Agile or just lazy?

When I first came across Agile it was 2007 and I was given a set of reasonably well-defined requirements and a team of developers and a mandate to create an app to solve a problem. Prior to this I was familiar with iterative methods like DSDM that date back to the 1990s, and I had responded to a few large requirements specifications in my role as Key Account. And now I was in new territory, one which I initially interpreted as “more power to the team” (sw developers) and less to the “bureaucrats”. I haven´t really changed my mind.

Agile can be seen as a reaction to the old paradigm of requirements, waterfall, and final testing, with all its cost-overruns and “failed” projects. Agile gives more power to the team, and what we have now is explicitly a running negotiation between the customer and the supplier. This may be a good thing. The realities of software development are what they are – we might as well face them square on, rather than pretend that all will be well if we apply sufficient amounts of old-school professional project management.

So what seems to be the problem? Software is a the same time malleable and rigid. If you apply a little pressure, it yields, and you can often see small changes. But if you apply large pressure to effect large changes, you find that this takes a lot of time and effort. Basic design assumptions permeate the system. A key element, often given little attention, is the information model. Often when we change a “system”, we are actually changing the information model. Moving an attribute up or down in a hierarchy can be extremely costly, because so much logic may depend on it.

The waterfall model was ditched because it is so hard to get the requirements right up front, and because they may change, and because there was too little focus on user involvement during the construction phase. But did we go to the other extreme, and get lazy? The danger in laziness is obvious: construction starts without sufficient probing of the difficult topics; as the project progresses you have to face them, and realize that you started to build the system on foundations or assumptions that turn out to be plain wrong. You have travelled far in the wrong direction.

So when the developer teams says “we don´t know what this will look like in the end so we will start here and refine it as we go along”, my response will be “why don´t you know? How hard have you looked? What effort would it take to improve your understanding before you start designing?”.

As for “agile business” , that looks to me like “retrofitting” or induction from agile as a software development approach. We are told that companies like Adobe and Apple are agile (!)(gimme a break), and Spotify (same app year after year). I find this a sterile discussion, where inevitably “agile” ends up being applied as a label on anything that you want to applaud or promote. Agile ends up a victim of its own success – the other day agile was touted as the means to achieve security in software development (!!). I rest my case.

So by all means, let´s work in 3-week periods and get feedback regularly and learn from each other. But let´s not get lazy. Many problems yield to a bit of determined analysis.

Access control in a medical VNA

Updated January 2022.

How do you make sure only the right personnel can see the medical media content stored in a VNA (Vendor Neutral Archive) – being sure that the access policies are adhered to, without devoting enormous resources to the task?

The answer is simple, but likely to prove unpopular.

Consider first the EPR (EPJ). There are two checkpoints to clear before a document is displayed to any employee with legitimate access to the EPR:
1) Does the employee have a current care relation with the patient (that the document describes)?
2) if yes, does the employee’s access profile include the category of the document in question?
The 2nd step is also crucial. As an example, a physiotherapist can read documents related to the work they carry out, but not the psychiatrist’s assessment, nor other clinical documents. Now, assume an image is added to the VNA relating to an aspect of the patient that’s outside of the legitimate needs of the physiotherapist How do we make sure the image is hidden from the physio? A modern teaching hospital has about 40 different professions, and maybe 100 document categories linked to the professions by access profiles.

To give you an idea of an access rule:
READ access to SOMATIC and PSYCHIATRIC documents created by NURSES
WRITE access to somatic NURSE DOCUMENTS .

There are many more documents the NURSE can read, and even more the NURSE cannot create or edit.

So far so good within the EPR.

We will now add the VNA to the mix. An image is added to the VNA in the patient’s folder. It is created within a clinical context (and encounter) with a purpose; generally the equipment that is used to capture the image receives some data from the EPR (metadata), and the metadata are stored with the image in the VNA (analogous to RIS/PACS workflow). As an example, an image shows “a bruise related to a fracture” caused by violence. The image is described in a journal record in the EPR which also includes remarks about a radiology report. We have a photo, an x-ray, and a document.

