Major League Baseball in the USA is heading towards the World Series, currently four teams are battling it out in the League Championship Series (LCS) to determine who will move on to the Fall Classic.* This is my first post-season where I am following almost exclusively via news reports and blogs. I would be able to watch or listen to the games, except for the time difference and that our Internet connection is not fast enough (or reliable enough) to follow.**
* I started writing this piece just as the LCS started, so at the time there were four teams. I put this piece aside until this morning and the news reports that the Texas Rangers have defeated the Yankees. This is the first time Texas is going to the World Series. Congratulations
* Of course, that my favorite team, the New York Mets, have been mired in a few year slump and are not in the post-season gives me less motivation to seek out and watch. I am pulling for both Texas and the Giants so as to spare another New York-Philly World Series, which is the worst possible of all possibilities.
I do miss baseball very much (even with the Mets being out of things) and because of this I went ahead and purchased the Ken Burns PBS series Baseball through iTunes. It is nice because it does include the latest episode as well. I recall seeing parts of the series when it first aired in 1994, at that time I was living in Honolulu, Hawaii and I felt lucky if I could see an episode here or there. I have never really watched the whole thing. I generally like the series and I think baseball history is a great topic.*
* I like the series even though I am aware that folks have pointed out numerous errors with it. I can live with the mistakes generally, well I am happy to overlook them. I've noticed a few of them, but what I have picked up on doesn't really diminish things.
Watching some of the early episodes makes me wish it were possible to go back and watch some of the old players in their prime playing the game. It would be fantastic to see Cobb, Ruth, Mathewson, Robinson, Mays, Arron all in their prime. I am happy that so much of the recent history of the game has been preserved, it is possible to go back and watch many games played in the last 40-50 years.*
* It would be nice if I could to do this on my computer over a fast network here in Kenya. The fast network being the big problem.
So even though I cannot watch much of the playoffs, I am managing to get my fill of baseball. It will tied me over until next season, who knows by then we may actually have enough bandwidth for me to watch the games live and online.
Saturday, October 23, 2010
Sunday, October 17, 2010
Reliable Power
On Friday, I visited the AMPATH clinic at Busia, near the border of Uganda and about 3 hours away by car. The trip was a bit bumpy on the way out, my Kenyan colleague noted that driving in Kenya was more of a sport. I thought it a pretty apt description, to drive here is to be constantly on the lookout for any type of road hazard.
The reason for the trip was to assess some power issues the site has been experiencing. By power problems, we are talking power outages, surges and brown outs. This is causing all manner of troubles with our server and PC equipment at the site. The worst part, each time something major happens, it usually involves having to dispatch on our team to repair and restore the hardware. This can take from 1-2 days given the severity of the problems. So, though we are not electrical guys, we have a vested interest in solving the issues in short order. At the very least, we need to protect our assets and our time.
In the course of the morning we learned quite a bit. The problems are numerous and they need to be addressed.* The mains between buildings seemed to be inadequate for the tasks, there wasn't proper grounding in most buildings, shorts seemed to be happening everywhere. In addition, the power being supplied by the local power company seemed to have issues as well. The sad part is that folks here have somehow accepted this as normal and there has been little action on repairing the problems.**
* Again I'm no electrician, but no way some of the electrical work should have passed code (in any country).
** Their solution has been to run the generator almost all the time. The generators are in place mainly as a backup, and in that capacity they do a great job. However, it appears that at the Busia site, the generators are seen as being more than a backup solution, almost another primary source of power.
We were able to meet with a few administrators, shared our concerns and agreed to work together to address the concerns. It will be interesting to see how things will work out in the coming weeks. We did agree to return to Busia in a couple of weeks to follow up. I'm optimistic generally and I hope this all works out. In any event, I'll keep everyone posted, like to keep you all riveted!
The reason for the trip was to assess some power issues the site has been experiencing. By power problems, we are talking power outages, surges and brown outs. This is causing all manner of troubles with our server and PC equipment at the site. The worst part, each time something major happens, it usually involves having to dispatch on our team to repair and restore the hardware. This can take from 1-2 days given the severity of the problems. So, though we are not electrical guys, we have a vested interest in solving the issues in short order. At the very least, we need to protect our assets and our time.
