Tuesday, December 29, 2009

Hypervisor Star Wars

With the technobabble name of Hypervisor, I think that warrants a slightly science fiction post title, don't you?

Server virtualisation, which is achieved using one of the hypervisors on the market, is on the agenda of every CIO or CTO at the moment, whether that is for server consolidation or a grander move towards utility computing and the much vaunted cloud. So, I decided I would rub my twopenneth together and post where my thinking is at on this theme.

When I look at this sort of infrastructure technology I’m looking at the clarity of roadmap. Whatever decision a CIO/CTO makes, they’re going to live with it for probably about 5 years so when I’m reading about the big players (Microsoft Hyper-V, VMWare and Citrix XenServer), I’m not just trying to see who can do what now, but who is demonstrating thought leadership which will put them in good stead for the future.

Now, you don’t even need to go digging very far to analyse Microsoft Hyper-V… you just can’t rule it out. The biggest OS company in the world, and with many $billions sunk into datacentres that they need to start to build revenues off, they simply will not drop the ball on server virtualisation. You might as well value MS shares at mere cents if you do! Interestingly, they probably haven't the greatest feature set right now (they can't do real time migration), but they will architect their product really well so the features will arrive in due course and they will not be killed any time soon. Beyond that you can see how they will develop Hyper-V in the medium term. I can see an interesting triple play emerging with Hyper-V, Azure and all those datacentres.

That triple play brings us to VMWare. It took me far too long to get my head around why EMC bought them because I couldn’t see the synergy. Anyway, a month or two ago they announced a 3-way partnership between Cisco, VMWare and EMC called Acadia and all becomes clearer. This is really exciting. Not only can I buy virtualisation technology, but I can buy myself a private cloud. Aside from that (as if you need it), VMWare have good public domain information about their roadmaps and you can see how a client can go from legacy server infrastructure, through consolidation to private cloud and public cloud. They also have a very mature vision of what separation of logic and hardware can do for you and that sort of quality thinking will keep driving their product development.

Now with Citrix XenServer I see more uncertainty. With a Market Capitalisation of $7bn and profits of $150m, Citrix aren't, in my opinion, big enough or equipped with the right strategic partnerships to ride this wave to the next level. So, they will only exist if they are bought (in fact, I’d have thought that much of their MktCap is acquisition speculation) and until that happens, I wouldn’t make a 5 year investment decision on them. There are acquisition rumours, but it needs to be the right buyer. I don’t think Oracle would be the right buyer for me- I don't see any synergy as potent as that envisioned in Acadia for example. With all that, their tech may well be great but I’m not even going to look until there is that corporate stability.

A great book here is The Big Switch by Nicholas Carr. Treat yourself. It plots the future of utility computing out and takes it to places where really innovative companies are playing- like 3Tera (watch the demo on their website where you just build your infra in a Visio-style GUI). Yes, 3Tera is too bleeding edge for us in midsize corp for now, but it will pay to keep an eye on how their balance sheet develops.

A really exciting future no matter which mast you nail your colours to. The one true lesson we would all agree on is, don't do nothing.

Wednesday, December 09, 2009

Explaining service oriented architecture using the analogy of local economics

Modern enterprise systems are complex and differences in approach are, perhaps, well described using the analogy of a town’s economy. The traditional approach of buying functionality as packaged systems and configuring the last few features is like the communist approach to town planning where the vendor is the state. The state strictly defines the services in the town from the butcher and the cobbler to the grocer and the taxis. For the system to continue to work, almost all changes (except perhaps the colour of the baker’s walls) must be escalated to the state for review, evaluation and decision. When the state agrees a change is a good thing, it simultaneously makes the change across all towns in its jurisdiction. As the town grows, this approach increasingly restricts further growth until a state of bureaucratic paralysis and economic stagnation is induced- the fact that the town can be any colour is frustratingly irrelevant when all the towns are functionally the same and real differentiation is not possible.

In a system built to service oriented architecture concepts the state’s governance moves to the client side. In our town, the economy is liberalised and trusted to market forces such that individual services can be defined autonomously from state controls. Thus, an ecosystem develops. A service owner can choose to respond to market needs and is free to specialise, compliment someone else’s service or wrapper another service to add value. For example, a taxi driver could encapsulate a cobbler service to create a new “home delivery shoe repair service”. In theory the cobbler service can be modified and as long as the published “service definition” is up to date, the taxi driver can maintain the quality of their overall service without needing detailed information about how the cobbler’s internal operation works. There are few restrictions to even consuming services from other towns. The state still has a responsibility to deliver essential or generic services such as core infrastructure and a directory of the town’s services, but its role is mainly about maintaining the rules of the economy (=standards), rather than trying to deliver value added services. With limited state intervention, growth breeds further growth and the macro economy of the town responds organically to external influence, especially competition.

