Genchi Gembutsu one of the core principles in Toyota Production System, translates in English as “go and see for yourself” and make strategic decisions by firsthand knowledge of the problem or the need.  There are numerous success stories from application of Genichi Gembutsu from Toyota Sienna to Harley Davidson’s reinvention and numerous others that you can read from here and here.

My personal experience is from a software project, where I was looking to hire a user experience designer for a web application targeted at consumers.  My brief exposure to user experience design in past projects, led me to believe that UI designers fill in an important role and they take care of making the application usable to target customers.  It may sound very simple in tradition project management methodologies, find the person or resource to meet the project requirements and schedule their time.  However, I started having problems in finding the right person as everyone I talked to presented me a different view of user experience design.

At this point I decided to use Genchi Gembutsu and that’s is making all the difference in the project now.  When I decided to go and see for myself, user experience design completely looks as the Focal Point of this web application and not just another important role in a project.  In my search, I stumbled upon an excellent book “Designing for Emotion” by Aaron Walter, lead designer at Mailchimp.  As Aaron puts it “It’s not enough for our websites to be usable. They need to be human.”  How many software or web applications we use in our daily life looks human and makes us come back and use it frequently and really leaves a pleasurable experience ?  Unfortunately the number is very low and enterprise software applications are the worst offenders really leaving the end user feel raged at the end.

Aaron shows in his book a translated Maslow’s Hierarchy of Needs into user’s needs from an application, which presents a paradigm shift in user experience design, where most of the applications today just meet the reliable and functional criteria.

Source: Designing for Emotion by Aaron Walter

That’s the power of Genchi Gembutsu, if you go and see for your self and get the first hand knowledge, you have a high probability of experiencing paradigm shift in your strategic directions.

Saravana Rajan

Source: How to Use Google Search More Effectively
Mashable: November 24, 2011

From Health Imaging’s excellent cover story on The Future of Radiology, Radiologists are evolving in to a role of “Clinical Partners” and “Strategic Planners” rather than just a specialist who effectively interpreted a study and reported on that.  Radiologists are expected to collaborate with referring physicians, oncologists and other clinicians to differentiate their service value and at the same time act as strategic planners in the changing environment of accountable care organizations(ACO).  Technology innovation is the key underpinning of that collaboration and strategic planning.

So what’s that to do with Waterloo Region startups at RSNA 2011, you may ask.  Of the 700 or more companies that exhibited at RSNA 2011, there were three startups – Client Outlook, Karos Health and Medicalis –  from Waterloo Region and all three are leading innovators in directly enabling radiologists, clinicians and health care providers to evolve Radiology and patient centered care into the future.  Here is the brief look into each company and their presence at RSNA 2011.

Client Outlook:

Client Outlook, led by husband and wife team of Steve and Brenda Rankin, is enabling access to medical image access to all clinicians seamlessly and collaborate with the performance desired by clinicians.  You may think what’s so cool and unique about that.  Well if you have lived in the world of clinicians and their experience in getting access to clinical images for providing better care for patients you will know their pain.  Getting access to diagnostic images and collaboration with peers was as hard or nearly impossible as fixing your own dashboard and steering wheel on the car you bought from a reputed car manufacturer.

Now Client Outlook‘s eUnity solution essentially allows the clinicians to have an exemplary imaging viewer with slick performance on their tool of choice (ipads, android powered tablets, or any browser technology you name it) and also it doesn’t matter what PACS technology is used by the hospital or healthcare provider.  Client Outlook had a bigger presence than last year and had an excellent response from their targeted customers at the show.  Here is a busy Client Outlook’s team at RSNA 2011.

Karos Health:

Karos Health led by Rick Stroobosscher and Michel Pawlicz is enabling clinical information exchange and storage networks to evolve healthcare and patient centered continuum of care from the current inefficient models. Though Karos Health has their roots in Radiology, their solution has benefits beyond radiology and wherever clinical information exchange is required to meet meaningful use requirements or to enable patient care coordination.

