Future Skills in Health IT: Workflow and Learning to Learn

[This post is in preparation for the Friday #HITsm tweetchat, Future Skills in Health IT, hosted by @rmacklinrecruit, thank you very much Rachel! I’m attending Cloud Develop 2016 on Friday, so I prepared my answers in advance and published them in this post. (I’ll try to participate from the conference during lunch though!)]


Last week I wrote about creating an informal curriculum to guide health IT social media efforts. In that post I wrote about my design of a health IT curriculum based on my own educational background (Accountancy, Industrial Engineering, Artificial Intelligence, and Medicine). During curriculum design one tries to both predict and create the future. This is highly relevant to todays #HITsm chat on future skills in health IT.

T1: What skill sets will be in highest demand over the next few years? #HITsm

The two most important skills in demand over the next few years will be understanding healthcare workflow (especially how to adapt health IT to healthcare workflow), and the skill of self-directed, purposeful learning (learning to learn). Workflow is key because it is the bridge between health IT soft skills (understanding users) and health IT hard skills (understanding IT). Learning to learn, creating your own informal curriculum (a learning plan), to guide your professional development, is a meta-skill that leads to specific valuable health IT skills.

T2: How can candidates gain new expertise to position themselves for these roles? #HITsm

These are not roles. They are skills. Roles will continue to come and go. However, moving from role to role is a metaskill (a skill about skills). That said, I see particular demand for the equivalent of Chief Workflow Officer (AKA Chief Process Officer), plus other process-centric & workflow-oriented roles lower in the personnel food chain chain.


In keeping with Topic 1, I also see particular demand for human resource officers who can, in effect, design constantly evolving curricular for health IT professionals, from helping craft learning plans to perhaps even entire corporate universities.

T3: Technical skills aside, what soft skills will be most important to hiring managers? #HITsm

In my humble opinion, as an educator observing ex-students, working with C-level hospital executives, and growing a start-up EHR company, the three most important health IT soft skills are empathy, ambition, and charisma. Empathic programmers understand users and help them do their jobs. Empathic managers understand personnel and help them adapt and thrive. Ambition causes staff to take reasonable risks and persist in the face of obstacles and adversity. (Technically, ambition may not be a soft skill, but it certainly affects interpersonal relations.) Charisma is required to get people to buy into your vision and join your crusade.


By the way, I’ve rarely seen anyone with all three soft skills in abundance. This is why you’ll often seen several health IT professionals work as a team, in successive organizations. One person is charismatic and driven. They make difficult decisions. They can’t afford to be particularly empathic. However, they often work closely with someone who keeps their antenna up, sensing the mood of co-workers, smoothing some of the rough edges, and some times even talking the charismatic leader into being just a bit less ambitious when it strategically serves shared purposes.

T4: How can leaders build their teams in a competitive candidate market? #HITsm

By competitive I assume you mean competition for the talented based on remuneration. But talented people want one thing even more than money. They want the opportunity to express, and be acknowledged for, their talent. Build a vision. Show the way. Remove obstacles. Get out of the way. Word will spread.

T5: How will the role of a successful CIO change as we enter the post-EHR era? #HITsm

CIOs will increasingly become Chief Process Officers (Chief Workflow Officer), as they struggle to optimize EHR workflow and to connect other health IT workflows. Key to success, up and down the management/technical stack, is health workflow IT literacy, as I’ve written about previously. My answers to questions T1 through T4 provide ideas about how this can be achieved.

The following are past tweets leading to interesting posts and threads about the idea of Chief Process/Workflow Officer…

The majority of the cost of health IT is in workflow configuration, customization, and management. For this reason, the evolution of CHI into CPO/CWO is inevitable.

Also see…

As I said, I’ll be tweeting about #CloudDevConf before, during, and after the #HITsm tweetchat. Look for my tweets!

P.S. If I interested you in the idea of creating a curriculum to guide your professional development, check out my last week’s #HITsm post!

@wareFLO On Periscope!


An Educational Curriculum Approach to Finding, Creating, and Posting Great Health IT Social Media Content

[This post is in preparation for the #HITsm tweetchat, Acquiring, managing & disseminating Healthcare Workflow IT Knowledge, hosted by @Shimcode, thank you very much Steve!]

Create an informal educational “curriculum” to guide your health IT social media and content acquisition, management, and dissemination efforts.

