Tom Munnecke

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Background Information

I spent the bulk of my 30-year career as one of the lead software architects for the two largest hospital information systems in the world, the Veteran's Administrations Decentralized Hospital Computer Program (now called VistA), and , as an employee-owner of SAIC, the Department of Defense's Composite Health Care System (CHCS).  I have consulted on health care information systems in Finland, Germany, France, Spain, Japan, Switzerland, England, and Nigeria.  Despite the scale of these systems, they started out as simple, grass-roots systems.  I drew a software architecture diagram in 1978 which depicted a very tiny core based on a single language (MUMPS), 19 commands, and 22 functions. This "getting small in a big way" approach eventually led to the formation of a bureaucratic Underground Railroad.  Looking back over 26 years, this has given me lots of lessons learned about large organizations, scalability, evolutionary systems, and information technology. This system is still evolving into an open source hospital information system called World Vista.

In the early 1990's, I started having nagging doubts that automating health care systems in their current form were actually improving our health.  I suspected that the perverse incentives in many of our systems were so great, that using computers to make them more efficient would only make them get worse faster.  This kind of thought, however, was a somewhat of a career limiting mode of behavior.  I began to look around at other ways of looking at the foundations of our health care system.

In the early 1990's, I was deeply influenced by complexity thinking at the Santa Fe Institute and met (Sir) Tim Berners-Lee as he was inventing the World Wide Web.  Tim's invention of the web was amazingly simple:  "What was often difficult for people to understand about the design of the web was that there was nothing else beyond URLs, HTTP, and HTML.  There was no central computer “controlling” the web, no single network on which these protocols worked, not even an organization anywhere that “ran” the Web."  This influenced my thinking greatly - if the web could explode from such humble beginnings, are there simple things that we can do now to make the world a better place?  Is it possible to create a virtuous circle, in which good things trigger more good things?

I got involved with Dee Hock and his chaordic principles in a health care reform effort called Vvaleo, which also introduced me to the work of David Cooperrider and his ideas about Appreciative Inquiry. I learned from the Vvaleo activity that it isn't productive to gather industry insiders and ask them how to disintermediate themselves.  I learned a lot the value of focusing on the positive, life-affirming aspects of communication.