Karos introduced a new product at RSNA 2011, named Rialto Keystone, an intelligence platform to efficiently deploy and optimize a clinical or health information exchange network.  From my 10 year long experience in health informatics, I have to say that I have never come across such a solution that provides visual intelligence to evaluate and optimize your clinical information exchanges.  Here is photo from their booth at RSNA 2011.

Medicalis:

Medicalis is a very interesting company and were way ahead of their customers in technology for years. Medicalis provides Clinical Decision Support solutions for Radiologists, their practices and payors in the world of ACOs.  Medicalis had a very big presence at RSNA 2011 and a quick chat with their management revealed that their leadership in technology for years is reaping rewards now as their customers are rapidly embracing their clinical decision support solutions in the current healthcare environment and context.

Medicalis also presented their cloud based decision support solution DS Cloud that they introduced earlier this year at AHIP.

Kudos to all the innovative exhibitors at RSNA 2011 and look forward to see more companies from Waterloo next year.

Full Disclosure: I don’t have any working contract or investments with the companies mentioned above and all are lead by very good friends and ex colleagues in the industry, who are visionary leaders and innovators and represent the entrepreneurial DNA in Waterloo Region.

Saravana Rajan

I am here at RSNA 2011 and mainly interested in imaging informatics where the focus this year is on vendor neutral archives, cloud based image archive solutions from innovative vendors, unified imaging viewer across the enterprise and of course imaging interoperability across the enterprise using IHE XDS-I framework.

From the informatics scientific presentations that interested me the most was from Quantitative Imaging sessions to enable “learning cancer systems” or help oncologists with their workflow by automating the capture and retrieval of imaging meta data from images to diagnose, discover cancer and use predictive modeling in their treatment plan for cancer.

For more information on Quantitative Imaging Network click here.

Unfortunately there is no Silver Bullet solution for all the problems that Dr. Halamka highlighted in his post. However, there are several learnings for IT organizations, enterprise solution vendors and service providers to IT organizations. I am eager to see his next post about on his speculation on the IT organizational model for the future that improves the context of the work.

Now coming back to the learnings,  IT organizations can take cues from startups, from lean principles like lean IT or lean startup to try to squeeze innovation out of existing operations budgets.  As a person who has straddled between the startup and IT organization worlds, I also see the challenges associated with it introducing lean / agile methodologies in a traditional IT organization, which is mostly organizational and cultural and has to be overcome first.

For enterprise vendors and services providers, IT organizations will love you when you provide capability to enable IT to charge back for the service business is using. Though charge back for IT services may not happen soon, at the least it will enable IT organizations to track who is using what and use as a leverage for budget increase.

If you are not already tuned into Dr. Halamka’s blog, here is the link http://geekdoctor.blogspot.com/

Saravana Rajan

I bet it wouldn’t be long ago and you face this every day and most probably it was at your work.

Why enterprise applications are the way they are – grey, not intuitive, slow, outdated and takes you back to 80′s ?  There have been many swipes on enterprise applications from user experience designers – very rarely enterprises have such a role! – and savvy saas application providers.  Here is a swipe from a sexy company 37Signals and I agree.

Why Enterprise Software Sucks ? from 37Signals

“The people who buy enterprise software aren’t the people who use enterprise software. That’s where the disconnect begins. And it pulls and pulls and pulls until the user experience is split from the buying experience so severely that the software vendors are building for the buyers, not the users. The experience takes a back seat to the feature list, future promises, and buzz words.”

Is this just an user experience problem ?

Well, user experience is one of the problem on the way how enterprise software applications are purchased or designed if it is designed in house, however, I think the real problem lies in the secret sauce of strategizing, leading, planning, developing and deploying IT systems and in a whole running an IT department.

So what is the secret sauce that can make enterprise software and IT sexy again?

How come new software vendors and saas based product companies churn out sexy software and new features at an incredible pace with probably less than half the resources ?

