Crowdsourcing–Social CRM at its best

Social octogenarians

I was settling in to my first bite of overstuffed pastrami and corned beef sandwich—apologies to the vegetablists.  One of the four octogenarians seated in the booth next to me was speaking loudly to the other three about the catheterization he underwent the prior day.

Thankfully, his friend, who was eating the egg salad special interrupted him and asked, “How long have you known Bernie Westoff?”

“I don’t know Bernie Westoff,” replied the cath patient.

“He is one of your LinkedIn contacts.”

“How do you know that?”

Egg Salad stated, “I looked at your contacts.”

“Who told you you could look at my contacts?”

“You set it up that way.  Everyone can look at them?”

This conversation continued for the next several minutes.  I was tempted to pull out my iPad, open the LinkedIn app, and join the fray, but instead I kept my eyes straight ahead and worried about the Russian dressing dripping down my arm.  Crowdsourcing 101.

I think the one application of crowdsourcing most overlooked is one which hardly fits the definition. This type is not premeditated. It is the type where the “machine” is a means to an end, and it does not originate within a company. More often than not, the company is the target of this type of crowdsourcing—Social-CRM.

Most definitions of crowdsourcing involve a call going out to a group of individuals who are then gathered via the call to solve a complex problem—problem solving—much like the Law of Large Numbers.  The crowd is likely to have an upper limit in terms of the number of members. By default, traditional crowdsourcing is fashioned to work from the top down; it is outbound, a push model.

Social-CRM (S-CRM) tends to work from the bottom up. There are no boundaries to the number of members; in fact, there can be thousands of members. Also atypical is the fact with S-CRM no single event or call to action drives the formation of the crowd. The crowd can have as many events as it has members.

The unifying force around S-CRM is each member’s perspective of a given firm or organization. Members are often knitted together by having felt wronged or put-off by an action, product, or service provided or not provided by an organization. Most organizations do not listen to, nor do they have a means by which they can communicate with the S-CRM crowdsource. This in turn causes the membership to grow, and to become even more steadfast in the individual missions of their members.

In traditional crowdsourcing, once the problem solving ends, the crowd no longer has a reason to exist, and it disbands. With S-CRM crowdsourcing, since the problem never seems to go away, neither does the crowd.

Every firm has one or more S-CRM groups biting at its ankles, hurting its image, hurting the brand, causing customers to flee, and disrupting the business model. Even so, most organizations ignore the S-CRM crowd just like someone ignores their crazy Uncle Pete who disrupts every family gathering.


Have I erred on the side of stupidity?

Twice in the span of twelve hours, I received unsolicited and honest feedback from two individuals whose opinion I value, about my attempt to share with you my thoughts about a range of issues concerning the business of healthcare.  One came from my father; since he holds that role he is allowed to offer unsolicited advice any time he wants, and I am entitled to listen to his advice.  The other bit of advice came in response to an email I wrote.  He is one of you, and he wrote the following:

I agree with many of your points and disagree with a few of them, and regardless, it’s a compelling, buzz-worthy angle that gets a lot of re-tweets and what have you, but I think it’s worth considering how these positions are affecting your ability to land consulting gigs in HIT. People want to hire consultants that they think will help them succeed, that think positively and pragmatically, and that are problem solvers (as opposed to problem recognizers): “we can do this together…I’ve had success before and if you let me, I will help you succeed…” that kind of thing. Just my 2 cents. It’s a trade-off, I know. You want to be honest and forthcoming, so I see the dilemma.

This was like being hit by lightening twice in the same day, so I thought I should take time to consider their input.  The feedback led me to ask if there are others who share the same opinion.  Is it possible my ramblings are about as well received, as I would be if I were to walk the streets of Tehran wearing a Star-of-David t-shirt?  What portion of readers drag my postings to their email folder entitled, “Kill him Later”?

Some believe a more effective use of consultants would be to compost them and use the energy generated to power a weed-eater.

Please permit me a few lines to try to explain my thought process for writing in my particular style and tone.  Before I began expressing my opinions on healthcare, I began reading what I considered the best healthcare blogs and editorials.  The first thing I learned is that I had nothing to offer of value on the clinical side of healthcare, so I focused my efforts on discovering what business issues providers dealt with, and which ones might benefit from receiving professional help—a consultant’s twelve-step program for problem solving.

