This is an extremely important book, in that I feel Martin accurately distills and describes a few integral pieces of China and the Chinese mindset that are almost universally missed by Western commentators.  These pieces, when placed in the proper context can often combine to explain the more (to Western eyes) puzzling questions about China, events that happen within China, and China’s reactions to external pressures.

One of the reasons why I enjoyed this book is that the author is a master at providing historical context and to illustrate and reinforce his ideas.  With a history as long as China’s this isn’t a small task, but he accurately makes the point that few nations are as cognizant of their history and traditions as China.  Ignoring thousands of years of constant cultural development leads to gross misunderstanding, and is something that is all too easy to do from a Western perspective that’s driven by the acceptance of a Western order that is really only three centuries old.

Jacques begins his book with the relevant facts of how China will most likely overtake the US as the largest economy in the world by 2027, and focuses on the central question of the book: What will a modern world dominated by China look like?  The prevailing thought of most attention paid to China is that capitalism, free markets, and Western style economies inevitably echo Western values of freedom, human rights, democracy, and culture.  In other words, free trade begets free societies.  Not necessarily so in China.

This misguided belief that a swing towards Western style freedom and government is inevitable is a key miscalculation that negatively affects US foreign policy and undermines true understanding of China and the rest of East Asia.

Reasons for China not following the Western model of modernism coalesce around different set of values.  In China, unity and stability is a key value that is reinforced by the strong, hierarchical family unit, the universal acceptance of Confucian thought, and the reality that China is a civilization-state, not a nation state.  The Chinese desire of unity explains the tolerance of the “one state, two systems” approach to Hong Kong, Macau, and Taiwan, and even within the numerous special economic zones found within the country.  This type of duality is almost inconceivable to the West.  Stability is valued highly due to China’s  experiences with turmoil during its history (estimations of 25 million dead during Manchu invasion, 50 million dead during Taiping rebellion, and as many as another 50 million dead during World War II and the ensuing Great Leap Forward and Cultural Revolution), and it’s long experience with a strong central government and its emphasis on a Confucian trained and tested government bureaucracy.  Stability, therefore, is enough of a priority that the Chinese are content with a system that values the group over the individual.

History teaches us that the Chinese civilization has never wavered in it’s attitude of superiority towards outsiders.  Indeed, even when conquered by external invaders, which happened often throughout history, the invading groups (Mongols, Manchus) forsook their own identities and adopted Chinese customs, dress, and language while moving their capitals and governments to China.  Today there is an overwhelming sense among the Chinese that China is finally regaining it’s rightful place in the world as the Middle Kingdom.  Most forget that in the 1800s, the Chinese standard of living was slightly higher per capita than that of Europe.  England had a strong navy and easy access to coal close to its urban centers, China did not.  A crippled and weak end of the Qing dynasty, the Japanese invasion, World War II and the disastrous effects of Communism contributed to a net decrease in China’s GDP between 1820 and 1950.

The idea that modernism must revolve around the Western model is rejected by the examination of how little modernity has affected Chinese politics.  China has always had a strong central government that was paternalistic in nature and was bound to the collective well being of society.  This is unlike Western governments, which have evolved to the point where they exist as a utilitarian entity in exchange for popular support.

Jacques also spends significant time exploring the reasons behind the current Chinese policies towards trade, it’s own citizen’s freedom, and it’s long term goals.  In the light of the many historical and political contributing factors, it’s much easier to understand China’s currency peg (which hurts China more than it hurts the US), it’s continuing support for US debt, and it’s aggressive stance towards opening its own markets.  According to Deng Xiaoping, two things must remain for China to lift its population from poverty: domestic stability and international peace.  Seventy-five percent of China’s economy is accounted for by international trade of some sort, and while this may decrease as China continues to diversify, this is an unprecedented level for a country that is so large.  This precarious balance between its economy and the implicit social bargain (like all Confucian states have) to its citizenry for future standard of living improvement are the key drivers to China’s behavior.

This book isn’t without its faults.  Jacques, like the good Marxist he is, glosses over the disastrous effects of Communism for China’s people and its economy.  Like many intelligentsia (Thomas Friedman and almost any other environmentalist) , he finds himself almost in awe of the incredible power that the Chinese Communist Party has to command policies that he wishes or wants to see implemented.  His exploration of China’s tributary system and it’s possible resurgence in the future is incomplete as it doesn’t resonate well with the Western reader.  Some of the book’s information is outdated or at least could have been updated, and some of the statistics feel as though they’ve been cherry picked.  There also doesn’t seem to be enough credit given to the remarkable lever of capitalism: lifting hundreds of millions of people out of poverty in just thirty years is nothing short of a miracle.

While the overall message of the book is that China will not become the US or a prototypical Western nation-state, this doesn’t mean that the China of today will exactly mirror the China of tomorrow.  It does mean that we shouldn’t prescribe the Western template to China, and should remain mindful of the powerful historical currents that remain in full force for China.