Take a look at this workflow for acquiring, managing, and disseminating health IT knowledge. It fits my frequently proffered definition of workflow quite well: a series of tasks, consuming resources, achieving goals.


Now take a look at this definition of “curriculum.”

“A planned sequence of learning experiences” (remind you of anything?).

Yes, workflow comes to mind. But I talking about curriculum, as in a structured collection of related educational classes and courses. Health IT social media and education have lots in common: sharing, learning, experts, novices, and communities come quickly to mind.

Here are some differences between curricula and health IT social media. Students are a captive audience. They proceed through task sequences. They actually do stuff that gets graded. Twitter audiences are quite literally the opposite. They come and go quite freely. They encounter my tweets in random order. And, for the most part, I have no idea what they do with what they learn. That said, there are exceptions. Folks who download workflow software and let me know what they think. Folks agree or disagree with my opinions. I suppose, who and how many follow me is a form of validation, but it’s more like they grade me than I grade them.

The curriculum plan = health IT social media plan analogy is imperfect. But it is still useful

I hope to convince you that an education curriculum, as part of your social media plan, is useful for designing and managing your health IT social media and content marketing workflows.

Most of you, my friends in health IT social media, are born teachers. I could go into why I believe that is true in general, but you already know I’m right! So why not take the next logical step? Design a curriculum to guide your acquisition, management, and dissemination of health IT content. You may likely already be doing so intuitively. But reflecting about your tweeting “curriculum” has important advantages for you and your efforts.

Twitter is incredibly malleable. I am continually surprised by its new uses. One popular use, especially among the #HITsm crowd I hang out is activism toward some goal. Examples include patient experience, engagement and empowerment; health IT system interoperability; user interface usability; design thinking; citizen (medical and health) science, and so on. In my case it’s healthcare workflow and workflow technology. For each of these topics I can think of at least a couple tweeps.

I am also reminded of the following Hatcam video of Michael Gaspar at HIMSS12: Can social media save the universe?

@MichaelGaspar on “Can social media save the universe?”

If the only reason you are on Twitter is entertainment, then God bless you. Until I got a puppy two months ago, Twitter was consistently the most entertaining thing I do. However… health IT social media has a higher than average number of participants who literally aim to change the world. Entertainment and changing the world are not mutually exclusive. My most entertaining experiences on Twitter have been due to not entertaining people, but entertaining debates between people with different ideas about what needs to be changed in healthcare.

If you aim to change the health IT world, turn your “WHY?” into “HOW!” by creating and leveraging an informal educational curriculum to guide your efforts.

To support our goals we develop a wide variety of personal and professional workflows, which we repeat every day to post great content. We speed-read thousands of tweets. We create lists of tweeps to whom we intend to pay close attention. Some of us create alerts in a variety of platforms to daily provide us raw content through which we pore, looking for the very best, most topically salient, tidbits of data, information, knowledge, and wisdom. We sort through this pile of content, crafting tweets. Sometimes we accept headlines as default tweet text. Sometimes we rewrite headlines to make them fit Twitter’s 140 character limit. Often we insert editorial comments, hashtags, images, and emoji, to serve a variety go professional and personal goals. And then we either tweet on the spot or schedule tweets to for later, sometimes relying on automatic scheduling services, sometimes picking specific dates and times.

This post is not about that.

Those are the tactical task workflows we’ve found work for us, through trial and error, since when we first dipped a toe in the Twitter water (and more like Niagara Falls during health IT conferences!).

As important as your practical health IT social media workflows are — to find, create, and post great content — to inform, to entertain, and, always, to connect and engage — I’m addressing something more strategic and fundamental: why are you tweeting (and then how to convert that why into health IT social media workflows serving your “why”).

Remember at the beginning of this post when I suggested you may already be relying on a “curriculum” to tweet? You have, in your mind, a collection of related ideas you hold dear. In my case it’s about a half a dozen healthcare workflow tech concepts (process-awareness, workflow engines, pragmatic interoperability, workflow usability, etc.). You arrived at your mindset after mastering prerequisite ideas. These were basic, not necessarily healthcare technology related… marketing, accounting, medicine, health, databases, networks, etc. These are ideas you had to understand in order to get to the ideas you hold dear. But then there is another layer of data, information, knowledge, and wisdom. This layer is about the goals and benefits of realizing your ideas in the world. Less disease. Happy patients. Reduced costs. And so on. You have to convince the world, AKA folks who follow you, or otherwise pay attention to the content you tweet out. These are the success stories and cautionary tales. Out there, in the world, your ideas are beginning to be realized. People, patients, healthcare organizations, and companies through trial and error and tells the world about the results.