Why enterprise really have to struggle it out to complete a project successfully, even if it is a project based on a commercial off the shelf(COTS) product ?

More to come…

Saravana Rajan

- the facade can be imitated but not the culture and every detail of a brand like Apple cannot be imitated.  Still this could have faked more than few customers.

2. No New Social Networks Launched Today (Borowitz Report)

- A friend of mine told me that in Silicon Valley every business plan thats being hatched up now is about a social network of some kind – are we in another tech bubble?

3. Tale of two countries: The Growing Divide Between Silicon Valley And Unemployed America (Tech Crunch)

4. Clinician to Clinician Communication (Healthcare Informatics)

- In this world of social networks, paying using your smart phone, come to healthcare world you will find FAX and Phone as the greatest thing since sliced bread.  There are numerours reasons for that, lets not get into what’s wrong with Healthcare, that’s another conversation over a beer.

Nhin Direct project is taking a think small and simple approach to connecting the physicians with other physicians using existing applications,  communication protocols(SMTP and XDR) and what not.  Simple direct to direct communication is key for healthcare technology adoption among providers.

5. The DNA–People, Processes, And Philosophies–Of Innovative Companies (Fast Company)
- innovation starts from within a person, who believes that a world can be a better place and the system (organization or country or any entity) they are in has to foster a culture of innovation.  If the system doesn’t foster, its just one more barrier to bring down for the innovator and create a new system.

Click to enlarge graphic

Source:
The Interconnected World Of Tech Companies
Mashable July 19, 2011

Remote health monitoring, means different things to different people.  The following report from California Health Foundation offers the current state of the market with a clear definition on the terms and the state of the market.

The Connected Patient: Charting the signs of remote health monitoring

Image Source: California Health Foundation – The connected patient: charting the vital signs of remote health monitoring.

Key insights: little has changed in the last four years with mixed results from pilot projects

Why little has changed when the economic benefits offer several millions and billions of dollars in savings and efficiencies ?   The author of the report points to the structural issues of the US health care system, which tends to be fragmented and focused on episodic care.  I believe that this is not just a US problem and is a common issue between the publicly funded Canadian healthcare& and friends south of the 49th parallel.  By far the biggest barrier to more pervasive adoption of DM has been the continued fragmentation of operations and information technology across health systems.

That is a well known problem with the providers paid on a fee for service basis.   In the US there are recent developments with the introduction of HITECT act and Accountable Care Organizations towards an outcomes based system.  In Canada, from my view the change appears even slower and the outcomes based model is being discussed at the provincial level, who are essentially payors of the service.

Though there are several drivers for remote health monitoring including communication technology advancements, mobile data standards, the chronic care tsunami we are facing as a society,  there are some significant challenges in adoption at the physician office,  consumer engagement and payment models for this service.

In spite of the challenges there are significant economic benefits and prospects to remote health monitoring both in US and Canada.

& Rethinking Our Approach to Disease Management: Technology and Information Flow Considerations

Keith Boone presented about CDA and CCD history at the IHE dinner in Toronto last night.

Highlights from Keith’s presentation:

- Interesting to know that CCD came from Vancouver Island Health Authority Electronic Medical Summaries project.

- Schematron for message conformance over XSD and it’s an ISO standard. Good to know.

- What is the difference between a document and a message?

Whenever you go back and ask for Information and if you get the same thing back then it’s a document. It is persistent compared to a message, if you are caught up in document vs messages.

- Where in the world is XDS ?
http://tinyurl.com/wwxds

- Checkout CDA Tools

- Keith also has a new book coming out in May 2011 on CDA.

And here is Keith’s post on his speech if you are looking for meat.

http://motorcycleguy.blogspot.com/2011/02/if-i-were-king-of-canada.html

——

Great to hang out with the standards geeks from IHE and meet great people and catch with up with old friends who are involved in improving healthcare and healthcare standards.

Thanks to HIMSS for the wine.

Saravana Rajan