Thursday, April 2, 2009

The Human Computer

Recently I was asked to review an article about IBM and the Mayo Clinic's recent decision to release natural language processing or NLP code to the open source community and comment on how likely the open source development model and delivery mechanisms like Software as a Service (SaaS) or Service Oriented Architecture (SOA) will become the preferred models for delivering healthcare IT solutions. I've pasted my response below...

Alright, here are some observations but be prepared, it's a bit out there......

I think that it's kind of important to draw a distinction between the FSF/OSF development model and SasS/SOA etc... as delivery model. Linux was sort of special in that it really set a new visible standard for collaborative development in a community. That's not to say that it never occurred before. DARPA/ARPA and the military contractor/technical academic community were the real pioneers for this in many respects. Think of BSD UNIX vs AT&T System V for example. You basically have academia, big R and D shops in new markets (Bell Labs) and military contractors setting up collaborative environments with tons of freedom for brilliant people who want to use their creativity. Richie and Thompson invented UNIX almost in their spare time. Ritchie invented C because he couldn't write UNIX in B (true story) and C was the great grand daddy of a ton of 4th generation languages and definitely set the standard for compilers.

The point is that Linux wasn't the prototype model. It's just that over time the companies that fostered these communities got a grip on their intellectual capital and switched the focus to selling them. Once money is attached to an idea it's no longer psychologically possible to maintain an open flow of ideas and creativity around that idea. This is a system that rewards true brainstorming where no idea is a stupid idea and the person who helps his brother/sister find an answer is more valuable than the person who builds a silver bullet to feed an ego. This I think is a key concept, more on that below.

Linux and GNU revolutionized things by understanding that a large number of brilliant creative people care more about the free and open flow of creativity and ideas than making money. CPA finance best practices don't seem to mix easily with people who are wired to understand things and solve them because it's satisfying. It creates a kind of cultural dissonance and a myth that there is a choice (albeit a suckers choice) between having either the open flow of ideas/creativity OR the efficient and effective financial principles of selling in a market. There are more and more companies though who recognize this as a suckers choice and know that it's not an OR but an AND to be successful. Red Hat supports the open source community, fosters and respects it while making buck. IBM's transformation from big iron hardware vendor to services company was enabled by their willingness to embrace the FSF community, contribute generously and then fill a niche helping their business partners deploy these far cheaper and high quality solutions to a variety of business problems. I suspect their real target in considering a purchase of sun is MySQL (the fabled open source database that does 80% of what you need a database for REALLY REALLY fast) and Java. I can imagine them turning Java loose in the FSF community and watching it blossom into capabilities that make their consulting services that much more valuable.

We're moving from an industrial age and economy into a knowledge and information age. The winners are no longer going to be defined by who can protect and sell "things" or products. Instead it's going to be more effective to foster people's built in desire to be creative, productive and, well, human. I think this is an important concept and yes, more on that below.

SaaS and SOA can be thought of as architectures. What people generally call Web 2.0 are also. They're the next layer of abstraction in the evolution of computing. Just as punch cards evolved over time into 4th generation languages each evolution brings ease of use to computing and generally amplifies our ability to solve problems more naturally. I think it's easy to forget just how unnatural it is that we rely on a bunch of signals traveling through solid state logic gates to synthesize meaning on a CRT or LCD display truly is. The real work is done at the end of the day by the person who reads and interprets those images and uses the most powerful computer known (the human brain) to translate those abstractions into action. While SaaS, SOA and Web 2.0 types of technologies can ease the burden of that translation and make it easier for us to use technology to communicate they are still terribly crude compared to the richness of human interaction. There will be successors to SaaS and SOA. So I think the REAL benefit that they provide is in simplifying the common understanding and language of how we interact with computers. Music is a pure and natural human language in many respects. Emotion and meaning can be conveyed in a very real and raw state through composition and arrangement. SaaS and SOA help us get closer (even if we're still light years away) to that quality of communication by giving us standard mechanisms to arrange how we interact with each other through technology. I think this is the link between SaaS/SOA and the cost of technology. As technology evolves towards allowing us to spend more time on the message and less time on constructing it the flow of ideas becomes easier. This is a key concept.

If the keys are that creative collaboration is becoming more valuable than proprietary protection, fostering creative collaboration will be the key to being sustainable in the future and that the evolution of technology is moving towards enabling the communication required for collaboration then where in the heck is healthcare as an industry and healthcare IT going to have to go? Here are my predictions...
  1. Healthcare's cost is driven by it's complexity and variability. The need for standardization in healthcare will be both drive and be driven by the need for easy interoperable exchange of patient information across the continuum of care.
  2. SaaS and SOA are most effective when dealing with the standardized exchange of data (think RSS) so if standardization continues to gain traction via HITSP, IHE etc then they will become even more viable delivery options.
  3. The need to exploit our most efficient and powerful resources, the minds of countless doctors, nurses, technologists, patients and other stakeholders, will drive us to converge on technologies that simplify the creative process.


I think that the end-point is likely to be SaaS, SOA or something that comes along later that fits this bill. Creative collaboration (aka the FSF model) is gaining momentum and will reach a tipping point once the pain of doing it the way we've always done it is greater than the pain of what will come next. I think that we're on the cusp.

So here's the deal. You can't just let me ramble like this without giving me some feedback. Help me develop this idea into something useful....


P.S. I think that NLP technology (as referenced in the article) has a ton of potential and could even break down some of the barriers and challenges associated with traditional business intelligence. In the short term though structured data and standards will serve us better since they help drive down the variability that is the root cause of our countries high cost of healthcare. The decision to open source it's development is both intelligent and responsible.

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