In the course of the morning we learned quite a bit. The problems are numerous and they need to be addressed.* The mains between buildings seemed to be inadequate for the tasks, there wasn't proper grounding in most buildings, shorts seemed to be happening everywhere. In addition, the power being supplied by the local power company seemed to have issues as well. The sad part is that folks here have somehow accepted this as normal and there has been little action on repairing the problems.**
* Again I'm no electrician, but no way some of the electrical work should have passed code (in any country).
** Their solution has been to run the generator almost all the time. The generators are in place mainly as a backup, and in that capacity they do a great job. However, it appears that at the Busia site, the generators are seen as being more than a backup solution, almost another primary source of power.
We were able to meet with a few administrators, shared our concerns and agreed to work together to address the concerns. It will be interesting to see how things will work out in the coming weeks. We did agree to return to Busia in a couple of weeks to follow up. I'm optimistic generally and I hope this all works out. In any event, I'll keep everyone posted, like to keep you all riveted!
Update on My Clavicle
I went in for an x-ray and then to see the doctor this past week. The x-ray did not reveal much, but I was told it sometimes takes up to six weeks to see results. The good news was that things are healing, the clavicle was no longer moving about freely. Positives right!
The good news is that I don't have to wear a sling when I am at home and I am beginning rehab. The rehab exercises are mostly range of motion type things. I can work up to where I feel pain. The old "doctor it hurts when I do this, the doctor replies 'then don't do it'"treatment.
It feels good to be out of the sling, if even for a little while.* I have no idea when I'll be cleared to take part in real physical activity again. My guess is that I should be cleared sometime in January. Feeling a little better overall.
* I still need to wear the sling when I travel about. Just for protection.
The good news is that I don't have to wear a sling when I am at home and I am beginning rehab. The rehab exercises are mostly range of motion type things. I can work up to where I feel pain. The old "doctor it hurts when I do this, the doctor replies 'then don't do it'"treatment.
It feels good to be out of the sling, if even for a little while.* I have no idea when I'll be cleared to take part in real physical activity again. My guess is that I should be cleared sometime in January. Feeling a little better overall.
* I still need to wear the sling when I travel about. Just for protection.
Thursday, October 14, 2010
One Stop for IT Help
As I mentioned previously, we have started implementing our service desk here at AMPATH. It is very very basic right now, but I see it as a very critical aspect of the ISC operations. For most IT operations, a service desk is a no brainer and there are great reasons for it. For one, it provides a central point of customer care our users. We can let everyone know where to go and how to get help. It makes it easy for end-user, they don't have to guess about where to go for help.*
* Of course, we need to publicize and make people aware of this new service. It won't do much good if our users don't use this service.
Another great reason to have a service desk is it's role in helping use improve our service delivery. This is done as a result of the information the service desk provides. By using metrics and measurement, the reports generated from service desk utilization will provide critical operations information that we can then use to better plan and address our needs. The numbers will also be used as part of our service level management.
As I said, the service desk at this point is very basic, we have literally a desk, a PC, a phone and an intern. That intern will be responsible to receive and log help requests and then forward them to the appropriate person. The next feature that will be added is a ticket system and that should be online within a week. We thought about waiting until the ticket system is online to start the service desk, but you know what, it doesn't really matter. Just starting it is the key, we knew it was going to be perfect on day one.
* Of course, we need to publicize and make people aware of this new service. It won't do much good if our users don't use this service.
Another great reason to have a service desk is it's role in helping use improve our service delivery. This is done as a result of the information the service desk provides. By using metrics and measurement, the reports generated from service desk utilization will provide critical operations information that we can then use to better plan and address our needs. The numbers will also be used as part of our service level management.
As I said, the service desk at this point is very basic, we have literally a desk, a PC, a phone and an intern. That intern will be responsible to receive and log help requests and then forward them to the appropriate person. The next feature that will be added is a ticket system and that should be online within a week. We thought about waiting until the ticket system is online to start the service desk, but you know what, it doesn't really matter. Just starting it is the key, we knew it was going to be perfect on day one.