I did a lot of homework; in addition to reading, I interviewed more than a hundred healthcare executives.  What was my takeaway?  One CEO told me the most needed skill on the business side of healthcare was “adult supervision”.  I did not charge in with uncorroborated opinions.  I used LinkedIn discussion groups to pose hundreds of questions about possible problems, studied the responses, and used them as a basis to formulate ideas about what was broken and what needed to be done to fix it.

I should note many of the blogs I read shared two traits; they often stated the same facts available on other blogs, and they rarely seemed to question the efficacy of the impact many of the Healthcare IT initiatives would have on operating healthcare’s business model—ours is not to wonder why, ours is but to do or die.

Not wanting to be superfluous, when I came to the fork in the road, I chose not to take a me-too position.  Instead, I threw metaphorical tomatoes and tried to get people interested in looking at the business model in a more disruptive manner.  Often, I did this by taking extreme positions on issues in the hope I might hit a hot button, and someone would think, “Perhaps we ought to talk to the tomato thrower and see if he can help us”.

My approach may prove to be less than brilliant.  What’s your take?

Why do witches burn?

Some argue that skewed logic is better than none at all. I’m not some people. What is skewed logic? It’s drawing an errant conclusion from a set of facts. If A and B, then C. For example, in Monty Python and the Holy Grail, there is the discussion to deduce if a woman is a witch.
Why do witches burn?
Villager: Because they’re made of…..wood?
B: Goooood!
Other Villagers: oh yeah… oh….
B: So. How do we tell whether she is made of wood?
One Villager: Build a bridge out of ‘er!
B: Aah. But can you not also make bridges out of stone?
Villagers: oh yeah. oh. umm…
B: Does wood sink in water?
One Villager: No! No, no, it floats!
Other Villager: Throw her into the pond!
Villagers: yaaaaaa!
B: What also floats in water? …
King Arthur: A Duck!
Villagers: (in amazement) ooooooh!
B: exACTly!
B: (to a villager) So, *logically*…
Villager: If…she…weighs the same as a duck……she’s made of wood.
B: and therefore…
Villager: A Witch!
All Villagers: A WITCH!

Let’s depict this like a business problem.

There you have it. So campers, where could we possibly heading with this? Here’s where. We’re starting a hospital; THEREFORE we need an ENR.  Washington is giving away money; therefore we need an EHR.

If that logic was correct, if that logic was both necessary and sufficient how would we know it? One way is we would see a bunch of doctors running towards EHRs rather than away from them. The reason this logic is faulty is that the lifeblood of the EHR is about one thing—the records.

So, if the EHR is made of wood and weighs the same as a duck…

Should you listen to the voices in your head?

Well, for starters, if you don’t nobody else will.

Just because I’m paranoid, doesn’t mean the voices in my head aren’t real. What voices?  They don’t like it when I speak of them, so I am going to speak in parentheses so they do not hear me.)

Riding the in the car yesterday with my son, the radio was playing Barber’s adagio, a mournful and eerily melancholy piece. It has long been one of my favorites.  I tried to get my son to turn off his PSP long enough for him to try to develop an appreciation for it.

He asked me to tune the radio to what he calls ‘his’ station while I kept extolling the specific virtues of the adagio, of Barber, and of classical music in general. I intended to win him over to my way of thinking.

The phrases I used to bolster my opinion kept coming to me, although I knew not from where.  I soon reached the point where I knew that I was no longer speaking to him, but role playing the very same discussion I had had with my father when I was about the same age as my son. Déjà vu. I have become my father’s son. The voice in my head was my father’s and I was not even charging my father rent for the space.

Do you hear the voices? No, not those voices. The ones you hear at work when you realize that the person speaking to you is your other self. The same voice you hear when you go out after work with your friends and begin to talk shop. By the third glass of wine the conversation has shifted from swapping stories about the craziest patient to wondering aloud when the company is ever going to learn how to fix their business. By glass five, you’re fixing it for them, diagramming solutions on cocktail napkins.

A word of encouragement. Listen to the voices. I bet you’ve come up with some great ideas. They won’t do anyone any good locked up in your head. Let them out. Show someone who can do something about it what you wrote on the napkins.

Jihad Joe EHR selection

When competing hypotheses are equal in other respects, the principle recommends selection of the hypothesis that introduces the fewest assumptions and postulates the fewest entities while still sufficiently answering the question. It is in this sense that Occam’s razor is usually understood.  There is no corollary that works with EHR vendors.

What if we look at HIT vendor selection logically?  Have you ever noticed at the grocery store how often you find yourself in the longest checkout line, or when you’re on the highway how often you find yourself in the slowest lane?  Why is that?  Because those are the lines and lanes with the most people, which is why they move the slowest.