Tele-Wine Tasting

Cisco, BT and Chief Wine Officer combined some Christmas cheer with a technology demo wonderfully last night. The team used a telepresence room in Cisco's London HQ to host a wine tasting evening from similar kit in BT's New York office. This was a fantastic test of the technology due to the need for it to allow extremely nuanced communication between two groups of people. Only two further things are needed from Cisco to make the wine tasting as good as having everyone in the same room:

1. Object teleportation- removing the need for the wine to be sourced and stored at each location.
2. Time machine- it had to be remembered that it was just 1pm for our valient hosts, who matched us glass for glass (except for the sommelier who diligently spat after each sip).

So, nearly there Cisco. Piece of cake.

Meanwhile, until such tweaks are made, a telepresence room has been set up by Cisco at the Copenhagen Climate Conference (and will stay for about a year thereafter), both to facilitate collaboration and also as a great demonstrator of a technology with the potential to reduce the need for travel.

Tuesday, October 13, 2009

Jurisdiction and Governance in Force.com

Many thanks to the kind people of Salesforce who hosted a CIO Roundtable at the Andaz hotel in London. More about the hotel later. The event wasn't just about sales pitch. It was a frank discussion about the wider benefits and issues of cloud computing. I think just one person around the table wouldn't agree with the summary that it's not about whether cloud computing should be adopted, but a matter of when and how. The afternoon was studded with some fine examples, but one of my challenges in healthcare is that when it comes to storing NHS patient-identifiable data, we need to store it in England. That's right, Connecting for Health do not even trust the Welsh or the Scots with the data! So, this was something of a damp squibb for the adoption of cloud computing (especially with the salesforce model where all users share a single instance). However, all credit to Tim Barker, who went away and came back to me with a way of residing some data in a specific jurisdiction, but without compromising the user experience of logic in Force.com... such as Swiss Banks might like when they want to physically hold some data within the country. Tagged "cloud data governance", PerspectSys have created ways of running salesforce.com applications in the cloud, storing private and sensitive data at home, under real or perceived control, and retaining all of the rich functionality of the salesforce.com apps.

Monday, September 14, 2009

Lots of Paper is Required to go Paperless

Clinical Reference BooksWhen you are going paperless in your hospital, do not underestimate the amount of time it takes to digitise reference data, lists, protocols, pathways, images, order sets etc. This is just one pile of books I came across to support the complex and lengthy discussions between our IT analysts and front line users.

It is not all about choosing and implementing an Electronic Patient Record product, it is more about making it work for your clinicians through detailed configuration. Sure, some vendors will have some information hard wired into their product and some will provide "out the box" configs, but you need to realise that to do this well in a hospital, or across multiple specialties, the effort can dwarf the equivalent product costs. Your hospital is not "out the box".

Thursday, September 10, 2009

What can IT Procurement Learn from the Construction Industry?

A letter by Mike Stranks to the 10th September 2009 edition of Computing Magazine "Overhauling government IT procurement" reminds me of a concept I've long advocated in our organisation, but not posted about yet. Mike looks to the construction industry, which has a much better record of programme success than IT (well, they have had several thousand years to work it out!), and observes that the role of design and construction is split between organisations. Along with a savvy client (often a chartered professional) these three parties create the necessary environment for programme success. In IT, the design and build roles are usually not distinct and are therefore usually awarded to the same company. This is especially true in public IT procurement where, ironically, the public purse want to derisk the delivery by passing that risk on to a prime contractor.

I wholeheartedly agree with Mike. Closing a deal for the design and build before the problem is understood means that the parties are playing with alot of uncertainty. Either the problem will be easier than expected to solve and the client pays more than was necessary, or as is more often the case, the problem is more difficult to solve than expected and the supplier either needs to play a game of "change request charges" to recoup the extra costs or the project fails to deliver.

By seperating the design piece out, the client is able to procure build services with a much better understanding of what they are asking to be done, and the incentives in the 3 way tie up are also more balanced. Classic conflicts between design and build are mediated between organisations which include the client rather than pitch the client against a single supplier who naturally has their own interests at heart.

Mike makes a strong case for chartered engineers in this process. Hooray to that too, but that's a subject for another topic.