The question now arises: who should be able to see this image? First of all, the care relationship must be present. There is only one system that can determine if it is indeed present, and that is the EPR: so, we need to ask the EPR: does employee X have a current care relationship with patient Y? If the answer is yes, the patient folder in the VNA can be displayed. But will the VNA reveal all images about the patient to our employee X? No, it cannot, for the same reason as we have discussed above: access if filtered by profession.

The figure below shows how this may be solved – the employee has a professional role attached to an access profile. The access profile includes document category 2, and so our Employee can see document Y, which is in this category. The document describes / is linked to an image, and thus the image must also be available to our employee.

Access control via EPR

In the figure below, the acces control is independent of the EPR once the document category has been assigned to the image: the image belongs to a category which it should inherit from the EPR. We can now establish access control outside the VNA, and the VNA must store the category that the image belongs to. The Access control function maintains a table of roles and access profiles, and thus is able to determine if a given employee should see a given image once it knows the category the image belongs to.

Standalone access control in VNA

How is the category linked to the image? Potentially through the work process. When a clinician describes an image and creates a record in the EPR, the record and the image are linked and metadata exchanged.

The conclusion is that the when the VNA is used to store clinical objects, such as images, ECG, video, and so on, it effectively becomes an extension of the EPR, and must use the same logical mechanism as the EPR to control access to content.
This is analogous to the way RIS-PACS interact with each other.

RAV4 4wd Hybrid 2016 second hand

Some quick notes on the ownership experience.

We bought the car 2016-model when it was 3 years old and had 90.000 km on the clock. It´s an Active S, meaning leather, powered driver´s seat, rear camera, driver assistance systems.

It´s a Toyota, so 2 years in and about 30.000 km we have not had any unexpected expenses. The drivetrain is bullet-proof. First set of front discs just wore out at 125.000.

The car is 4WD on demand, with an electric motor living all alone at the rear driving the rear wheels. This motor is also a generator and participates in energy recuperation. The front wheels are driven by the 150HP petrol engine and a separate electric motor – or two, actually: Quiet, linear acceleration.

Aspects to consider:

  • Space is good. 5 adults can ride in the back, 4 very comfortably. Lots of leg room
  • Decent 500 litre boot with strange hump in floor due to battery intruding
  • Excruciatingly slow powered tailgate
  • Very very comfortable and very silent running. Love the soft suspension, avoids the sea-sickness of old Volvo XC70s
  • Rolls a bit in corners
  • Good acceleration but you have to really ask for it
  • Conti W7 (nordic) studless / friction tyres fantastic
  • Dunlop Sport Maxx RT2 for the summer. Much less noisy than standard tyres, very very comfortable (235/55 R18). Highly recommended
  • Four wheel drive excellent in middle to quite hard conditions: car feels planted and goes hard, needn´t worry when parking in snow and rough ice
  • Four wheel drive 100% useless when you really need it: ice and slight uphill from standstill, computer sends zero power to rear wheels, no selective braking of spinning front wheel. Nada. As ineffective as a FWD Yaris. Really disappointing. Seriously, Toyota! A few lines of code and you could get the car moving.
  • The whole instrumentation etc smacks of 2001. The various systems are clearly not talking when the parking sensors start to complain at 100km/h because they are covered in slush. When you change wheel-set (winter/summer) you have to reset the tyre pressure sensor via a dedicated button hidden on the steering column. C´mon, c´mon, Toyota! I call Toyota twice a year to have them tell me how to do this, the instruction booklet has in inaccurate description. The EV button has no impact on anything. The manual selection of “gears” is there, but no-one ever uses it. So – if you´re hooked on the future, this is not for you. This is the past in terms of systems architecture
  • Connecting phones via Bluetooth is reliable but infuriating. Well hidden, and max 4 phones at a time… what on earth?
  • Fuel economy: computer says about 6.5/100 in summer, 7.5-8.0 in winter. The combustion engine runs a lot in winter just to keep occupants warm. Takes a while to heat the cabin – efficient engine gives off less heat. I always leave it in ECO- mode. Switch off ECO for more throttle response and more thirst. Switch to SPORT for …nothing!. Switch back to ECO.
  • Towing capacity ot 1650 kg nice to have
  • If you want a spacious, affordable, comfortable, reliable, 4WD that´s cheap to run and own and keeps its value, runs on petrol, and you rarely venture onto hills covered in ice, this it the car for you.
  • When you get stuck, slap on snowchains in 3 minutes, and off you go

