliminate risk; the budget process surfaces as a key strategy. Those giving strategic input and making decisions have unprecedented pressures to assure accuracy and agility in cost cutting. Those who need to find opportunities for revenue are at a loss for validating an option’s viability. An organization is likely to forgo an opportunity without the ability to articulate its profitability, avoiding the risk of catastrophe.

Today’s battlefield is dynamic and most participants are deep in the trenches. We know that this gloomy economy will end and we intend to abandon the trench to take new ground. Our challenge is timing and selecting the method to move forward. While we are trenched, let’s review the budgeting tools and design a system giving us the agility to adapt to the changing markets, locate opportunities and operate effectively.

Enterprise e-Commerce on a Shoe String Budget?

Image courtesy of Flickr

While inexpensively built and operated mom and pop e-commerce websites are as common as snow in New England in January, is it possible to build and operate an enterprise grade e-commerce site on a shoe string budget? E-commerce at an enterprise level is not simply slapping a shopping cart to your website and calling it e-commerce enabled. The demands of an enterprise solution may require:

• Integration with legacy systems
• Integration with supply-chain systems
• Support for multiple currencies and tax codes
• Multiple store-fronts
• Profile and history driven offer management
• Integration with a content management system
• Business user control over promotions and pricing
• …and more

Challenges of integration with existing systems alone are daunting enough never mind the fancy e-commerce functionality that is often considered vital for competitive differentiation. No wonder why starting an e-commerce venture or an upgrade is considered a seven figure expense. The cost of an enterprise grade e-commerce product alone can easily account for twenty to forty percent of the budget. The other option is to go with a hosted or SaaS based approach and avoid capital expense for software and infrastructure – not a bad approach for testing the waters but in the long run, charges and fees can really add up.

A well executed e-commerce site can provide great returns on the investment by generating new revenue streams, enhancing existing ones, or reducing operational expenses – and that can’t be too bad for the budget or your career. However, in tough economic times the challenge becomes harder as getting approval for large complex projects becomes difficult and even the approved budgets can get slashed. If your budget gets cut, is there a way to still implement enterprise grade e-commerce? Can an open source e-commerce solution be the answer to the “do more with less” mantra? Is open source e-commerce ready to play with the big boys in the enterprise domain? Let’s explore these questions and the capabilities of the open source e-commerce solutions.

Let’s start with a common misconception that an open source e-commerce product requires significant customizations and the cost of customizations more than offsets any savings from not having to pay license fees. Implicit in this assumption is the notion that a commercial product requires little or no customizations. However, the real-world experience shows us that this is not the case. Even the best commercial products cannot be used out-of-the-box unless you decide to adopt their look and feel and their model of e-commerce. The cost of customizations can add up just as rapidly in a commercial product as they can in an open source one. Therefore a prudent approach would be to adhere to the industry standards and best practices and use out-of-the-box functionality in areas which are not competitive differentiators. Heavy customizations should be limited to the aspects of the website that are true differentiators and result in a unique user experience. This guiding principle applies regardless of the decision to use an open source or a commercial product.

There are a lot of inexpensive and open source e-commerce products out there; however, most of them are nothing more than a simple shopping cart. They are only suitable for the most basic needs of a simple web site. However, Apache OFBiz and Magento are two promising contenders that break from the pack and compete in the enterprise space. In this article we will primarily focus on OFBiz.

Apache OFBiz is actually an integrated suite of products that does not only include e-commerce capabilities but also provides support for accounting, order management, warehouse management, content management and more. An enterprise e-commerce implementation cannot exist as a point solution. It has to integrate and work well with other back office processes and applications. OFBiz’s integrated suite can be used to automate and integrate most back office functions. Even if you decide not to use the built-in functionality it can still be integrated with other existing systems albeit with more effort and cost. It provides enough e-commerce functionality out of the box to match most enterprise needs and the rest can be customized if needed. Here is a summary of our assessment of OFBiz:

Technical Capabilities

#	Criteria	Rating	Comments
1.	E-commerce capabilities	B+	Provides Robust e-commerce capabilities OFBiz e-commerce capabilities include: catalog management, promotion & pricing management, order management, customer management, warehouse management, fulfillment, accounting, content management, and more.
2.	Sign-on and Security	B	Granular and robust security framework The OFBiz security framework provides fine grain control of the security including multiple security roles and privileges. Roles can be used to control access to screens, business methods, web requests (URLs), and/or entire applications.
3.	Technical flexibility & ease of use	B	Very flexible but complex  OFBiz is an application development platform that can be used to build applications and as such provides a tremendous amount of flexibility.  The use of the entire framework (which includes the database, an Object Relational Mapping (ORM) layer, business object layer, scripting support, and UI tools) is optional.
4.	Integration with other apps and locations	A	Multiple integration methods  OFBiz business services can be exposed as services and accessed by multiple methods including Remote Method Invocation (RMI) and XML Web Services.  Integration directly with the OFBiz Relational Database is also possible.
5.	Scalability	A	Highly Scalable  Java systems are highly scalable provided a production architecture that is designed to support heavy load.  A load balancing device and redundancy at the web, application and database servers can redundancy and scalability.
6.	Relational database integration	A	Support for all major database platforms  The most popular OFBiz database platforms are PostgreSQL and MySQL (both of which are open source).  OFBiz has also been tested with Oracle, DB2, Sybase, and MS SQL Server.  The default installation uses an Apache Derby database which is not recommended for production use. Our research indicates some problems with MS SQL Server database – this should be investigated further prior to selecting that database platform.
7.	Skill Set to support	NA	OFBiz framework and application are based in the following technology components: XML Web Development: HTML, CSS, AJAX/JavaScript, Apache Java Development: Java, JSP, Freemarker, BeanShell, Tomcat application server (possibly) Database Development and Administration: MS SQL Server (possibly), SQL, JDBC Long term support of the application would require knowledge and familiarity in each of these technology sets.  While these technologies are mainstream and skills should be readily available in the future, skills and experience with the OFBiz framework that is built upon these technologies may not be.

Business Position

#	Criteria	Rating	Comments
1.	Financial stability	B	OFBiz is a “top level” project in the Apache Software Foundation.  The Apache Software Foundation provides support for the Apache community of open-source software projects. The Apache projects are characterized by a collaborative, consensus based development process, an open and pragmatic software license, and a desire to create high quality software that leads the way in its field.
2.	Maturity of product suite	B	Open For Business (OFBiz) was initially launched in 2001.  In early 2006, the project went through the Apache Foundation’s “Incubation” process to review projects for quality and open source commitment.  OFBiz was promoted to a top level Apache project in December 2006.The community for OFBiz is very active.  The major web posting board receives between 20-40 postings per day relating to OFBiz.  The original contributors are very active in monitoring these sites and sharing knowledge.
3.	Reference Accounts	B-	Total number of installations is unknown due to the nature of open source software. The OFBiz websites lists more than 70 companies that use their software. However, there are very few marquee names.

Implementing an enterprise e-commerce solution can be expensive and complex process that requires analysis and investment in people, processes, and technology. While it would be insincere to say that an enterprise e-commerce solution can be implemented on a budget in the ballpark of a mom and pop e-commerce store, the budget can be significantly reduced by:

• Carefully crafting business requirements
• Adapting the business model to match industry’s best practices
• Reducing and carefully planning data migration and application integration
• Keeping the customizations to a minimum
• And using an open source e-commerce platform

OFBiz provides a viable open source e-commerce stack that can be used to implement enterprise grade e-commerce. When combined with good implementation practices and solid execution the combination can result in slashing costs by twenty to forty percent — which sometimes can make the difference between getting funded or getting shelved.