Now that I’ve read, and re-read The Life-Changing Magic of Tidying Up, I’m more conscious about what I keep and what I throw out. I’m hard-core now. Most birthday cards go in the garbage; we have a lot of birthdays and I saved the cards since when I was five years old, and believe me, I didn’t need to.

But I took a look at this card and I couldn’t throw it out. It’s touching because it is so typical of my husband. He is an ISTP so he’s very detailed about his physical world, he’s accurate and he sees everything. This is a peek inside his brain and it’s so true that it feels intimate.

I put the card in a box to save. And then, because I write about careers, I thought: The qualities of this card are the exact qualities we look for in a job interview. Our goal in an interview is to be so effortlessly true to who we are that the hiring manager can’t help but feel a connection to us.

So I got to thinking that you can divide job interview questions into three types, and each type is a way for you to take control of the conversation and show the interviewer who you are.

1. The Classic Question

Tell me about yourself? or What are you passionate about? or Where do you see yourself in five years? 

Even though each of these questions seems quite different, it’s actually the same question. It means, “Okay. Let’s get started. You first. I want you to do the talking.”

The right answer to all those questions is a story. There is a story of your life that tells people how you got to where you are. There are a million stories within each person’s life. Each story is a true story with a different focus or theme. The focus of the story you tell to answer the question is how everything you did leading up to now has made you a great candidate for this particular job.

Additionally, Herminia Ibarra’s research shows that when we tell stories about ourselves, we look more pulled together -we feel more confident inside and people understand us better. Chip Heath’s research shows that people connect with us best under those conditions. Remember: the point of an interview is to make a personal connection with each person you talk to.

Telling a cohesive story about yourself takes time and talent, and your resume story should match your interview story. (Yes. Every resume tells a story. If you don’t know how to make a cohesive story with your resume, you should get help.)

2. The Brainteaser

How many telephones are in the US? or How heavy is the Statue of Liberty? or What’s a good product for Pepsi to launch next?

Technical candidates often have to take a skills test. Maybe you take something home and write code, or  you write code in the office as a timed test. Finance candidates might create a spreadsheet. There are right answers to those tests. Brainteasers are not asking for a right answer per se.

A brainteaser aims to discover out how you think, or maybe whether you can think in situations where you don’t know everything you need to know to reach a simple answer. But the answer you give is not so important as your approach to getting the answer. Your tactic to finding the answer should match the personality type that will succeed in the particular job you’re applying for. The brainteaser question reveals if you are applying for the type of job that will best leverage your natural gifts. (Not sure about your natural gifts? Take a personality test to find out.)

So, for example, if you are interviewing to be CEO you would probably think in terms of who you’d need to hire to solve the problem.  If you’re interviewing for a statistics position you would want to lay out the exact problem and you might even assign some numbers to variables and start solving.

Neither approach is right or wrong, as long as you are doing the type of thinking in the interview that you want to do in the job. If you are interviewing for a job that is a good match for you, it’s likely that you’ll give an answer that is appropriate for the type of thinking the interviewer needs to see.

Think out loud as you work through the problem. This is the consummate “show your work” moment! Also, approach this question, like all other interview questions, as a conversation. Each question in an interview is a way for the hiring manager to decide if he or she wants to spend eight hours a day with you.

3. The Behavioral Question

Can you tell me about a time you had a fight with a co-worker? or What would happen if you disagreed with your boss’s direction? or What is your weakness?

These questions might sound wildly differently, but they all ask for pretty much the same thing: Tell me a story. And if you have a resume that is written to make you shine, then each bullet on your resume is a tiny story.

Each question in a behavioral interview asks for a description of a moment in time. For example, if you tell someone your weakness is math, that’s not nearly as informative as how your weakness came up in a single situation in the context of work.

Each good story has a beginning, middle, and end, and this is true in a behavioral interview as well. So tell about the situation, and the conflict you faced, and how you overcame it. The story should take about a minute to tell.

Your ending will have a quantified achievement as the kicker (delivered ahead of schedule, increased revenue 10%, etc.) And you’ll have them fresh in your head because on a well-written resume every bullet is a quantified achievement. (Don’t tell me you have a career that does not lend itself to this sort of achievement. Every career can be framed as quantified achievements. You hire me to show you how to do that if you don’t already know.)

This means that every behavioral question is an opportunity for you to tell a good story that will make you stand out.

The only questions are asking what you want (the first questions) how you think (the second question) and how behave (the third). If you have good self-knowledge, the answers to all three of those questions make sense together. And that, really, is what makes you likable.

Now that you realize how few questions there really are in an interview, you can memorize your answers. Make them perfect. It will feel calculated, yes, but people who have great careers got them by being calculating.

Taylor Swift has been accused of being calculating in her interview answers. And in response she said, “You can be accidentally successful for three or four years. Accidents happen. But careers take hard work.”

 

 

2014 was quite a year.   Thinking back to December 2013, I cannot believe that so much has happened.    Let’s take a look at the major HIT events that shaped 2014 and what they portend for 2015

Affordable Care Act - despite challenges with healthcare.gov and state health insurance exchanges, the notion of moving forward with an open insurance marketplace and accountable care got traction.   The IT needed to meet the needs of the patient centered medical home, the ACO, and Care Management spawned a new type of software - the care management medical record.    Not many products exist and none are mature, but HIMSS was filled with promises of workflow engines, population health, and protocol driven care management tools.   2014 made it clear that the EHR is just a starting point and over time there will be a new generation of tools used by clinicians and non-clinician extenders to keep people healthy, not just record their encounters when they’re sick.   Hopefully we’ll see maturing products in 2015.