Surfski for the newbie: Epic V10L and Carbonology Boost

And so it came to pass that I was given a secondhand V10L for my birthday, and I have spent a fair bit of time in it, and also some time out of it… this is my first full season in a kayak, and the 44 cms of support for your clumsiness that the V10L provides is sometimes not enough, and I have been in the water many a time. But I am improving, I am…

Our hero surrounded by obsolete technology

I have used it on the flat, on the somewhat choppy, and on the ocean. The ocean was a bit too much, the rest I can just about manage, though there are many heart-in-mouth-moments.

When I first got into the V10L all went well; and so I bought it.

The next trip I fell in immediately and couldn´t get back in. This was 15 metres from the quayside, and my kids were witness to my failed attempts.

One or two Youtube videos later – “surfski remount” – and all was well. I can get back in. Once in, I lean back in the seat until things quieten down, and then I set off. The added adrenalin gives the drive to move the boat; it´s far more stable on the move.

I bought an NRS 0.5mm wetsuit of the long-John type with no arms. On top of this I sometimes wear a thin wool underwear thingy. This works well, but I will probably get an NRS vest next season for colder days.

I bought a secondhand Bracia paddle, adjustable & all. I kept it screwed together for a month in and out of salt water, and now it´s impossible to budge.

The desire to challenge myself and the elements is always there – but in order to challenge the ocean outside Tvedestrand, I have ordered a Carbonology Sports Boost LV. I have been on the open ocean in “interesting” conditions once, that was in an Epic V7. The V7 felt very stable, and I only fell in three times (!).

Surfski and Kayak has opened up a new chapter alongside rowing, and I am working on technique and strength – thanks again to Youtube!


Eg kobla meg opp mot labradoren med ei lærreim og gjekk ned trappa. Eg logga meg ut gjennom utgangsdøra og steig ut på gata. Det var stilt ute. Eg trakk i reima. «Kom no, Online», sa eg, og satte kursen mot parken.

Kona mi hadde straks gått for forslaget mitt om å ta hunden ut ein tur. Vi gjekk ikkje tur saman meir pr. idag. Kommunikasjonen mot kona var eigentleg inne i ein down-periode, hadde eg funne ut.

Bikkja kom med eit innspill: ho ville bort til eit tre. Eg ga henne aksept på det, og ho gjorde ein release mot trestamma.

Vi tusla vidare. Borte ved gate’n til parken sto ein mann og supporta seg på ein stokk. Han såg litt trøytt ut. Kanhende fekk ikkje han heller nok oppbacking heime?

Det var kaldt og eg følte for å avslutte sesjonen ute. Det var verkeleg mykje overhead med denne bikkja. Kanhende skulle eg avslutte leasingavtalen hennar, sjølv om det stod att eit år ? Nei, ho var jo så søt. Og no som kona…. Nei, best å ikkje kome inn i ein loop av tunge tankar.

Eg ruta meg heim att. Kona var ute då eg kom inn. Eg visste at ho hadde outsourca somme tenester som eg hadde vore supplier for tidlegare. Kanhende hadde den nye kortare turnaround tid, tenkte eg resignert.

Eg knytta meg opp mot ein site i USA og downloada ein cyberburgar. Eg tok meg ein byte.


Susanne Sundfør: The Brothel + alt annet

Billie Holiday: Strange Fruit

David Bowie: Ashes to ashes

Miles Davis: Time after time

J.S. Bach: Ehre sei dir, Gott, gesungen! (Spotify)

Sia/David Guetta: Flames

Jessie J: Price tag

Michael Kiwanuka: Cold little heart

Marillion: Kayleigh

Eminem: Without me


Master and Margarita (Bulgakov), Pan (Hamsun)

AKSON varslet katastrofe

Et samlet IT-Norge er kritiske til AKSON-prosjektet, eller med andre ord “ikke gjør det på denne måten”.

Likevel turer Direktoratet for e-helse frem.