Tuesday, October 12, 2010
Service Design
We have begun to implement certain aspects of ITIL here at AMPATH. So far we are implementing a new service desk and we have started focusing on the ITIL concept of Service Design. Service Design is a way of designing IT services for our end-users as well as our stakeholders. The goal is to deliver a cost-effective, flexible, efficient, and usable service from the point of view our end-users and stakeholders (our “customers”). The outcome of Service Design is something that the project development team can take and begin to implement.
This is new to everyone at AMPATH and though we have a good sense of what we want to do, we do expect to make a number of mistakes along the way. The plan is to constantly evaluate our Service Design implementation and refine things as we go. This is a process.*
* I have read that some people criticize ITIL as being too rigid. I disagree and find the counter to this argument to be more in tune with our approach. The counter-argument states that ITIL is simply a set of best practices that each organization should tailor to their needs. ITIL is a set of guidelines and not something carved in stone.
To achieve our ends, Service Design requires that our ISC group work closely with our “customers” to develop the IT service. We must understand exactly what they need, their requirements and we must do so in their language and not the language of IT. The process is based on developing relationships and fostering good communication. It is critical that both sides understand the expectations from the start and through out the entire service lifecycle.
The first real service to be developed using this model will support the AMPATH Nutrition Program.* We held our first real "Service Design" meeting today and I think it was a shock to Nutrition folks. When we explained to them that we will be working for them, they really seemed flabbergasted and had a hard time fully understanding exactly what we were saying. I honestly don't believe anyone has ever approached their group in such a way, we explained that we really need to understand their needs from their point of view and that this was critical to provide them with a service that they could actually use.
* The nutrition program helps provide food for qualified AMPATH patients. The program manages food inventory, distribution, and delivery. The program is actually a part of clinical care here at AMPATH.
It was a little amusing and made me think about how projects (not just IT projects) are developed and delivered.* How often do we actually take into consideration the end-user'a wants and needs.** I think back to other projects I have been involved with and how often we worked with the end-users during the design and development process. Truth is, we did not spend enough time.
* It also reminded me of some good friends of mine and their experiences in having their house built. It seems that they were not qualified to know what they wanted. The architects however were more experienced in such things.
** This takes me back a bit to my previous conversation with the Director. He wants the EHR that we have developed at AMPATH at his hospital. I wonder how many of the medical professionals want it and how many would use it if they were not part of the implementation process.
This is new to everyone at AMPATH and though we have a good sense of what we want to do, we do expect to make a number of mistakes along the way. The plan is to constantly evaluate our Service Design implementation and refine things as we go. This is a process.*
* I have read that some people criticize ITIL as being too rigid. I disagree and find the counter to this argument to be more in tune with our approach. The counter-argument states that ITIL is simply a set of best practices that each organization should tailor to their needs. ITIL is a set of guidelines and not something carved in stone.
To achieve our ends, Service Design requires that our ISC group work closely with our “customers” to develop the IT service. We must understand exactly what they need, their requirements and we must do so in their language and not the language of IT. The process is based on developing relationships and fostering good communication. It is critical that both sides understand the expectations from the start and through out the entire service lifecycle.
The first real service to be developed using this model will support the AMPATH Nutrition Program.* We held our first real "Service Design" meeting today and I think it was a shock to Nutrition folks. When we explained to them that we will be working for them, they really seemed flabbergasted and had a hard time fully understanding exactly what we were saying. I honestly don't believe anyone has ever approached their group in such a way, we explained that we really need to understand their needs from their point of view and that this was critical to provide them with a service that they could actually use.
* The nutrition program helps provide food for qualified AMPATH patients. The program manages food inventory, distribution, and delivery. The program is actually a part of clinical care here at AMPATH.
It was a little amusing and made me think about how projects (not just IT projects) are developed and delivered.* How often do we actually take into consideration the end-user'a wants and needs.** I think back to other projects I have been involved with and how often we worked with the end-users during the design and development process. Truth is, we did not spend enough time.
* It also reminded me of some good friends of mine and their experiences in having their house built. It seems that they were not qualified to know what they wanted. The architects however were more experienced in such things.