I take a slightly different view.  First, while I think that banks should get involved in the PHR space, I think it should be in a different capacity than simply providing a spot to store or view health data.  Instead, I think that banks should instead focus on being in the identity management business, an “identity broker” if you will, and provide authentication services to any PHR vendor or hospital that might be interested.  If you think about it from the PHR vendor’s perspective, their service increases in value the more confidence they can have in the validity of the identities they serve.  Correctly identified accounts means you can combine them with other data sources (at the account’s request of course) so that the PHR can serve as the hub of a person’s medical data.  Incorrect data is almost impossible to manage or transfer between systems, and serves to defeat the original stated purpose of a PHR.

The financial services industry (read: banks) are one of the few industries that take identity management SERIOUSLY.  Multiple forms of identification are required, addresses are consistently maintained, and people really care about making sure their passwords to their accounts are remembered and treated securely.  Nobody types their username and password to their checking account on their monitor at work, or sends it in an email to their friend who needs it, etc.

If I were a bank, I’d use that asset (the one-time and continuous identity management) and sell it to PHR vendors (again, with the account holder’s consent).  Instead of creating a new account with Google Health, let me authenticate with my Chase username and password, and everyone can feel comfortable.  The PHR can now rest assured it’s got clean data, the account holder trusts Chase and has an interest in maintaining their information.

As for the second prevailing view: banks are the best at financial transactions, my response is, “So what?”  Maybe as some claim, everything in healthcare is a financial transaction (or should be a financial transaction) but that’s like saying lets let Visa and Mastercard determine the price of the car I’m buying.  Banks already process all the financial transactions, and without in depth knowledge of the services being rendered, they’re not going to be able to price, process, or provide transparency to healthcare claims.  A lot of discussion seemed to revolve around the vein of “but we can get paid to move the data” and again, who cares?  If banks really wanted to get involved in the healthcare claims adjudication process, they should invest in technology tools that provide a platform for insurance plans to define and transaction rules related to services and payments.  Not a single bank in the Medical Banking Project (save for one that I talked with) has any desire to do this.  The solution for banks in this area is to get closer to the details, not farther away.  That’s where all the cost savings and the benefit of transparency exists anyway – at the long tail of the bell curve.  Banks should know better anyway, they’ve been preaching this for years.

This year we’ll have a demo of our Sentinel RCM Mobile Manager handheld device.  It’s a device we built on the Symbol MC70 platform and is the first Windows-based product we’ve released.  We were able to leverage some nice libraries that let us provide some really fast searching on large numbers (65,000+) of drugs.  The product provides a lot of functionality for pharmacy users without them having to march back and “tether” their device to a machine or docking station.  Ordering product, checking prices, receiving product, and reconciling inventory can all be done wirelessly.  Catalog updates and software upgrades are downloaded automatically each night when the unit is docked for recharging.

We’re also showing the latest updates to our HealthBIT business intelligence tool.  We’ve seriously upgraded the Report Builder (formerly named Query Builder) functionality which provides a really nice step-by-step graphical method of building reports to access the data we collect for the application.  All you need is a web browser and you can drag and drop your way to assembling really powerful reports, choosing outputs, and then sharing these reports to other users in your organization.

This is my first time visiting Las Vegas and being how I don’t gamble, am married, and promised my wife that I wouldn’t go to any Cirque shows without her until we could come back together, there’s not much for me to do here.  Probably good that I have to go through budgets for next year during downtime.  I have to say the Venetian hotel is really massive by any standard, and the room I’m in is probably the biggest I’ve ever stayed in.  One surprise is the weather: roughly 34 degrees out right now which seems COLD to me for a desert, but what do I know?

Stop by the booth to say hello if you’re interested!

If you’d asked me five years ago if I thought this would be a good approach to take, I would have rather emphatically told you no.  In fact, I resisted it pretty strenuously for quite a while.  You had to be a senior developer, having spent significant time on site (at least a year), and working remote was a reserved privilege.  While we had a few guys working remotely, it wasn’t the majority you see, so Bad Things couldn’t happen, but we still had folks dialing in right from the beginning.  And yet, in hindsight, it may be one of the factors that helps us squeeze more productivity out of our staff, helps them produce higher quality code, and allows us to get the leg up on competition.

For starters, it forced us extremely early on to invest in systems, processes, and a way of working that brought everything we did online.  Project management, change control, bug tracking, issue tracking, source control, testing, collaboration, documentation, document management, communication, all of these things needed to be ubiquitous and consistently used by the entire staff.  If things weren’t accessible online, that meant Bob in Utah wasn’t going to be able to contribute, learn, participate, or even know about it.

