October 11, 2010
Building an ecosystem
I lived in New Orleans for 10 years going to school at Tulane University (undergraduate, medical, graduate, public health). When you live in New Orleans you are always cognizant of the wetlands that surround the city, a buffer between land and water which cradles a delicate balance of life. A cycle of growth and diversity exists in that space, with a wide spectrum of life. This ecosystem has the capability of not just sustaining life, but also producing a mass of raw nutrients for new growth and buffering harsh storms.
Well, we are now riding out our own “storm” so to speak, as healthcare reform transforms the world around us. Traditional practice models are succumbing to change while payment structures and new entrants to the space are starting to shape the environment. As a healthcare company that strives to deliver clinically appropriate and workflow-enhancing solutions to our clients, Cerner is challenged with the task of standing alongside our clients to help them meet these uncertain challenges. In the past, the metronome of our clients’ environment moved at a much slower pace, and the components of their worlds were well-defined. Given those relatively static parameters, a large-loop development cycle was an effective means of delivering value to our clients with a “one size fits all” solution strategy. But now, with a rapidly changing environment and a much more diverse spectrum of client needs, we have to change our development process.
This brings us back to the ecosystem. Our clients come in a variety of shapes and sizes: large, small, simple, complex. For some, the “out-of-the-box” solution will serve their needs with a minimum amount of customization. For others, the gap is much larger and requires some amalgam of customization and bending of workflows. It is in this gap where many of our future innovations exist. Taking the lead from Williams and Tapscott’s bestselling book Wikinomics and acknowledging that a good number of future successes lie outside of the “four walls” of Cerner; we have to bring our development cycle even closer to our clients, both in the time of delivery of innovation and in the degree of client involvement in development. We are creating the nexus of the development ecosystem. It is one thing to take a requirement from a client and convert it into a specific, precise solution for that client. Borrowing from an old proverb, you went fishing, caught one fish, and fed one man. It is a much greater undertaking, albeit one with a much greater reward for both Cerner and our clients, to both allow and aid a client in the co-development process. Once done, you have not just caught one fish to feed one man, but you have taught someone how to fish. The rewards of this cannot be understated. Beyond the straightforward resolution of a single problem for a client, you have elevated that traditional, static business-client relationship to a highly cyclical, co-development partnership that can produce solutions and innovations that extend far beyond the original client.
How can we do this? Well, it has already started. Beginning with the MPage technology, we opened the door for client development by enabling the ability to make custom, flexible user interfaces. These new interfaces can exist inside a traditional desktop application or be consumed via any web browser, including mobile devices. Numerous clients have learned the technology and are now building their own MPages, some of which are available for general distribution in the uCern store. But this is just the beginning. For some clients and situations, we are exploring the potential of client co-development at the core application level. This development technique has the potential to generate leading-edge, innovative components and applications that truly push boundaries. Bear in mind that this approach of co-development is not limited to traditional Cerner clients. It could also include third party solution providers who see the advantages of partnering with Cerner to produce next-generation interfaces with their solutions and hybrid applications allowing Cerner and third party solutions to work seamlessly side-by-side.
As an engineer, my computer programming skills were “reared” in the LINUX world where “open source” development was the norm. While our evolution of an ecosystem has many of the benefits of that type of development, it will always be an environment that is mentored by Cerner to maintain the focus of this company. Teach. Guide. Learn. These will be the watch words we follow on this journey, and much of this will be on display and in discussion this week at the Cerner Health Conference. I hope to see you there.
John David Larkin Nolen, MD/PhD/MSPH, calls himself “the engineer who went medical school”, and he leads the design and implementation of Cerner’s laboratory solutions and enables the vision of the future of laboratory medicine. He joined Cerner in January 2010 and has been instrumental in guiding the incorporation of new technologies, such as RFID, advanced diagnostics, and integrated reports into current and new Cerner solutions. Prior to joining Cerner, he worked as a medical director in a reference lab and as the medical director of a blood center. He received bachelor’s degrees in electrical engineering and mechanical engineering and cell and molecular biology; a master’s degree in public health; a medical degree and a doctorate in biomedical engineering, all from Tulane University in New Orleans. He completed his pathology residency at Emory University in Atlanta, and subspecialty fellowships at the University of Iowa in Iowa City. Nolen is board certified in pathology with sub-specialty boards in transfusion medicine and hematopathology. He has extensive experience in HLA, coagulation, molecular diagnostics, and informatics and is fluent in multiple computer languages.