If you are asked in which line is Mr. Jones, you would not be able to know for certain, but you would know that the most probable option is the one with the most people in it.  You are not being delusional when you think you are in the slowest lane, you probably are, you and all the people in front of you.  The explanation uses simple logic.  It’s called the anthropic principle– observations of our physical universe must be compatible with the life observed in it.

It can be argued that the business driver which shapes the software selection process of some is the aesthetics of efficiency, a Jihad Joe approach to expediency.  Buy the same system the hospital down the street bought, the one recommended by your golfing buddy, or the one that had the largest booth at the convention.  Or, one can apply the anthropic principle, rely on the reliability of large numbers and simply follow the market leader.

Might work, might not.  My money is on might not.  There’s still plenty of time to do it right.  If that fails, there will always be time to do it wrong later.  Of course, you can always play vendor darts.  If you do, you should sharpen them so they’ll stick better.

Should you consider disregarding Meaningful Use?

Here’s a reply I wrote to a FierceHealthIT on some of Dr. B’s comments on Meaningful Use.

I know of a hospital who has already implemented a top tier EHR costing millions.  This organization ‘gets it’.  They are currently building a work-plan to see what additional work they must do to meet Meaningful use in time to qualify for 100% of the ARRA money.  First blush—it will take tremendous amount of work for them to do it, but they will get there—if they choose to do so.  They have a choice and the fact that they know that is their trump card.

If a hospital hasn’t even begun the EHR process, as more than 80% have not, coupled with the more than fifty percent failure rates, I’d estimate their chances their chances of making the deadline at less than 1/3.

So, what to do?  Stop and think.  Ask the right questions.  You have a choice of two strategies.  Let ARRA money drive your decision, possibly implement it wrong, and probably miss the deadline.  Then what do you have?  Not much.  Strategy number two; define your requirements, figure out what business problems you need the EHR to help solve, and buy the best one for you.  Confused?  Map out two work-plans for yourself.  One work-plan that shows what you would have to do and what you would have to spend to meet the ARRA requirements.  Draft a second work-plan that shows what you would have to do to implement what you really want.  Compare the two plans and determine your deltas, your gaps.

Are you going to chase this for ARRA money?  Because someone in Washington thinks you should do this?

Answer this question first.  Is every hospital the same?  Are you as good as the best, better than the worst?  The EHR vendors think the answer is yes.  Keep you processes the same, skip change management, and the implementation will be a breeze.  We make every hospital look and operate the same.  When did the EHR vendors become the best practice savants?   The government thinks the answer is yes—that is why they are holding everyone to the same Meaningful Use standard.

One standard does not fit all hospitals—nor should it.  Set your own standards and decide for yourself if you fit your version of Meaningful Use.  ARRA money will end—then what?  You’re stuck with your EHR.  Get one you need.

How measuring Brittan can improve your EHR success

So, last night I am watching NOVA.  The episode discussed fractal geometry and aired the same time as the Viking Bears game.  Admittedly, not a typical Y chromosome choice, but interesting none-the-less.

A fractal is a fragmented geometric shape that can be split into parts, each of which is a reduced-size copy of the whole.  Simple enough.  Common examples of fractals include the branching of trees, lightning, the branching of blood vessels, and snowflakes.  In the seventies the mathematician Benoît Mandelbrot discovered that fractals could be described mathematically.

It turns out that a shoreline is another example of a fractal.  For example, let’s say you wanted to determine the length of the coast of Brittan by measuring it instead of just using Google.  The coastline paradox says the measured length of the coastline depends on the scale of measurement.  The smaller the scale of measurement, the longer the measurement becomes.  Thus, you would get a longer measurement if you measured the coastline with a ruler than with a yardstick.  This paradox can be extrapolated to show that the measured length increases without limit as the unit of measures tends towards zero.  In the first picture, using a 200 km ruler, the coastline measures 2,400 km.

In this photo, using a 50 km ruler, the coastline measures 3,200 km.

I’m not sure why this idea needed to be discovered, it seems a little obvious—more information yields more informed results.

A few years ago I was hired by a firm to report to their board on their vendor selection process.  The firm was about to issue a two-page RFP to two vendors.  I convinced the firm to redo the process.  They ultimately issued an RFP of more than a thousand requirements and selected a vendor who was not on their original list.

Again it seems obvious, but being obvious doesn’t always result in smart behavior.  If you’re getting ready to spend seven to nine figures on and EHR, wouldn’t you like some degree of confidence that you selected the best one for your hospital?