KS støtter Direktoratet. Men etterpå er det langt mellom støttespillerne.

Næringspolitisk er det vanskelig å forstå tilnærmingen, som med stor sannsynlighet vil ende opp med å favorisere én stor utenlandsk aktør.

Fra ståstedet til IKT-arkitektur er det liten støtte å hente. Alle tilsvarende prosjekter har feilet internasjonalt. 100%. Hvis pasienten dør av behandlingen, må den avsluttes. Medisinen må seponeres når dødeligheten er så høy som dette.

Diagnosen av pasienten er overflatisk. Han har det vondt, klager over smerter her og der. Bandasjen gnager, sier han. Eller mangler helt og holdent. Løsningen: en bandasje som dekker alle behov. Alle. En magisk bandasje. Hvordan denne skal se ut, eller hvori magien ligger, kan ikke Direktoratet svare på.

Det vi upresist kaller “Journal” er et produksjonssystem som må være tilrettelagt for lokale forhold.  Den medisinske delen (pasientjournalen/EPJ) er forsvinnende liten sett ved siden av logistikk, økonomi, organisasjonsstruktur og roller; roller som varierer  avhengig av organisering.

TIlgangsstyring vil bli kritisk og er tett knyttet til profesjoner, organisatorisk tilhørighet og turnus, og det siste betyr at turnusssystemer må integreres. Så har vi allehånde brevmaler, lokale integrasjoner, osv.

“EPJ” er bare en liten del av dette, “PAS”-delen dominerer fullstendig.

Den snakker ingen om.

AKSON kan best forstås sosiologisk og økonomisk.

– KS trenger økonomisk bistand og politisk bistand fordi de har underinvestert på området og leverandørmarkedet reflekterer dette (mikroskopisk, amatørmessig).

– Direktoratet for e-helse forsvarer sin posisjon og eksistensberettigelse og store budsjetter

– Departementet? Aner virkelig ikke. Snodig at Høyre som er næringslivspartiet vil nedlegge hele den norske helse-IT-bransjen.

Checkpoint by Sidsel Wold (Palestine)

This is a resumé of Sidsel Wold´s book from 2006 published in Norwegian by Gyldendal.

Sidsel Wold has been the correspondent for the Norwegian Broadcasting corporation (NRK) in the Middle East for many years. The NRK cherishes its neutrality, but what does a correspondent do when injustice stares her in the face and she is on a sabbatical from her job?

Maybe she writes a book about her stay in Jerusalem. She writes from up close. You can smell the streets, see the flesh from the suicide bombers, smell the smoke from the water pipes and feel the November rain; you can see the living rooms, the tea-cups and the veiled girls…

Checkpoint takes its name from the many checkpoints that break up the daily lives of Palestinians, and ensures that the different Palestinian societies remain apart. To live in Gaza, or a refugee camp on the West Bank, or in a Palestinian-controlled part of the West Bank, or in Tel Aviv with an Israeli passport – these are completely different realities.

Gaza is hell on earth – and this was 2006! The main topic there seems to be death and martyrdom, and the murderous, blind violence meted out by Israel – or shall we call it the Zionist state?

The book makes a few points very clear that are familiar to those that know Israel, briefly summarised:

  • the settler invasion by the Zionists was well organised and well funded
  • the will to displace the indigenous population was there from the start
  • the Palestinians were ill equipped to withstand the onslaught, which essentially pitted the first world against the third world
  • the campaign to squeeze the arabs has gone on relentlessly since 1948
  • after the second Intifada the Wall came up, and security returned to Israel. With it, the will to make a meaningful peace with the Palestinians disappeared. They also disappeared

Wold brings a lot of nuance to our understanding of Israel, with its immigrant populations from myriad countries. It is criss-crossed by sectarian and social fault lines, but unified in its loyalty to the Israeli state. As an example, the rise of Likud is tightly linked with the rise of the political power of the Jews of Arab origin (sephardim, mizrahim) who had been held down by the Askhenazi Jews of European descent (those that spoke Yiddisch).

