Book Review: The Big Short by Michael Lewis

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This is a fascinating book about the financial crises that hit the U.S. economy full force in 2008. Describing the many people and institutions involved, Lewis eloquently presents the complex system of calculation errors, lack of attention, and greed that drove the collapse. At the time a few people kept asking questions and challenging the assumptions, in fact these people purchased insurance that the real estate loans would default. These few people were immensely rewarded for their insight, a bittersweet reward seeing the loss on the other side of the equation. Lewis does a great job teaching the reader the complex configuration of the sub-prime mortgages and bond structuring. He has a way of making the reader feel smarter after reading his explanations.

Lewis unfolds this account through the views of three hedge fund managers. These individuals are not big players in the financial market, yet they were part of a very small group of people who saw the fallacy in the situation. The book introduces Steve Eisman, a Wall Street regular whose reputation for rudeness and social ineptitude was renown. People braced for his insults and endured his criticism of the sub-prime mortgage structure from the very beginning. Another individual introduced in the book is Michael Burry. Burry’s education was as a physician, but his knack for researching and picking stocks led him to investing. Later he learns he has Asperser’s Syndrome, accounting for his antisocial behavior. Through his diligence and quest for value investments, Burry becomes the first to purchase insurance against the mortgage defaults. Greg Lippman is a Wall Street salesman and promoter of purchases insurance against the collapse, seeing how the structure was not sustainable. The last group is a young hedge fund company in California, owned by Charlie Ledley, Jamie Mai and Ben Hockett. They stumble onto the opportunity and question why no one else sees it as they do. All of these players become wildly rich with the fall of the financial market. Getting rich in this manner is something that Lewis describes as difficult for them because of the devastation that occurred.

A book like this provides a number of lessons for its reader. Clearly the reader learns about real estate, mortgages, and the financial business of re-packaging mortgages for investors. For me this was fascinating and answered a number of questions I had regarding the recession and the sub-prime mortgage market. However the bigger lesson is on leadership. As leaders we have to understand how our organizations work, what is the underlying mechanism for what we do, and they way the company fits into the community. In addition we need to attend to the people who question the foundation. That is not to say that every question is accurate or should cause the organization to change course. However, we cannot disregard rational thought. I was impressed by the diligence of research these people had in understanding companies before they made investments. We need to do the same with our own companies; understand what is really happening. I will dig deeper in the future.

Book Review: Subliminal by Mlodinow

Book Review: Subliminal by Leonard Mlodinow

Another wonderful book by this author, this time providing the research behind our unconscious behaviors. Written in a manner that doesn’t scream physicist, Miodinow makes the scientific research approachable and practical. This book helps leaders understand how our minds fill in the blanks or blind spots in our knowledge. Just like the blind spot in our vision, we will “make up” what we don’t know and incorporate this into what we believe are facts. Additionally we have skills, such as facial recognition, that works below our active thinking. The unconscious skills create certainty in what we know and do, which we cannot explain to other people.  However, we can be led astray. The first part of the book focuses on the subconscious of the individual and the second part how the subconscious influences social interactions.

Knowing how we can mislead ourselves is important in being clear as a leader. In a research study discussed in Miodinow’s book, what someone saw or heard before they made a choice influenced their answer to something else. We seem to carry information forward without meaning to do so. This makes me think about agendas and structured questions and how important it is to consider how one topic will influence the next.

If you are concerned about reading a book on psychic mumbo-jumbo, don’t worry. This book is written entirely on scientific fact. You are likely to finish the book thinking there is more going on below our awareness than you thought.  I recommend this book to leaders who want to better understand their teams as social structures with both conscious and unconscious behaviors.

The buzz word: Interoperability

Interoperability for EHR is a complex nut to crack. As I am becoming more knowledgeable about the topic it is apparent that a number of really smart people are making some progress on providing solutions, and there is still a lot of work to be done. That being said, it is helpful to see where we are right now.

What does interoperability mean? As defined by eHealth Initiative, it is the ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed. (Reference: http://www.ehealthinitiative.org/).

Right now there are two forms of interoperability. They are differentiated by how the data is initiated; one is initiated by a push and the other a pull. In the push initiated form, a provider will see a patient and “push” the information to another provider. This push is an encrypted message sent over the internet. Some organizations call this a Direct operation. The push form is inexpensive and many providers have the capabilities for this type of interoperability through their secure email systems. A challenge with this form is that the receiving provider does not know the message is being sent until it arrives and may not need or expect the information. In addition, the message may not contain the health information necessary for the care of the patient, or it may not be timely. The second form of interoperability tries to solve these challenges.

The second form of interoperability is initiated by a pull of information. A provider is looking for information on a particular patient and “pulls” it out of the available EHR systems. Through a health information exchange (HIE) a query checks for the existence of data and if present pulls it back. To do this EHRs have to follow standard data and technical specifications plus the providers have to use interfaces to translate the data to the HIE. To make pulled data timely to the provider, many organizations need to be connected to the HIE. The challenges to connectivity are many including duplication of records, ability to handle an opt-out process for patients, integration into the EHR so providers can access the information without going to a separate system, and ease of use. Despite these challenges progress is being made toward the goals.

The federal government has had interoperability in its priorities for a long time. Beginning with the Department of Health and Human Services goals under the Bush administration in 2004, Health Information Technology has been a priority. Now that objective is applied into the world of EHR. Minnesota has an interoperability mandate of 2015. This is putting pressure on the software vendors, HIE systems, and providers to find solutions. As I stated, there are some really smart people working on this challenge and I believe we will get there because it is in the best interest for the patient.