** This takes me back a bit to my previous conversation with the Director. He wants the EHR that we have developed at AMPATH at his hospital. I wonder how many of the medical professionals want it and how many would use it if they were not part of the implementation process.
Sunday, October 3, 2010
Delivering Value in IT
I had a meeting recently with the Director of Moi Teaching and Referral Hospital (MTRH).* We discussed a number of things, mostly though, it was a conversation about his frustrations and the inefficiencies with his organization.
* A little background or reminder. AMPATH is an academic partnership between MTRH, Moi University, Indiana University-Perdue University Indianapolis (IUPUI), and a host of other US and Canadian universities. There is no formal AMPATH organization per se. AMPATH exists as a way for academic institutions to organize and partner together with the goal of providing access to health care (the PATH part of AMPATH).
When the time came to discuss the situation with IT at MTRH, the Director was extremely disappointed and quite frustrated with the level of service he was receiving from his close to 60 member IT team.*
* MTRH IT is separate from the AMPATH ISC. Generally, people around AMPATH, MTRH and Moi University are quite impressed of the job being done by AMPATH ISC. Our 7 member team really do an amazing job managing things here.
For example, the Director made mention of a computer system used in one of the wards that was down for more than three months simply because the mouse was broken. In another example, he was dismayed to see members of the IT staff sitting around playing cards or walking up to the cafeteria during work hours for coffee. He wondered why he was paying these people when it seems like they did nothing at all. At one point, he asked the Kenyan colleague of mine what he learned in college, the Kenyan colleague was a little flabbergasted and didn't really know how to answer the question. So the Director answered it for him, “you were taught how to think creatively.”
At one point, he mentioned that he was so tempted to fire all of them and start over with a new team. Whether or not he was serious about this threat is unknown to me (he could actually do it if he wanted). However, I can understand the frustration expressed by the Director, if I was in his position, I would be equally as frustrated and might want to fire my team as well.
* A little background or reminder. AMPATH is an academic partnership between MTRH, Moi University, Indiana University-Perdue University Indianapolis (IUPUI), and a host of other US and Canadian universities. There is no formal AMPATH organization per se. AMPATH exists as a way for academic institutions to organize and partner together with the goal of providing access to health care (the PATH part of AMPATH).
When the time came to discuss the situation with IT at MTRH, the Director was extremely disappointed and quite frustrated with the level of service he was receiving from his close to 60 member IT team.*
* MTRH IT is separate from the AMPATH ISC. Generally, people around AMPATH, MTRH and Moi University are quite impressed of the job being done by AMPATH ISC. Our 7 member team really do an amazing job managing things here.
For example, the Director made mention of a computer system used in one of the wards that was down for more than three months simply because the mouse was broken. In another example, he was dismayed to see members of the IT staff sitting around playing cards or walking up to the cafeteria during work hours for coffee. He wondered why he was paying these people when it seems like they did nothing at all. At one point, he asked the Kenyan colleague of mine what he learned in college, the Kenyan colleague was a little flabbergasted and didn't really know how to answer the question. So the Director answered it for him, “you were taught how to think creatively.”
At one point, he mentioned that he was so tempted to fire all of them and start over with a new team. Whether or not he was serious about this threat is unknown to me (he could actually do it if he wanted). However, I can understand the frustration expressed by the Director, if I was in his position, I would be equally as frustrated and might want to fire my team as well.
I continually remind the AMPATH ISC group about the importance of delivering value to the organization, if they can do this the organization will see them as a valued asset, an important part of an AMPATH. In addition, I constantly hammer home the notion that the last thing the ISC team needs is for management to question “why are we paying these guys.” Clearly, the MTRH Director is feeling this way right now, he is questioning the value of and why he is paying his IT team and if you are the IT Director at MTRH you are definitely not a good position. I met earlier with the IT Director and I don't believe he is aware of how tenuous his position is.*
* I do plan to talk with the IT Director at MTRH and let him know the situation and I will work with him to help improve overall IT operations. It remains to be seen whether or not he will execute and perform up to expectations.
