The Healthcare IT Guy

Sounds like progress has been made on at least one of the myriad number of standards catalog efforts out there: an ANSI Panel Recommends Initial Standards to Support Nationwide Health Information Network. Here’s what the announcement said:

Initial work has focused on the areas of biosurveillance, consumer empowerment, and electronic healthcare records – the three initial use cases identified by the American Health Information Community (AHIC). The ninety standards delivered today were identified by the Panel as being relevant and suitable for further consideration. The next HITSP deliverable, due in late September 2006, calls for detailed interoperability specifications to support each use case.

A reader recently introduced me to this stpBA Storyboarding tool and I must say I’m impressed by the simplicity, low learning curve, and automated generation of important artifacts like requirements documentation, traceability, test scripts, and GUI screen flows. Using the stpBA tool mere mortals and teams without dozens of business analysts can actually do the right thing and improve their specifications phases without creating days worth of useless documentation activity. It’s definitely worth checking out.

I took down lots of notes about my next two days in India but didn’t have a chance to blog due to time and some connectivity issues. So, it’s a week late but I’m sure it’ll be worth reading. Days 3 and 4 were spent doing “deep dives” into architecture, design approaches, and potential implementation approaches. Having worked with offshore firms for many years, it’s clear that they think a bit differently but how does that translate into practical and deliverable work? That’s what I wanted to find out.

One side note I’d like to make is that these guys are deadly serious about software engineering practices and processes. SEI CMM Level 5 is not just a marketing slide for them, it’s the way they work because they think it’s the right thing to do. The Japanese took many of our Western ideas about manufacturing process and implemented those better and faster than we did and jumped ahead of us in that industry back in the 80’s. Don’t be surprised to wake up in the 2010’s and 2020’s to see that the Indians do that with IT Services & computer software/hardware R&D. Processes don’t help you invent or innovate but they sure do help deliver. And, from what I’ve seen first-hand, the Indians are definitely delivering (profitably!).

Ok, back to architecture and design approaches. I went going in with the idea that the Indian firms should be able to code. After all, that’s the easy part. The question I had was — can they invent, innovate, architect, and design as well as us? So most of my questions revolved around how they would approach problems not solve problems. Do they focus on the right things like business requirements, design principles, and architectural attributes? Do they spend more time on figuring out how to ensure reliability, performance, and maintainability than on initial development? Given that they are so process oriented, what kinds of questions do they ask the beginning of a project that aren’t on a checklist somewhere?

After two days of grilling these guys showed that they’re just like us: some architects know what they’re doing and can really think out of the box, many designers have the right ideas that overall principles are more important than specific checklist items, and that coders can work in agile as well as rigorous project models. I must say that was impressed. There were very few questions that they didn’t answer directly and they actually said “i don’t know” instead of trying to make things up when they didn’t legitimately know. Where they lacked knowledge I’m sure they could’ve found a couple of guys in other areas of their firm that did know the answer. Because I was concentrating on design approaches and concepts and not specific coding questions there were very few “right answers” but plenty of “appropriate answers” and while I would debate with them on almost all their answers I couldn’t say they were wrong.

These last two days of my India trip were very long but probably the most fruitful. I still had my fun in traffic and I didn’t get to see much of India these two days but I got to see some smart folks doing some great work. I’m not convinced they can invent as well as we do here in the states but taking what we have, innovating around it, implementing it as well as or even better than we can is something they are getting very good at. I’m convinced there are very few projects that we’re doing here that they can’t do just as well as we can.

My second day in India (the first full day that I wasn’t half asleep) went well. I had to drive from my hotel in Old Bombay to the outsourcer’s office to New Bombay, which couldn’t have been more than 15-20 miles away but took 90 minutes to get there due to traffic. And the driver said that the traffic was good. And, the monsoon season hasn’t kicked in yet. Yikes!

The story is that roads in the city of Bombay were created during a time when owning a car was not something the average man did. Given the recent booming economy and growth in personal and disposable income, though, many people with even modest jobs can afford cars and it’s created gridlock in many areas of town.

My roughly 90 minute trip again took me through areas of town that looked like they have changed for decades into areas that are literally months old. Once I arrived at the offices in New Bombay I was pleasantly surprised by my surroundings: generally modern looking offices, open work spaces, full air conditioning, and good conference rooms with excellent connectivity and IT staff. It’s like any other “first world” office building so getting down to business was easy.

I spent most of the day talking with engineers, testers, product managers, and some junior architects. Everyone spoke english so well and the offices were similar to what we’d see in the States so I almost forgot I was in India talking tech. We talked about RFID, mobile solutions, open source, and some specific clinical applications. Each of the engineers was articulate, very business oriented, and eager to speak to me. They answered questions directly and easily and I was impressed that each of the engineers was much more focused on the what (the business problems they were solving) than the how (the technology). They were quite knowledgable in technology and I will be diving deeper today and tomorrow but if these guys represent the status quo in India’s outsourcing shops India’s made it pretty far in a short period of time and they’ve got a great future.

As some of you already know, I’m in Mumbai and Bangalore, India this week working with a couple of outsourcing firms on clinical IT projects. I’ve been working with outsourcers in places like Pakistan, Russia, and India for almost a decade and it’s going to be great to get out to India to see how “offshoring” works first-hand instead of across thousands of miles.

I can’t say I enjoyed my visit to my travel nurse before the trip. If you read the CDC warnings and bulletins (which she recited almost verbatim) for India you’d think you were headed into a germ warzone. I got all my shots (5!) to get me up to vaccination standards and got some anti-biotics and ant-malaria pills and I was off.

My first day in India went well: I arrived on a British Airways Club World class Boeing 777 aircraft and the service and lay-flat seats were pretty good. I got some sleep so I didn’t have to battle too much fatigue. As soon as I arrived at the airport my driver (that sounds so pretentious), Sheikh, picked me up and walked me towards my car. There I was mauled by about a half dozen orphans all under the age of 9 asking for money for food. I’m a softie so I gave them each $1 (which is alot of rupees for them). Sheikh said that might have been a mistake and he was right since the moment I handed out the first dollar about another half dozen or so kids attached themselves to the car and I thought we might accidentally run them over.

Sheikh drove me from the airport to my hotel and the drive, which couldn’t have been more than 10 miles, took almost forever given the slow pace of traffic and crowded streets. The driver was great and talked me through the landmarks and important places to see. He also pointed out “asia’s largest slum” area as we passed through it and I saw first-hand how devastatingly poor much of the country really is. As I got closer to the hotel the living conditions for folks seemingly improved but I must say I wasn’t prepared for what I saw in the slums.

Once at the hotel I was pleasantly surprised to see that there’s little or no difference between my hotel and a 4-star or 5-star hotel in the US. The service is impeccable, there are people catering to almost any need, and it seems like there are more service people available than actual guests. Very nice.

For dinner I met with one of the VPs of the outsourcing firms I’m visiting to setup an agenda for the week. He was knowledgable and articulate, something I’ve found of most of the Indians I’ve met so far. We spent about 2 hours discussing clinical IT architecture and other related topics over my first “real” Indian meal — but it seemed to taste similar to what I have eaten in the States.

Well, that’s the report from my first day. On day 2 I’ll actually be visiting offices and talking to actual architects, coders, and testers to get first-hand knowledge of what’s going on in offshoring of IT. I think I’m going to have a blast. Stay tuned.