Wednesday, July 15, 2009

Indicating the Way to Quality Care

The NHS Information Centre has published a set of 200 indicators of quality care. This is the result of a piece of work started by Darzi's report 'High Quality Care for All' and you can tell the clinician involvement has been continued into the deliverable with the phrase "assured by clinicians for use by clinicians". The report, downloadable in specific sections, is structured around pathways so that the indicators are clinically relevent. I've not done a count of indicators to see whether the report really has 200 indicators, but I actually find it refreshingly transparent that many sections of the document as described in one way or another as 'to be done'. It has to be said that the mechanics of governance and maintenance have been put in place around the report too so it will continue to evolve. The indicators address Effectiveness, Patient Experience and Safety, and therefore reflects current progressive thinking about what value means in health care (see "War on Waste" by Ali Parsa).

Monday, July 13, 2009

More Money Than Can Be Spent? In a Credit Crunch?

I had a fascinating meeting with a senior officer of the Department of Health today to look at access to innovation funding through the National Institute for Health Research (NIHR) and some of the projects under their mentorship. What was particularly surprising is that we are seemingly conditioned to expect that funds are scarce, but actually fewer innovation grants are allocated than are available. A later check in the NIHR Annual Report confirmed that the organisation has an annual sum to spend and that for almost all categories, the 2008/09 spend is less than the forecast for 2009/10- implying that this year was underspent. This is not a criticism because the organisation rightly sets the quality bar high, but it is still a surprise that we're not generating enough good ideas to qualify for funding. Long live the Government's enthusiasm for innovating our way out of the credit crunch... thinking caps on people!

Thursday, June 25, 2009

Leonardo the Inspiration for Robotic Surgery

In the fourth of my posts from the NHS Healthcare Innovation EXPO, I'll share a video I took of a magnificent piece of technology- the Da Vinci surgical robot. Designed so that surgeons could operate remotely on soldiers in the battlefield, the robot is increasingly being used for challenging laproscopic procedures. In this video you can see, briefly, how two surgeons are able to control extremely dextrous instruments in a confined space. At the last count I heard of, there were only a small handful of these robots in use in the UK. Unfortunately, it is hard to imagine what might drive an increase in adoption as it is difficult, if not impossible, for a healthcare provider to be reimbursed more for improved outcomes or for carrying out more complex procedures for which there is no tariff.

Monday, June 22, 2009

Virtual Worlds for Healthcare

The NHS Healthcare Innovation EXPO had an excellent demonstration of a Secondlife simulation- sort of the virtual world of healthcare helping to make the real world of healthcare better. Put together by Imperial College London, the Medical Media and Design Laboratory (MMDL) explores how to use digital media in healthcare. Although created to explore new models of care delivery in the widest sense it seems that the Secondlife simulation fulfils a fairly immediate training need.

Fantasmagorical Train Ride

Fantasmagorical Train RideThere I was thinking "Here we go on another commute from Leeds to London", when the onboard WiFi opened my eyes to a whole world of possibilities. Suddenly we were on a magical mystery tour where "No map contains our current position". Just as I was holding out for our arrival at Narnia, The Garden of Eden or Atlantis, we pulled into Kings Cross. Disappointing.

Thursday, June 18, 2009

No Shortage of help in NHS Innovation

We all know that the economic situation is going to make the public purse smaller (in absolute or real terms- depending on who you believe) over the coming years so it makes sense that the NHS looks to innovation to improve the value of healthcare service delivery. It should therefore be little surprise that healthcare is burgeoning with organisations and talented people to help those with good ideas bring them to fruition. I've spent much of today meeting with these organisations to understand what's hot and what's not in healthcare innovation and will be posting on them in due course.

Many thanks to Brian Winn, Marie Maher and Dr Nigel Sansom of the NHS National Innovation Centre and Dr Peter Blenkinsop of NHS Innovations for taking the time to explain their organisations roles. They have some exciting projects going on. I'm not sure I have absolute clarity yet of how it all works because there are other organisations in play and, as you can imagine, there is much history in "idea generation" in the NHS which has created pockets of capability which is now being joined up. For example, on just one lap of the exhibition hall, you could see stands for NHS Institute for Innovation and Improvement, NHS National Innovation Centre, NHS Innovations, NHS National Institute for Health Research, NHS Improvement and NHS Technology Adoption Centre... and this excludes CfH, direct involvement from the Department of Health and occasional engagement with the NHS Purchasing and Supply Agency. Perhaps a more consolidated structure would be more effective?

