Written by Frank Tucker
If you look at the magazines to which I subscribe, you will find two things in common. First, I subscribe to several technology magazines that are both consumer technology and enterprise related. Next, I subscribe to several health magazines that support my profession as a Physician Assistant and Public Health Practitioner/Professor. These magazines are all delivered to me in digital format because I enjoy my tablet’s portability and this option is green. As I curled up to read a new Linux subscription, I asked myself, does this officially make me a geek or was I always one?
Approximately 20 years ago, I got my first computer. If I recall, it was a 486DX266 with 420mb hard drive and 8 Megs of ram. It was running MS Dos 6.x with Windows 3.1. It was top of the line for its day and my first computer. Why did I get it? Simple. Because my supervisor at the time suggested that I get one. After getting it, I asked him what I should do with it. He kindly replied, “Start computing, it will come in handy some day.” I really did not know what that meant, but I did know that I could play some games on it, so I did. Interestingly enough, getting games to work in those days took lots of work: LOTS OF WORK. I recall spending many hours configuring the autoexec.bat and config.sys to get the upper memory (EMM386) and the alternative memory (QEMM386) optimized for games. I must have gone in and reconfigured settings within MS DOS countless times for each game I wanted to play. As games and PC hardware matured, I learned to replace PC components, upgrade drivers and ultimately squeeze every ounce of power out of the computer just to get a decent game play. This was so important to me during that time, that when modems finally got to 56k, I learned to squeeze out every ounce of networking speed by purchasing a second modem to perform dual modem binding for gaming against my friends online. Crazy, right?
After a few years of this, PC gaming lost its luster. In my quest to constantly upgrade, it took time away from actually playing the game. At that point, I had a subscription to Computer Shopper, which was a mammoth of a magazine, several inches thick. I used it to keep up on the coolest, newest hardware and software in order to get the best gaming experience out of my PC. Soon, it was the upgrades that were, in fact, the game. I stopped actually playing the games, as they were not nearly as enjoyable as conquering what I thought could not be done.
At some point, my computer grew pretty old and quite expensive. I asked myself, what should I do now with my computer? Well, I put it to work. I wanted custom software to help me in the Pharmacy, so I began to learn how to program. These programs were designed to track things within the Pharmacy. I tracked everything from topical ointments that I made, like hydrocortisone in ultrasound gel (which was popular back then), to creating prescription forms used across the hospital. It began to really show me its true utility. No longer was it an expensive toy, but an important tool that helped me get work done more efficiently.
Fast forward a few years and now I was a Physician Assistant in the US Army. I spent an enormous amount of time compiling population health based reports for commanders to provide evidence for recommendations. These reports ranged anywhere from the health status of the unit to who was admitted to the hospital. Everything was done on paper which required a records review, logbook review and simply asking the team, “do you remember when…” in order to compile data into a spreadsheet that was put into slide presentation on a weekly basis. It was so frustrating to determine injury or illness rates or to understand whether action was needed. It was so time consuming, that I started trading patient care appointments for more administrative time to do these reports.
In this experience, I learned two things. First, I formally learned about preventive medicine and public health. This included some formal schooling along with hands on experience in everything from field sanitation to research methods to epidemiology. All of this was in an effort to better manage the population, rather than just the individual. Secondly, I learned the value of my supervisor’s statement from a few years before, “start computing, it will come in handy some day.” I wrote a program called MedBase, which was an electronic medical record for the population I served during a time when few Electronic Medical Records existed. It was selfishly designed to help me capture the care I provided within my workflow. By doing so, it automatically produced the reports I needed to better manage the health of the population and advise the commanders.
Soon, I was spending less time compiling data and more time with patient care. Eventually, my commander told other commanders about Medbase and the program grew from just one unit to several units to the entire base. It happened so quickly, that seemingly moments later, I found myself constantly coding, providing updates and taking trouble tickets when I really wanted to spend that time providing patient care. Medbase grew to the point where I needed a team to support the 14 hospitals, including 2 medical centers, using it. The irony was that I had stopped seeing patients and was spending all of my time doing information management, information technology and project management, not only for Medbase, but also for other health related technology programs as well. The program grew arms and legs from feature creep then ultimately portions of it became part of the DoD’s EHR, called AHLTA. I am not going to tell you which parts went into AHLTA because they are the ones with the most bugs! In all seriousness, it was nice to be a part of something that provided value. I do miss the simple utility it served before the feature creep took it over.
I must admit “computing” in those days was simply fun. It was a hobby turned profession, with excitement in every corner as technology exploded with enthusiasm. The lines at the store for the next edition of the Windows Operating System have now changed to lines waiting for the next Apple iPhone. An interesting turn of culture: from enterprise-driven-consumerism to consumer-driven-enterprise. Consumerism has influenced technology so much today that you can see it in the rapid expansion of tablets and the decline of PC sales, not only in your household, but also at your work place. Do not get me wrong, I absolutely love consumerism’s influence in enterprise and technology today. I particularly like how it is driving human factors and industrial engineering into our customer’s greater expectations of usability and simplicity. They deserve the best user experience technology has to offer. Now what to do with that pesky ‘bring your own device policy’? That is another blog article. We are still figuring that one out.
So what did this subscription to a Linux magazine do for me? I have to say it put the fun back into computing. I found myself reading the articles with the same enthusiasm and wide-eyes that I did 20 years ago. Do not get me wrong; Linux itself certainly is not new. But its acceptance in enterprise, consumer technology and usability is relatively new. The technologies we see today that influence so much of what we do from cloud computing to big data to consumer devices like the Android all have their roots in Linux. What makes it so exciting for me is that they were born of innovation through the efforts of the community: absolutely powerful.
What also excites me about this is the philosophy of the blank canvas that Linux and Open Source computing brings. When I stare at the command line (yes, there are also graphical user interfaces) of the Linux servers we have, I can paint the canvas using a palette of useful tools to end up with a landscape of beautiful colors filled with affordability, scalability, extensibility, stability, simplicity and utility. The only limits are my own imagination and, of course, my now mediocre coding skills. If I really want a product to behave in a certain way, I can simply “get in the code” and modify it. As a small company I get the short-lived pleasure of being the CEO, CIO and CTO but those days are numbered. If you listen closely, you can hear the cheers from the MicroHealth Staff for a new CIO/CTO, as I snarl at the thought of me no longer getting my ‘geek on.’
Did Linux and Open Source make me a geek? I think I was always a geek and I am okay with that. But I do think it helped bring the geek back out of me. It has been lying dormant since I have been in management and leadership over the last decade. The beauty of getting back to my geek roots is that I am never disconnected from what these tools should accomplish in the first place: helping to solve issues, be they in health care or in business. In a previous article, I discussed our open source infrastructure along with its proprietary tools and their benefits. I am not saying one is better than the other as the “best athlete” should be chosen based on the mission requirements, total cost of ownership, priorities of the enterprise and what the intended business outcome is for the organization. What I will say is that I am kept current with technology because Linux and Open Source affords me far better access to those technologies. Coupled with cloud technologies like Amazon’s EC2, I am able to “tinker” at a very small budget, but quickly go to scale when it goes to production.
But I digress; we are in the business of health IT and not technology. It is about the utility that technology can bring and the outcome for which an investment was made to ultimately improve health. Although improving health is the most important aspect of what we do, I would argue that it is the geek in me that helps put the public health and patient outcome ideas to reality where technology tools can assist. This is the Innovation arm for which MicroHealth is founded and I am proud to be a part of it.