The second major factor that a distributed team gives us is a national recruiting footprint.  We’re not just going up against Acme Software in our back yard down here in Fort Lauderdale (South Florida has its own disadvantages for hiring technology workers), we’re getting to compete for the top talent across the US in every job market.  Our pool of potential applicants increases by an order of magnitude or more, which really amps up the talent level and allows us to be super picky.

Third, I recently came across this article recently which was discussing some research from Microsoft, exploring traditional myths about Software Development, and they touched on the fact that distributed teams in their experience don’t have a negative impact on team performance.  They rightly point out that this flies in the face of a “one of the most cherished beliefs of software development” but they also illustrate how any worker would much rather talk to someone knowledgeable on their team 4,000 miles away than a less knowledgeable guy next door.  Makes sense, and it jives with our experience as well, but I can’t say I expected this outcome at first.

Are there drawbacks?  Sure.  It’s nice to have everyone over for a barbeque on a long weekend, and that can’t happen.  It’s fun to walk by and joke with everyone while making the rounds in the morning, and that’s harder to do, but we still manage to interact a good deal as a team.  The flip side is it’s nice for the remote guys to be able to live where they want,  stay in touch with family and friends, and yet still have a great job at a fun company.  This really contributes to retention – we’ve had several guys move several times in the last few years, which I count as a “save” on losing an employee each time.

If you’re considering running your organization’s software teams in a distributed fashion, here’s some things you’ll want to make sure you’ve got covered:

• Excellent communication methods: cell phones, VoIP phones for extension dialing off the corporate network, private instant messaging network, email, and more.
• Organizational Discipline: People in the organization need to understand that they will often be interacting with remote individuals, and that they can’t cherry pick projects to those who are in the office.  Yes, a phone call is not as nice as face-to-face, but often it’s more productive.
• Team-Based Activities are Still Key: This is an easy one for us.  We play video games every Friday afternoon/evening.  Combination of shooters (Team Fortress 2) and other games (DoTA and HoN) and the games are part of the employee start up paperwork.
• Everything Must be Online: Bug tracking, brainstorming, documentation, everything.  A major advantage this gives you is it’s a head start on preparing for audits or other certifications (SAS70, etc.) you might need to complete as an organization as everything will be easily accessible.
• You Still Need to Be Involved: If you like to walk around and say hi to everyone each day like I do in the office, you still need to do it “online” via instant messenger or phone call.
• Figure out if a Satellite Office Makes Sense: We found that we had roughly 5 people clustered in one city, so we sprung for a satellite office.  It’s a cheap thing to do and helps our recruiting in that area.
• One Timezone: We work on US Eastern time.  You can live where you want, but you’re going to work that timezone.  This is critical, in my opinion and while it does mean the guys in California are up at 5AM, it’s not the end of the world and really helps keep things simple from a scheduling and planning perspective, and maintains the ability for quick communication.

It probably isn’t for every organization, but it’s really worked out for us, and it’s definitely something we’ve grown organically and will continue to improve.

When people hear the term “medical banking” they’re often confused, and that confusion doesn’t improve much even among the medical banking project members.  With such a broad scope and so many different vendors and other organizations involved, everyone’s definition seemed to be different.

To pare things down, here’s a few points that most members would agree with:

• Banks specialize in well defined discrete transaction processing coupled with high visibility.
• Healthcare organizations specialize in complex decision making that often requires the distillation of large amount of data into generalized care protocols that are often adjusted based on specific peculiarities.
• Financial organizations are not very well equipped to deal with “creative” or “non-standard” processes or products.  When your only tool for evaluation is a balance sheet, context gets lost very quickly.
• Healthcare organizations face a really large challenge distilling down their very fluid, complex, customizable environment into financial transactions, and as a result, are really bad at providing visibility to anyone involved in the healthcare spectrum (patients, providers, payors, regulators, etc.).
• Trends suggest that patients will become more responsible for costs out of pocket, and combined with rising expectations of online access and visibility, will begin demanding more from healthcare providers.

When you discuss these items with banks, they feel as though they can provide back office support to healthcare institutions and get paid for the transactions that would flow through their already-established networks.  Healthcare providers are generally just desperate to get out of the billing and payment nightmare that has been created for them so they can focus on providing care.

The question is, how?

This questions is particularly challenging when you have the CIO of Vanderbilt University Medical Center, Dr. Bill Stead, one of the Leadership Forum’s keynote speakers say with certainty that “we have no systems or technology available today that can provide what we need.”  Healthcare providers want more information that’s more accurate more quickly comprised of huge volumes of more data.  Banks and consumers want less information that can be presented as a line item on a statement, priced accordingly, and compared to other options quickly.