A few more points are worth mentioning, like the role of religion and tradition. For the Palestinians, religion and tradition often mean a patriarchical society where a womans´s destiny is to bear children and obey her husband. The theme is drearily familiar. It is hard to see how emancipation will take place in a situation where men are oppressed and locked into their roles as breadwinners and fighters. With the demise of the PLO and the rise of Hamas, the space for secular social  politics is limited.

On the Jewish side of the fence, religion also plays a central role, both as provider of identity for all Jews, and as a provider of destiny for religious settlers and the Orthodox. Both these groups seem to inhabit a universe where reason cannot penetrate.

It is often overlooked that about 1.2 million non-jews, mainly muslim arabs, carry an Israeli passport. They enjoy far more freedom than their relatives (figuratively and literally) in the West Bank and Gaza. But they are not wanted. They are not Jews, after all, and this “Nationality” is known by the state and has a huge effect on your prospects in Israel. Whether you are a Jew or not, is a question only the rabbis can decide (Wold does not state this latter fact anywhere, but Shlomo Sand has a lot to say on the issue of Israeli identity politics). And as unwanted citizens, they are discriminated against. Simply put, this is apartheid. One set of rights for me, one for the others. In this case the other is the Goy.

Sidsel Wold uses her skill and charm to connect with Jew and Palestinian, and she has the sensitivity and non-judgmental attitude which allows her to make meaningful connections with people and observations about life in Israel. And yet – her blood boils at the checkpoints.

“As I stand in line, I spot an elderly Palestinian in a green jacket and checkered keffiyeh on the other side of the road. He´s trying to move south on the West Bank. Clearly he was born long before the state of Israel saw the light of day. Two Israeli soldiers, a man and a woman, stop him. The old man gesticulates and tries to talk his way through the control post. A third soldier, sitting smoking on a concrete block with his legs crossed, looks the old man up and down.

– what, won´t they let you through? says the soldier and smiles mockingly. He´s enjoying himself. As always when I am upset, I put on my dark sunglasses. The female IDF soldier lights a smoke and leans into the concrete block.
– but I pass through here every day, says the Palestinian with mounting desperation
– “but I pass through here every day”, repeats the soldier and laughs out loud
– so, you´re here every day? That doesn´t mean you will get through today, you know! says the soldier teasingly. He looks at his colleagues, and they all laugh. The old man turns around slowly and starts on the long journey back.” (page 189)

This episode says it all, really. Occupation destroys the soul of the occupier. It´s about as far from the Jewish spirit as one can get.

Til en AUF-er



Kanskje 25% er en passe oppslutning om et parti som Ap i 2020?

På hvilken måte skiller Ap seg fra Høyre i dag?

Det bør dere tenke på når dere møtes.

Og se “Gerhardsen” på NRK; hørte Erling Borgen på radion i går. Sterkt.

For noen år siden sa Jan P Syse “Arbeiderpartiet stjeler våre klær mens vi bader” (som igjen var et sitat fra Disraeli fra 1845), og det er en sannhet i dette; Ap har beveget seg mot Høyre og åpnet for marked og markedsmekanismer på flere samfunnsområder. EØS og NATO legger rammene for økonomisk politikk, arbeidsliv og sikkerhetspolitikk. Rommet for politikk er mindre enn før.

 For oss som husker de store idelogiske bataljene på 70- og 80-tallet virker dagens debatt litt tam og navlebeskuende.

Den gangen var det skattenivå, åpningstider, mediemangfold, NATO, Sandinistas, contras, Reagan. Arbeiderpartiet var på vikende front i alle disse spørsmålene, og er det i og for seg ennå. Nå som jernbanen blir privatisert, vil neppe Arbeiderpartiet reversere dette.

Dengang var Reiulf Steen gift med en Chilener som hadde opplevd Pinochets regime – Inés Vargas. Og dermed var virkningene av amerikanske utenrikspolitikk ved kjøkkenbordet.

All jævelskapen USA har bedrevet i sør-Amerika har vi glemt. Bortsett fra at den nye generasjonen latin-amerikanere står ved Rio Grande, da. Men men. Details metails.

Utenrikspolitikken i dag handler mest om Russland, og her har vi valget mellom nyanser av kalde krigere. Hvor står AUF? (er konflikt med Russland uungåelig?).