Posting from the NHS Healthcare Innovation EXPO

I'm typing this post from the very glamorous NHS Healthcare Innovation EXPO 2009 at ExCeL in London. I'm not sure why EXPO is all uppercase, but I am sure that it is by design because this is a slick looking event in terms of marketing, the presentation of the venue, the stands and the supporting materials. It's the beginning of the day, with a Director of NASA kicking things off right now and luminaries to follow such as Prof. Lord Darzi and Martha Lane-Fox (the Government's new Digital Champion). I can only hope that the content of the EXPO lives up to the quality of the event. The big question for me is whether what is clearly a substantial amount of taxpayer money being driven into healthcare innovation is delivering results? Let's hope I'm not disappointed.

Tuesday, June 09, 2009

Sustainability is not just about being green

The evidence that our planet is undergoing major climate change is all around us, but whether or not you accept that is irrelevent (yes, and possibly parochial). Sustainability is a word often attached to the "green lobby" but actually, it has far wider connotations and there are few excuses to be cynical. I thought that this video about our changing world illustrates the point really well.

Watch the video and then consider how these trends, which are beyond any one of us to change or escape, will affect your business. This is also what sustainability is about. Further, all these extra babies will be needing energy and resources too. In fact sustainability is not just about how much pain can you tolerate, or how can you dodge the bullets- there is opportunity in change for the smart and agile.

Wednesday, April 29, 2009

Will $2.5bn of Chinese Healthcare IT spend trickle through to innovation?

By most commentators' estimations, healthcare IT lags that of other sectors, in maturity terms, by a decade or more. This situation has been created by decades of underinvestment. More recent effort in England to inject £billions into healthcare IT procurement have simply reinforced the entrenched positions of the incumbent suppliers who wield monolithic architectures based on outmoded service models. In fact, most of the circumstantial evidence shows that the 'investment' in English healthcare IT has squeezed the very start-ups who were the new lifeblood.
The rearchitecting of IT is what the sector needs to enable the new models required to balance the rising expectations of consumers against the downward pressure on the public purse. More focus needs to be placed on interoperability of loosely coupled components and useability than on further bloating the feature sets of systems breeding their own information silos.
So, what difference will, by very conservative estimations, several billion USD from China make? Well, the early signs are promising with comments from IBM's Labs, who are one of the few major players who have made serious attempts to implement open standards at scale. However, there is still an overriding fear that the opportunity in China might be squandered if a procurement approach is taken which fails to ignite the marketplace. Those of us who want to buy our IT from a fertile, imaginative and interoperable marketplace have our fingers crossed.

Monday, April 20, 2009

Should we turn Corporate Hospitality on its head?

I'm sure many readers of this blog, like me, are in a "decision making*" position and therefore enjoy hospitality courtesy of suppliers and potential suppliers. Well, I'm wondering whether there is a role for customers rewarding suppliers with hospitality? Now before you say "Isn't payment incentive enough?", "Are you mad?" or, I day say "Shush, you're giving the game away!" please hear me out. Now, I work in information technology, and many IT companies, particularly the large systems integrators and outsourcers, feature corporate hospitality somewhere in their business development strategy. Perhaps it is more pervasive in IT than other supply chains (my observation looking round the tables of Twickenham, Silverstone and Cowes) because of the abstract nature of many of the goods/ services sold, the emotional attachment to large procurement and complexity of subject matter leading to a strong emphasis on brand trust? I digress...

However, my thought is that only in rare circumstances do the people who lead service delivery directly benefit from financial mechanisms between customers and suppliers designed to reward quality and high performance. Perhaps it would be effective to reward good service with some entertainment for individuals? You can imagine that across procurement budgets of £tens millions this could provide a great return in terms of achieving stretch from those responsible for delivery who are otherwise difficult to motivate from outside their line management.

Has anyone tried this approach? I'd be interested to know.

Maybe it's just too radical an idea. I fear being outed by the IT establishment as I type this... and my boss!

* I've long been amused when asked "are you the decision maker?". If only it were that simple.

Sunday, January 25, 2009

Replies to "donotreply@..."

On reading an automated message confirming a flight last week, I starting musing on whether anyone ever, in a bored moment perhaps, reads the replies people send to "donotreply@" email addresses. I think there's a great stocking filler book in there somewhere! Just imagine... from the mundane queries to the most profound of outpourings. Reams of this material is sat on the world's email servers, unsighted by human eyes. We should begin a quest to explore this lost world.

Then an Internet search turned up the strangest of phenomenon. Many automated emails are sent with the reply having a "donotreply.com" domain address and someone actually owns that domain. Read more on The Consumerist about what he finds.