In a traditional educational curriculum the prerequisites are called… core courses. That collection of related ideas is the “major”. And the real world benefits are the capstone projects and work study arrangement.

For example, an article about how people interpret tweets is not itself healthcare specific, but may be a useful prerequisite to understanding how people interpret tweets about healthcare. The core or major idea may be about using social media in healthcare. The project or thesis corresponds to case studies and success stories. All three kinds of content can come from a variety of resources, from health trade news sources, research papers and conference, from blog posts (including yours, specifically crafted to leverage and supplement you larger social media curricular efforts.

How do you create a curriculum? Brainstorm! Use mind mapping software to create a graph of related knowledge. Design your perfect degree program. If you could invent your own major, what would be the courses? Now look at what you create and generate search terms. Subscribe to any of a variety of services, Google Alerts being the most popular, and receive as many links to recent new content about what you love. Scan and sort. Craft tweets. Then post, but not all at once. When folks read tweets, they don’t want to see one hundred of your all in a row. Use Hootsuite or Buffer or some other service to spread them out during the day. But if you do this, I’d leave your notifications on. The very best time to reply to, thank, or retweet someone is almost immediately after they do the same. Once you get your workflows down, this last thing is the most time consuming, but also the most fun!

Fundamentally, curriculum design and development is about predicting and creating the future. I can’t think of a more useful strategic concept for use by health IT social media activists.

Examples of Curricula, and How They Were Created

Here is an undergraduate medical informatics curriculum I developed back in the nineties (the first!) Here’s the 25-page description (we changed it’s name when we partnered with the business school). This curriculum was developed over several years by a cadre of health IT educators. I often think of it when I am casting my net for great content, sorting through that great content, and crafting and posting even greater content! 🙂

(Your curriculum can be much, much simpler! See below…)


And here is the official document we submitted in order to get accredited… if you click through you’ll see lots of boxes and arrows: workflows!


Example collections of courses were paths through the curriculum (there are a bunch of these, depending on whether students want more clinical, IT, or business emphasis, in the original 25 page curriculum, which is much more readable).


Finally, each of those courses expands into actual course descriptions.


By the way, I published in a post descriptions and syllabi for the health IT courses I taught (they hold up remarkably well 20 years later!): Some Mid-Nineties Medical Informatics Course Outlines: Enjoy! (Oh, and there is a two-frame-per-second video of me introducing on of the courses for 1997… thinner, mustache, thinner…)

Of course you don’t have to do even one percent of the work necessary to create a curriculum as complex as ours. Instead, think of a three-course sequence, to get certified. Here’s an example I prepared for healthcare systems engineering conference.

How courses fit together:


Verbiage from one of the courses:


So, there you are: a three-course certification curriculum, fitting on less than a half dozen pages (and big font at that!). The search terms for content alerts come from the course descriptions. And all the pieces fit together into a coherent whole. When you select your links and craft your tweets, think about how the basics feed into the major and then how the success stories reinforce why folks need to play attention, learn, and, perhaps, even buy your wares.

In fact, a three-ring Venn diagram of domain knowledge is exactly where we started, to get to the 25 page description.


(If you’d like to see a retro animated gif of these circles revolving in 3D, see it here. I just couldn’t bring myself to embed it in this webpage: it is soo irritating 🙂

Then we fleshed out the knowledge circles with word clouds.


From there we wrote course descriptions and figured out what knowledge had to come before what knowledge. While you can’t enforce a similar order of reading your tweets, understanding the relationship among the knowledge(s) behind the tweets is invaluable for understanding the relationships among your tweets. For example, during a conference you may wish to schedule tweets linking to prerequisite content first, then “major” content second, and then benefits. Or maybe the reverse order! Or maybe in a cycle between the three sorts of content. That’s up to you, based on your strategic educational-marketing(-edutainment?) interests (edumarketainment?), plus gradually accumulated experience with what seems to work best.

In other words, a curriculum, even an informal sketchy outline of a curriculum, is an excellent addition to your health IT social media plan.