How do you deliver value in IT? Well the easy answer is, deliver cost-efficient, flexible, responsive services that meet the needs of and help drive the organization. How you actually do this really depends on your organization, again the devil is in the details. Here it AMPATH we are beginning to refocus and reorganize the IT operations with an eye towards IT service management. Our role right now is first and foremost to deliver services in a reliable fashion to the healthcare providers and to be as a partner in the ongoing efforts here in Eldoret.
We are at the start of our journey and there is much to do. One initial initiative began last week with the implementation of a new IT service desk. We want to give our users a place to go when they need IT help and provide for them a one-stop place where they can turn in time of need. Were starting out very simply with just a ticket system, a central e-mail address, and phone number. My hope is that our service desk will grow to the point where we can be more proactive when it comes to supporting IT efforts at AMPATH. I do believe that this small effort will deliver value and and our end-users will appreciate our efforts.
Clavicle debacle
Sorry again for the long delay between posts, things have been really busy here and it left me little time to think about writing let alone actually taking time to write. Add to this and unfortunate event that occurred on September 19th when I fractured my clavicle while playing soccer with some colleagues and some Kenyans. A truly painful event, but fortunately I had doctors around me who were quick to help and get me the proper treatment.* The fracture has put my right arm in a sling and I'm to stay in this predicament for about six weeks. Being in the sling forces me to type most things with one hand, and let me say for the record, that one-handed typing is no fun. All-in-all, I have been in no mood to write.
* A work on Kenyan health care. I didn't spend much time in the system, there are enough Western Doctors here that they were able to diagnose and get me the proper X-rays. We also sent the copies of the film to Orthopedic Surgeons in the US (both in Indianapolis and New York) for additional consultation. I will say one thing, I have had three X-rays taken here and so far I've spent less than $20 US for all three. Actually, I spent less than a co-pay for the X-rays.
The timing of the fracture was unfortunate, I was starting to write the ISC strategic plan. Given the difficulties with typing I decided to look into dictation software for the Mac. I was well aware of Dragon NaturallySpeaking, but I was not sure if the folks at Dragon produced a similar title for the Mac. Fortunately, there is Dragon Dictate for the Mac and as a bonus I could buy electronic version and not have to worry about having a CD or DVD shipped to me.* Of course, as with many things in Kenya, actually getting the software and the necessary equipment to make everything work was not going to be an easy thing.
* Having things shipped from the US to Eldoret is nowhere near as easy as having something shipped from Indianapolis to New York. First off, it could take upwards of a few weeks for anything to arrive via international shipping. Then there are always issues with customs here in Kenya and that can cause further delay.** Finally, once the item has arrived in Kenya and cleared customs, there is still the challenge of getting the item from Nairobi to Eldoret and the additional issue of getting the item to where I live. With the last part, you should know that street addresses, though they exist to some degree, are not as formalized as they are in the US. There are street names here, but I have been unable to figure out if actual address numbers even exist.
** We recently have some android phones shipped out from Indianapolis via DHL. AMPATH is being helped by the folks at DHL, whereby DHL will help ship items to Eldoret for little or no cost. They also agreed to help deal with customs related issues to help us move equipment and supplies fairly quickly and with little hassle. Unfortunately, in practice this doesn't always work out as planned. The phones that were shipped took less than four days to move between Indianapolis and Nairobi and have been stuck in the customs process for more than 10 day.
The first step in getting dictation software was actually being able to download the software. As I said, I purchased the electronic version of DragonDictate and I hoped to simply download the software even if it took a few hours to do so. Unfortunately, it seems like the folks at Dragon block downloads to certain places like Africa. So, I had to enlist the help of a colleague at the Regenstrief Institute to download the software and posted up on one of our temporary download server servers. I next had to transfer the software to one of the AMPATH servers and finally transfer the software to a USB flash drive.*
* The Internet service that we currently have is incredibly slow, I'm talking mid-90s modem slow. To transfer the software directly to my laptop at home would have taken close to 15 hours. I do understand that the file size was fairly large (1.5 GB), but it only took three hours to download the software to our AMPATH server.
