IT’s law of frustration strikes every time

There's always someone who's unhappy with an IT decision, says John D Halamka

The first law of thermodynamics tells us that energy is neither created nor destroyed; it is simply converted from one form to another.

For IT professionals, I believe in the first law of project dynamics: Aggravation is neither created nor destroyed; it is simply converted from one project to another.

As CIO of the Harvard Medical School and the Beth Israel Deaconess Medical Centre, I oversee 200 projects a year. Here are a few examples of the Law of Conservation of Aggravation:

1. In 2003, we had a growing problem with spam, and I was receiving many requests each day to implement a centralised spam filter. We initially tried SpamAssassin but found that it didn’t work well in a medical environment. It couldn’t distinguish between advertisements for enlarging body parts and physician referrals to clinics for diseases affecting body parts. We wanted very few false positives, so we implemented Brightmail, now a Symantec product. It has worked well, but I now receive many requests a day to relax the spam filters because they are blocking “important business email” such as eBay receipts, newsletters from professional sports organisations and casual correspondence (Subject: Hi!) from friends and relatives. Aggravation has been conserved.

2. In 2002, Beth Israel Deaconess experienced a network outage that lasted a day and a half after a misperforming application flooded the network and overwhelmed the spanning tree algorithm in our older network gear. In 2003, SQL Slammer and other Microsoft-related security problems caused server downtime. As a result, I spent a year creating highly redundant state-of-the-art networks, server clusters and virtualised central storage. Uptime in the period covering 2004 to the present has exceeded 99.9% for all applications and services.

Of course, on rare occasions, I need to take down an application to upgrade hardware or firmware. But trying to find an acceptable 15-minute window to take down IT services for a large metropolitan hospital is nearly impossible. Sunday at 4am? Trauma patients could be arriving in the ER then. By providing 99.9% reliability, we have made downtime unacceptable. Aggravation has been conserved.

3. In 2006, we implemented electronic prescribing for our clinicians. We replaced unreadable, handwritten and free-text typed instructions (“Take some Tylenol”) with structured, standards-based, secure electronic messaging from doctor to pharmacy. Clinicians welcomed the idea of more accurate, safer medication practices that would require fewer callbacks from pharmacists with questions about handwritten prescriptions.

However, clinicians rapidly discovered that older prescriptions that had been written before the new system was implemented with its requirements for structured prescribing had to be retyped. The computer couldn’t automatically convert “Take some Tylenol” to “Take Tylenol 1-2 tabs every 4-6 hours as needed for pain.” The clinicians wanted both accuracy and ambiguity to be acceptable simultaneously. Aggravation has been conserved.

Writing this has made me feel much better. But will the catharsis of having shared the challenges of being an IT professional lead to less aggravation? Nope. Within 48 hours of this column being published, 25 salespeople will call or email me (note that my email address is published as well) to tell me about their companies’ antispam applications, which can block all bad emails while allowing the email of the eBay/sports/casual variety to get through; or about their highly reliable infrastructure components, which require no maintenance; or about e-prescription systems that do everything for everyone. Some of these emailed sales offers will make it through the spam filter. (Do these folks believe that CIOs have the time to read unsolicited sales emails?) Some salespeople will pester my assistant on the phone to the point that she will whimper in frustration. I have no doubt that aggravation will be conserved!

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