There’s also a content marketing angle here. You have to educate your potential customers before they can fully understand your unique value proposition. Engage your internal subject matter experts. Explain you are creating a hypothetical curriculum to help potential customers understand the theory and concepts behind you products. Turn that hidden health IT knowledge gold into public health IT knowledge, value, fame, engagement, and sales. (By the way, the genesis of this idea, of creating a curriculum model to driven content creation and social media efforts came from a conversation at a content marketing conference I attended several years ago.)

Who knows! You may have just founded your company’s corporate university.

Happy curriculuming! (and changing the worlding!)

Here are the topics for the #HITsm tweetchat on Acquiring, managing & disseminating Healthcare Workflow IT Knowledge, hosted by @Shimcode

T1: What are some of your favorite tools & methods for finding, curating, storing and sharing information? #HITsm

T2: What/who are some of your favorite and ‘go to’ resources for health IT information? #HITsm

T3: What are your preferred media, channels and formats for consuming and conveying information? i.e., Google, PDFs w/lots of graphics #HITsm

T4: What are some considerations you make when assessing the validity, reliability and usefulness of information? #HITsm

T5: What are some of the ways you organize and store the information you obtain? #HITsm

@wareFLO On Periscope!


P.S. I know, I need to get rid of the Blab link… just… not yet… 🙁

Healthcare’s ‘Not My Problem’ Problem, Workflow Technology, and Memories of Jess

[Written with respect to the #Kareochat Twitter chat about healthcare’s “Not My Problem” problem, hosted by @TechGuy…]

This blog post has two parts. First is a brief account of my interactions with a beloved member of the Twitter community, who recently passed away after a long illness. She frequently tweeted about her experience with a dysfunctional healthcare system. In the second part I pivot to workflow technology and healthcare’s “Not My Problem” problem.

First, a bit about my own Jess Jacobs connection.

I met Jess in 2013 at Google Glass meetups in Washington, DC. Hardly knowing me, Jess invited me to the zoo (she was like that).

We tweeted about recording dates and times of healthcare events (workflow!).

I also referenced one of her tweets about her “most actionable patient instructions I’ve ever seen” in a blog post called The Workflow Prescription.

I didn’t know Jess well, but she was the kind of person I instantly liked.

Relative to healthcare’s ‘Not My Problem’ culture (to be discussed during 8/18/16 #KareoChat), there most definitely is a workflow angle. Here is a quote from Business Process Management Systems: Strategy and Implementation.

“In the BPM organization, delivering customer value and optimizing process performance are two central goals….This discourages the “not my problem” mentality and the practice of throwing issues over the functional wall.”

From a systems engineering perspective (one of my grad degrees), systems and workflows must be designed so as to not allow problems to disappear between the cracks (handoffs). In a business process framework (what used to be called workflow management systems) “problems” are “tasks”. These tasks are literally represented in the computer, so they can be tracked. If a problem/task is assigned to a person or role, the person or collection of people, cannot say “not my problem.” It IS their problem because the workflow model says it is their problem. The workflow model is a contract-like agreement to participate in, and execute, a workflow or process. If problems/tasks aren’t dealt with, then, because task status is transparent and visible to everyone, both during and after the fact, this is how BPM solves (or at least better manages) the “not my problem” problem.

Tasks also need to be tracked between healthcare organizations. For more information about the kind of interoperability necessary to avoid “Not My Problem” between organizations, see either of my five-part series…

One may object that healthcare’s “Not My Problem” problem is a cultural, not a technological issue. I would argue it is both, and using BPM has important potential affects on organizational culture.

“Visible organizational structures and processes”

Healthcare has historically underinvested in “process-aware” technology, both the older workflow management systems and current business process management systems. Fixing healthcare’s “No My Problem” problem will require a healthy dollop of workflow technology.

Here are the questions for the upcoming #KareoChat tweetchat.

  • Have you seen the “Not My Problem” culture in healthcare? Where and what impact did it have?
  • How can small practices avoid the “Not My Problem” culture that sometimes exists?
  • What can a small practice do to become more patient focused?
  • Will becoming more patient focused be good or bad for a small practice’s business? Why or why not?
  • What can we do to better help chronic patients who are suffering like #UnicornJess suffered?
  • Do we see the “Not My Problem” issue in health IT towards doctors? How?

@wareFLO On Periscope!


P.S. Yeah, I know, I need to get rid of the Blab link. Maybe in a couple posts…