So now, with software and hand I had to overcome next major hurdle. And that was to find a suitable headset to work with Dragon dictate. This proved to be pretty much impossible, though some stores sold computer headsets, none of those headsets were quite good enough for what I needed. This resulted in me having to order the proper headset, have it shipped to Indianapolis and then make arrangements to have it transported here to Eldoret. I was faced with having to wait at least 2 to 3 weeks for the headset to arrive and see my productivity shot to hell. Fortunately, a colleague happened to have a headset that met specifications, let me borrow it and now I am able to get some work done. I'm using Dragon Dictate to write this blog, I've not yet mastered it, but it does generally work beyond my expectations.
Things are not always easy here, and quite often, to quote the Rolling Stones, “you can't always get what you want.” Fortunately however, the rest of the lyric (“if you try sometime, you find, you get what you need”) also holds true.
For now, I will spend some time learning the software, hopefully catch up with my work, and get some more time to write about things here on this blog.
 |
| My Broken Right Clavicle |
The timing of the fracture was unfortunate, I was starting to write the ISC strategic plan. Given the difficulties with typing I decided to look into dictation software for the Mac. I was well aware of Dragon NaturallySpeaking, but I was not sure if the folks at Dragon produced a similar title for the Mac. Fortunately, there is Dragon Dictate for the Mac and as a bonus I could buy electronic version and not have to worry about having a CD or DVD shipped to me.* Of course, as with many things in Kenya, actually getting the software and the necessary equipment to make everything work was not going to be an easy thing.
* Having things shipped from the US to Eldoret is nowhere near as easy as having something shipped from Indianapolis to New York. First off, it could take upwards of a few weeks for anything to arrive via international shipping. Then there are always issues with customs here in Kenya and that can cause further delay.** Finally, once the item has arrived in Kenya and cleared customs, there is still the challenge of getting the item from Nairobi to Eldoret and the additional issue of getting the item to where I live. With the last part, you should know that street addresses, though they exist to some degree, are not as formalized as they are in the US. There are street names here, but I have been unable to figure out if actual address numbers even exist.
** We recently have some android phones shipped out from Indianapolis via DHL. AMPATH is being helped by the folks at DHL, whereby DHL will help ship items to Eldoret for little or no cost. They also agreed to help deal with customs related issues to help us move equipment and supplies fairly quickly and with little hassle. Unfortunately, in practice this doesn't always work out as planned. The phones that were shipped took less than four days to move between Indianapolis and Nairobi and have been stuck in the customs process for more than 10 day.
The first step in getting dictation software was actually being able to download the software. As I said, I purchased the electronic version of DragonDictate and I hoped to simply download the software even if it took a few hours to do so. Unfortunately, it seems like the folks at Dragon block downloads to certain places like Africa. So, I had to enlist the help of a colleague at the Regenstrief Institute to download the software and posted up on one of our temporary download server servers. I next had to transfer the software to one of the AMPATH servers and finally transfer the software to a USB flash drive.*
* The Internet service that we currently have is incredibly slow, I'm talking mid-90s modem slow. To transfer the software directly to my laptop at home would have taken close to 15 hours. I do understand that the file size was fairly large (1.5 GB), but it only took three hours to download the software to our AMPATH server.
So now, with software and hand I had to overcome next major hurdle. And that was to find a suitable headset to work with Dragon dictate. This proved to be pretty much impossible, though some stores sold computer headsets, none of those headsets were quite good enough for what I needed. This resulted in me having to order the proper headset, have it shipped to Indianapolis and then make arrangements to have it transported here to Eldoret. I was faced with having to wait at least 2 to 3 weeks for the headset to arrive and see my productivity shot to hell. Fortunately, a colleague happened to have a headset that met specifications, let me borrow it and now I am able to get some work done. I'm using Dragon Dictate to write this blog, I've not yet mastered it, but it does generally work beyond my expectations.
Things are not always easy here, and quite often, to quote the Rolling Stones, “you can't always get what you want.” Fortunately however, the rest of the lyric (“if you try sometime, you find, you get what you need”) also holds true.
For now, I will spend some time learning the software, hopefully catch up with my work, and get some more time to write about things here on this blog.
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