Internasjonal solidaritet – er det noe som hører fortiden til? I sin tid var det ett av grunneelementene i arbeiderbevegelsen. Den var internasjonal. COSATU var på sommerleir i Norge! Betalt av LO.

 Norsk politikk er preget av masse samarbeid på tvers av blokkene og masse enighet om grunnleggende spørsmål. Det er ingen som mener at arbeidsledige skal sove på gata, f.eks. Likevel – Ap har potensielt en posisjon som en form for garantist for den norske/nordiske modellen. Høyrekreftene “ there is no such thing as society” og dyrkingen av enere som Stordalen og Røkke – er en motpol til dette. Høyre representerer et annet syn på samfunnet, og har andre krefter bak seg. Og deres ideologi har vunnet fram! (og det er fordi vi er rike nå; husk hva Marx sier om basis og overbygg).

Ap er skeptiske til børsen. Høyre hyller den. Der i gården er Mammon gud – men obs obs, Høyre er også et sosialdemokratisk parti. Det er ikke en Darwinistisk jungel som er målet med samfunnsutviklingen. Mye decent folks i Høyre. De aller aller fleste. Men de er happy med at rengjøringen av togene gjøres av folk som jobber med dårlige vilkår i egne selskaper. McJobs. Den tid er forbi da det stod “NSB” på alles uniformer, enten de kjørte tog eller vasket dass.

Høyre mener den som har flaks og er god med penger og står på og har mage til å rake til seg frukten av andres arbeid – han skal få. Mer. Ap mener i bunn og grunn det samme. Svært mange mener dette! (ellers hadde SV hatt større oppslutning, ennsi Rødt).

 Og her er vi inne i menneskesyn og ideologi. Hva er et menneske? Skal vi reduseres til konsumenter og produsenter? Er det OK å utnytte andre bare det er “frivillig”? Hva slags narkotikapolitikk skal vi ha? Hva slags arbeidsliv skal vi ha? I landbruket er det 30.000 utenlandske sesongarbeidere.

Hvis en person vil starte en bedrift i Norge i dag kommer hen til dekket gratisbord:

  • effektivt byråkrati
  • tilgang på utdannet arbeidskraft
  • veier og annen infrastruktur
  • rettsapparat og lovverk som beskytter virksomheten

Alt dette er gode som er betalt av fellesskapet. Det må vi ha en økt bevissthet om! Det finnes ingen self-made man, det er bullshit. BULL-SHIT. Dette vet selvsagt både Ap og Høyre; dette er kjernen i sosialdemokratiet, dealen mellom kapital og arbeider; et skattenivå alle kan leve med, fellesgoder som gir et lavt konfliktnivå: kapitalen slipper å leie private sikkerhetsvakter.

Og så er det klart at identitetsdimensjonen har vært undervurdert. Folk stemmer Frp selv om Frp vil rasere arbeidslivet, fordi Frp forsvarer «det norske». Arbeidere stemmer tilsynelatende mot sitt eget beste. Fordi det norske er viktigere enn alt annet? Eller fordi de føler seg så trygge i arbeidslivet takket være LO at de kan gamble på det, og stemme “identitet”? Hvem vet. Hvem vet…

For å vinne må man ha en visjon som er god. Smak litt på det. Visjonen var klar på 50-tallet: forsvare arbeidsfolk og bygge landet. Man kan ikke sitte på tinget av gammel vane.

Ved valget nå, og i 2017, hadde ikke Ap noen visjon. De fortjente ikke bedre. 2017-valget var en disaster med Støres aksjer, hans vanvittige portrett, og det aldeles håpløse «stø kurs» eller hva det var. Forglemmelig. Glemt.

2019 med skolemat er historie. Hva er storyen i 2021?

Forslag. Ap som garantisten for den nordiske modellen. Forsvarer av det kollektive. Den nordiske modellen. Det må vi ha en økt bevissthet om! 

Men igjen – for å fortjene å styre, må man ha en visjon. Man kan ikke sitte på tinget av gammel vane.

Bøhler skriver her: jeg er enig i noe, men det defensivt i noen grad – det er preget av FrPs retorikk.