The key, we all agreed while at the Forum, was a national network for transacting healthcare and financial data.  Where the group didn’t always agree, was whether querying the data in aggregate would be useful.  The bankers in the group pretty much didn’t understand how valuable such analytics could be and how much cost could be wrung from the system by examining the whys behind the transactions.  That’s typical.  Most who haven’t been in healthcare can’t imagine how small variances can introduce magnificent variations in the costs to provide a service or procure a product.  The healthcare entities in the group kept stressing that they wanted to provide the data, but had nowhere to send it and major challenges paying for the applications and training that would facilitate collection of the data.

We’ve got a lot going on right now in the industry, what with the healthcare stimulus (ARRA), an increasing drive by Medicare and Medicaid to introduce pay-for-performance measures and more accurate reporting requirements (example: the Deficit Reduction Act of 2005), and a general push by everyone for better technology and better visibility.  Most of what we covered is too long for a single post, so I’ll continue to post thoughts on the Medical Banking Project over the next few days.

Trust is the new currency that really matters in an increasingly distributed and technically delivered world.  Regardless of whether you’re using a “cloud computing” resource or a more traditionally provided computing resource, you’re relying on that provider to fulfill their commitments and think about preventing disasters.

Implementing good security, good backup strategies, disaster recover planning…these things are all very difficult.  They are even more difficult when you’re talking about the volumes of data (multiple terrabytes, possibly even petabytes) and users (millions) that clouds are designed for.  The good news is that these are all solvable problems.

Here’s what I’d look for in a cloud that I’m using:

• published disaster recovery policy
• independent review of some type of outside auditor (SAS70 or an equivalent)
• published backup strategy
• multi-homed setup (different geographic regions)
• a publicly accessible status page that details system health and open issues.

It looks like in this particular instance a botched SAN upgrade might be to blame.  Not having any backups or a mirrored SAN is really troubling, and even more troubling is the fact that this was the case when the design of the phone is such that it requires the cloud to be up for the phone to retrieve and use any of its contacts, pictures, etc.  Cloud computing isn’t the problem here, but it does make for a grabby headline.

Read about it here.

Update 10/12/2009:

Apparently there were major issues with employees, morale, and the product that Danger was providing was already two years late.  Read some more anonymous details here.

I think there’s a huge market for the displaced college sports fan, and the first person to figure out how to get me a one stop shop for Wolfpack basketball and football wins.  Now, a few things to remember: I am very busy, and making 4 hours a week of my schedule available for two basketball games or one football game means a lot.  I also just want to come back home on a Thursday night and know that my game is being covered, I don’t want to have to think about it too much.

Here are the things I’ve tried, and their limitations:

• ACCSelect – a streaming video service that shows usually non-broadcast games for 10 bucks a month.  The camera work sucks, it’s not HD, the games are bizarre, and often don’t work, and it’s not all games.  Plus, every now and then they put on this ridiculous kid to commentate games and get all the player’s names wrong, etc.
• Slingbox – you still can’t get all the games (those that aren’t shown on TV), and you have to have someone living in a broadcast area that you can depend on.  Depend is the key work as you’re introducing a major weak link into the delivery chain (their internet, the existence of that person to start with, their TV schedule, and even the weather if there’s an ice storm or power outage, etc.)
• Pirated Broadcasts – this is way too much work, and it means trying to find torrents of the game while banners of scantily clad women jump all over the page.  Then you have to wait for it to download.  Then it’s not what you thought it was.  It sucks.
• CBS Sports – this worked OK for March Madness, but it doesn’t get me regular season games.

The killer is, I can’t get the broadcasts even AFTER the season is over, so I can go back and relive a really great season (Philip Rivers’ junior year, culminating in a Gator Bowl win).

Here’s what I’d like and what I’d be willing to pay:

• Netflix style streaming of the event, it can have commercials, but I want to be able to skip them if I’m time delayed.  I’d pay up to 50 bucks a month for this, as long as games were archived for the entire season, so I could re-watch them whenever I choose.  I’d also pay a flat rate of up to 150 bucks for each season.
• A DVD set with each game from the season.  I’d pay up to 100 bucks for this at the end of the season, or I’d pay 10 bucks more per month to get this if it was packaged with the streaming service.  For bonus, throw in a database of the box scores and writeups from the home town paper and you’ve got basically a must-buy gift set that families will have to give their sons and fathers each Christmas or birthday.

I don’t know anything about the content delivery or television business, but it seems like this is a golden opportunity to deliver college sports to fans across the world.  My entire life I’ve lived in spots where I couldn’t watch my favorite teams, and we’re not much more advanced than when I’d check the sports scores in the International Herald Tribune at a nice hotel in Asia.  Sure, now I can read blogs and get recaps, but I can’t WATCH anything or see a game, let alone see it live.  It kills me that so much time and money is spent on bringing TV Shows to fans for free, but nobody hones in on getting all the content owners together, and generating what would be some serious recurring revenue for college sports fans.

Healthcare Cloud Computing Platform