CIO Straight Talk - Issue 4 - 62
for clinicians today, I can definitely see a day when
computing devices are more integrated into the clothing
or body of the clinician.
In the current environment, how do you ﬁnd time to
spend on an experimental project like that?
I end up doing a fair amount of the design work myself,
and I bring in talented members of my team who do it
through pure strength of will. A few hours at night, and a
few hours on the weekend, as it can be fit in with operational constraints.
Speaking about ﬁnding time, you are now becoming
a professional farmer, in addition to everything else
you do. You have blogged about "building a brand"
for your farm and formulating "a multi-year strategic plan leading to full recognition as an agricultural
enterprise." Is this your new start-up?
Yes. This weekend we harvested honey from eight
beehives. We have honey. We have the fiber from the
alpaca, and we have the hoop house going in this
summer, which means that I will be able to have quite an
array of vegetable production for at least about eight
months per year. Then we will have about 500 pounds of
shiitake mushrooms fruiting this spring. We are getting
The Toad and the Snake: An Excerpt from Dr. Halamka's Blog
Over the weekend while working in the orchard, I found a small
garter snake trying to eat an enormous toad. [Halamka includes
with the post a photo he took of this unusual encounter.]
Did the toad not realize that by wriggling its feet, it could
easily escape? Was the toad unaware of the impending threat?
Might the toad have given up and thought that the end was
Did the snake not realize that the toad was much larger than
it could possibly digest? Garter snakes have special jaw hinges
that allow them to swallow things wider than their bodies. Was
the snake so optimistic about the beneﬁts of an enormous meal
that it was willing to discount the risks it faced in the swallowing
process? Might the garter snake have seized the opportunity
because the conditions were right for eating the toad slowly over
As is often the case, I tried to ﬁnd deeper meaning in this
encounter with survival of the ﬁttest. On a daily basis, I examine
my life, asking who I am, where I've been, and where I'm going.
In my early years as CIO, I did not know the risks I faced, what I
had to lose, and who I might upset along the way. I was the garter
snake. Out of this period came new advances in interoperability,
patient portals, and clinical applications. Everything was
developed in a disruptive rapid cycle improvement fashion.
66 CIO Straight Talk
Today, might I have become the toad? Have I become too risk
averse in a world of enhanced regulatory enforcement? Have I
evolved from the innovative rogue to the keeper of the status
quo? Have I become too attached to the customer relationships
I've formed, the incumbent vendors I've chosen, and the strategy
I have shepherded for 15 years?
In analyzing my behavior, I do not believe I've become the
toad quite yet, but I am very sensitive to the warning signs. In
1996, when I was faced with impossible tasks for which there
was no technology, no standards, and no policy, the answer was
simple - create them and if they failed, try again. In 2013, with
auditors reviewing my every project, government agencies
scrutinizing my process maturity, and boards wanting to
minimize risk, how can we reduce the barriers to innovation?
I do not have a complete answer, but I have an idea. I would
like to begin raising funds from inspired philanthropists, grateful
BIDMC patients, and partner companies to create what I'll
metaphorically call the New Organization for Transformative
Outside-the-box Application Development (NO TOAD).
Of course we'll continue innovating in all my operational
BIDMC IT groups, but somehow NO TOAD has to be constructed
and chartered to do work unconstrained by convention, risk
aversion, or anxiety about the things that create overhead in
2013 and did not exist in 1996. . . .