Pay for Performance

April 30, 2014

In healthcare, great in theory. In practice, not so much

Measuring quality is hard. It really, really is. P4P requires that it be reasonably easy. They need metrics they can get from everyone without the gathering of data taking too much time or money. But those factors sometimes lead us to measure the things we can easily measure, not the things that matter.

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Private Cloud?

April 30, 2014

I recently read some nonsense about the benefits of a “private cloud”. It’s a good PR line because most people don’t understand the cloud and you can make it sound scary.

Werner Vogels is the CTO at Amazon and has been for a very long time. He knows the cloud and he knows security. I mean he really knows. I’ve blogged about him before.

One of my favorite blog posts from him was written in 2006 about storing credit cards. It’s titled, “You Guard it with Your Life”. In light of everything that has happened lately, remember this was in 2006. Two great quotes:

Credit card information should be kept in a physical secure location separate from your other servers with armed guards in front of it (I am not kidding).

I won’t tell you exactly how we implement our schemes but to get to Amazon customer credit cards you will need a small army of Marines

In 2009 he wrote what is still the best post on “what is the cloud” I’ve seen. He was announcing Amazon’s Virtual Private Cloud, while pointing out that a Private Cloud is not the cloud.

A key quote:

These CIOs know that what is sometimes dubbed “private cloud” does not meet their goal as it does not give them the benefits of the cloud: true elasticity and capex elimination

This may require some explanation. Elasticity is one of the key benefits of the cloud. Origami could double the number of servers we are using in a matter of hours and then scale back down a day later, paying only for what we used. A private cloud cannot do that. “Capex elimination” is CIO speak for capital expenditures, meaning paying for physical servers. Again, if you have a “private cloud” where all resources are dedicated to you, then you are paying for those resources. If it is possible to double your resources quickly and those resources are available to only you, then they are just sitting there and you are paying for them. That’s not the cloud.

Vogels states that the cloud has three key benefits:

  1. Eliminates Cost
  2. Is Elastic
  3. Removes Undifferentiated “Heavy Lifting”

The last point means that operating a data center is a pain in the butt. You have to be an expert on air conditioning, power supplies, flooring, a bunch of stuff that your clients don’t care about. Not having to think about that is a big benefit. That’s the only one of the three that the “private cloud” gives you.

So if your vendor is in a “private cloud” they are not as elastic as they should be and you are paying them more for storage than you should be.

Even Salesforce.com’s Desk product uses Amazon EC2 and touts their security (Salesforce is a leading cloud provider as well). If you have a private cloud, ask if

critical locations have extensive setback and military grade perimeter control berms

They probably don’t know what “berm” means.

People do not understand the cloud. That means other people will try to fool them. Anyone who is touting their “private cloud” is trying to fool you.


Full Stop

April 28, 2014

This headline is three words too long…


Judgmental NYC

April 27, 2014

Via Judgmental Maps. Click to biggify. I live in the Strollers and Bars part of Brooklyn and work in the Artsy Folks section.


Don’t Waste My Time

April 27, 2014

From Doonesbury. “I reject that model”…

(click to enlarge).


More Net Neutrality

April 26, 2014

A good, but long, explanation of the Net Neutrality mess…


Vaccines Rock

April 25, 2014

From the Incidental Economist (which you should read) reporting on CDC findings:

Among 78.6 million children born during 1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses

Averted 732,000 premature deaths. Not trivial.

Vaccination will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented in these birth cohorts.

$402 billion dollars. Again, not so trivial.

Or feel free to listen to Jenny McCarthy. She is, after all, attractive…