View from the Bridge

Words and Context Matter

Like many people in HIT, science fiction and fact fascinate me. So, I took my wife on an HIT person’s kind of date to see the “stellar” movie Arrival. [You can read on from here without any concerns about spoiler alerts beyond what the movie trailers reveal.] She loved it. Score one for science fiction nerds.

The primary challenge in the movie is how to communicate with aliens (a politically correct term in this situation). The dialog was filled with interesting, thought provoking discussions between the linguist and the scientist who had come to “talk” with the aliens. After the movie, I couldn’t help but smile when I thought about the challenges of communicating in our HIT world today.

Words, collections of words, syntax, messages, concepts, and context are changing rapidly. In 2016, the Oxford English Dictionary (OEM) added 1,200 new words and updated more than 1,000. The OEM also adds abbreviations, acronyms (pronounceable abbreviations such as YOLO), and portmanteau words (one word created by combining 2 or more words, e.g., freemium which is free + premium). Communication is not getting easier. Making matters more complex, HIT has been hijacking terms used by other industries for decades. Boot, Drive, Bus, Cloud, Lake, Phishing (even if it’s spelled differently), and Engagement are not being used the same way as when I was a boy. And terms that we thought we understood are changing. This post will focus on 4 key words and phrases I feel strongly about.


First on my list is the abbreviation that has a great deal of meaning for me, CIO. This abbreviation derives from the phrase Chief Information Officer, and not as many have joked, from “Career is Over”. But the role is undergoing a transformation and many discussions include versioning, e.g., CIO 2.0, to acknowledge the changes. CIOs are important change agents who must learn to embrace change as they encourage others to do the same. Today’s CIO needs to be a contributor in the executive council, not just an invitee, who helps craft the future for clinical, operational, and administrative areas. I know CIOs who have taken on operational responsibility for areas as diverse as marketing, supply chain, and population health, a far cry from the early role as the director of EDP (Electronic Data Processing). Some CIOs are doing business development for their employers both in the States and across the globe.

There are, however, challengers to responsibilities previously associated with CIOs including but not limited to the Chief Digital Officer, the Chief Health Information Officer, and the Chief Data Scientist. Analytics, once a part of IT, is finding new homes in many areas of an enterprise. Innovation labs are being established, some focused on IT, others enabled by it.

Strong CIOs will embrace the changes and seek collaborations to ensure the goals of the Triple Aim. One of my favorite Darwin-like quotes says it well, “…it is not the most intellectual of the species that survives; it is not the strongest that survives; but the species that survives is the one that is able best to adapt and adjust to the changing environment in which it finds itself.” (Leon C. Megginson, 1963)


Despite the success of deploying EHRs (an abbreviation with a wide range of arguable definitions), interoperability is still a major challenge. Part of the problem is the way in which we define it. Hopefully, when you’re exploring, implementing, and supporting interoperability you’ll take a holistic approach and consider the impact that interoperability has on the people and environments in which it is (and should be) happening. If you do a Google search on “define interoperability in healthcare”, you’ll get more than 500,000 sources. Though I discussed interoperability in a previous blog, the key to note here is that interoperability must take into consideration the impact on workflows, or lifeflows if you’re dealing with patients, for both the sender and receiver of the data. Note that content is important but so is context.


The use of this term as a field of study and as an adjective or noun appearing in job titles has exploded. From a Google search for “informatics healthcare” you’ll find, “As defined [in January 2014] by the U.S. National Library of Medicine, health informatics is the interdisciplinary study of the design, development, adoption, and application of IT-based innovations in healthcare services delivery, management, and planning.” This is another area where responsibilities overlap and opportunities abound. The number of Chief Informatics roles is exploding with modifiers such as Clinical, Laboratory, Medical, Nursing, and Pharmacy. Applied and Research are other modifiers.

If you visit, you will see, “The science of informatics is inherently interdisciplinary, drawing on (and contributing to) a large number of other component fields, including computer science, decision science, information science, management science, cognitive science, and organizational theory.” The key here is the word interdisciplinary and the requirements of “drawing on and contributing to.”


Success in HIT and healthcare requires radical collaboration, which I define as selfless interest in the greater good that involves seeking input from and providing support to all participants, considering and attending to the needs of all stakeholders involved in and affected by an activity. No one, no organization succeeds alone. My successes have been based on the support of my family, my community, my nation, my globe, and the efforts of the incredibly talented people who’ve led me, followed me, worked and walked arm-in-arm with me, taught me and learned with me, laughed and cried with me, and met every challenge. Lastly, let’s not forget the importance of Spirit, however you define it. May you be blessed with a life of success.


  1. Interoperability is really not what we’re after. Is it? We’re after predictability. As a clinician, I want and expect some things out of my technology. I want it to work, Every time. I want it to bring value to myself, my colleagues and my patients, Every time. I want to know what I’m getting, how I’m getting it, where am I getting it from, etc. Predicable each and every time.

    The engineering side of me knows that these systems of systems can be interoperable but I submit what we really want is to have them be “interchangeable”. I have 5 different apps on my smart phone regarding my health and links to providers patient portals. Yet, I lack the very thing managing my personal health as my providers do, a single snapshot of the care I’ve been getting. Because these data don’t connect at all, I have to sort through these applications and hand jam them into a spreadsheet to show my docs. All of which doesn’t end up in the “official” medical record. We aren’t yet working on that problem in earnest. We’re still trying to figure out how we connect my system to other systems reliably and invisibly to the provider.

    In some of my speaking engagements, I talk about how medicine’s IT needs usually dissolve into a conversation that equates to medicine being “terminally unique”. A different animal. Terminal uniqueness is a term I coined at UVA where I predicted that the way we see ourselves is so different from other IT modernizations that it will eventually kill off the full impact of such to deliver better care and drive outcomes. The market will still have to sell me on the idea that costs can be reduced in a statistically significant fashion across the board rather than selected use cases. Not buying it wholesale yet.

    Yes, our data is complex, It is rich and axial. Yes, it is safety-centric. But that does not mean our problems are unique. In my office hangs a sign one of my teams had made for me. It reads: “If you want interoperability, just do it my way!”. And therein lies the rub. There can’t be just one way. But the “ways” have to be interchangeable.

    1. I appreciate your point of view. The very frustrations that you mention, which unfortunately are common to all participants in the care continuum, are the reason that I think the definitions of interoperability success must include the element of meaningful interoperability. Thank you for sharing, David

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