Meaningful Use/Standards - 2014 was really the first year we could take a look back at the Meaningful Use program.    I think we can conclude that Meaningful Use Stage 1 was generally perceived as a positive step, laying the foundation for EHR adoption by hospitals and professionals.   Stage 2 was aspirational and a few of the provisions - Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist.    The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.    At this point the only way out of the readiness/adoption challenge is to allow more time for the ecosystems to develop by changing the attestation period in 2015 to 90 days.    Although Direct/CCDA was a reasonable starting point for 2014, the future belongs to FHIR/REST/OAuth, which are going to be much easier to implement.    We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption

HIPAA Omnibus Rule - 2014 saw increased federal and state enforcement of the HIPAA Omnibus Rule with record fines for security breaches at a time when the nature of security attacks became increasingly sophisticated - witness the Home Depot, JP Morgan, and Target breaches as well as denial of service attacks on numerous healthcare and non-healthcare organizations.     Healthcare as an industry directed substantial resources toward improving the security protections of their networks in 2014.    It will be interesting to look back at this era in several years and ask the question if million dollar fines for stolen laptops/smartphones was a helpful policy or if other enablers such as the evolution of security technologies and culture change were more effective.

ICD10 - ICD10 was delayed until October 1, 2015 and it’s clear that stakeholders are divided about the concept.   One the hand, professional coders correctly identify that ICD9-CM is incomplete and does not include several important disease states.   On the other hand ICD10-PCS is so complex that it is unlikely clinicians will  not be able to produce the documentation needed to justify a code.   The cost to the country post implementation in lost productivity will be enormous.    If I could ask for a “do over” I would suggest that clinicians use SNOMED-CT to record clinical observations and that in a world of global capitated risk, not fee for service, the notion of using ICD for billing is no longer relevant.  ICD was intended as an epidemiological classification, not a billing vocabulary.   Only the United States uses ICD for billing and only the United States has proposed ICD10-PCS.   2015 will give us the next chapter in the debate.

In all industries, the concepts of social networking, mobile technology, analytics, and cloud hosting became increasingly important in 2014 for business and personal applications.    Healthcare has been slow to adopt these techniques but increasing cost pressures and new business models are motivating healthcare IT departments to embrace cloud services.   I believe that 2015 will be a tipping point, with increasing use of social networking concepts for care team communication, smart phones/tablets becoming the preferred tool for clinical work, real time decision support based on analysis of similar patients becoming mainstream, and cloud-based EHRs becoming essential for the agility of merging/changing organizations.  

2014 was a year of increasing stress for CIOs, accelerating workflow change, regulatory burden, unquenchable demand for automation, and rapid technology evolution.  2015 may see less new regulatory requirements, more mature products in the marketplace, and an increased role for the private sector to innovate.    As always, I remain optimistic for the future and am ready for the challenges ahead.

Here's a guest post by Dr. Henry Feldman from BIDMC's Division of Clinical Informatics:

I am writing this from the Apple Worldwide Developer Conference (WWDC) today here in San Francisco, where I got to substitute for John Halamka at the Keynote (now I keep having urges to raise Alpacas); John missed the most amazing seats [front row center!]. There were many, many, many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for healthcare.

If you remember the state of digital music, prior to the introduction of the iPod and iTunes music store, that is where I feel the current state of the healthcare app industry is at; there is no common infrastructure between any of the offerings, and consumers have been somewhat ambivalent towards them as everything is a data island; switching apps causes data loss and is not a pleasant experience for patients. Amazingly there are 40,000+ apps on the App store at Apple alone, showing huge demand from users, but probably a handful can talk to each other in a meaningful way; this is both on the consumer and professional side of healthcare.

Individual vendors such as Withings have made impressive strides towards data consolidation on the platform, but these are not baked into the OS, so will always have a lower adoption rate. If we take the music industry example further, Apple entering a market with a full push of an ecosystem at their scale, legitimizes the technology in ways that other vendors simply can’t match. In their introduction, Apple introduced 2 healthcare specific items, the Health App and HealthKit Framework.

The Health app is a central data repository on your phone that any HealthKit enabled app can deposit data into or read data from, under user control; it also serves as a display dashboard for the user of this data repository if they don’t want to use the source app. This will allow patients to aggregate their fitness and health data from a myriad of sensors (e.g. FitBit) and sources (say a PHR app) into a single place.

They showed using this as a gateway to broker between health goals, such as blood pressure control, set up by a physician on the Mayo Clinic’s EHR and then tying that back to the patient via the PHR app/Health App linkage. Since the patient can push data back once they grant permission to an app, you can imagine as a physician who is titrating blood pressure medications in the home, getting objective data from the patient electronically (the last mile problem). Engaging our patients is both our sworn duty as physicians and over time as we learn to use these tools effectively, will help us help our patients to be more self sufficient; as our mentor Warner Slack always says “the least utilized resource in the healthcare system is the patient!”

HealthKit is to me in some ways more significant, as it allows a common platform internally for health apps allowing for common data formats, data exchange, storage and presentation to the patient; Apple again is establishing an ecosystem here. Having centralized support for healthcare data, makes applications more interoperable and useful. Several of the healthcare vendors, such as Epic (I was seated near their CTO who was pumped), who were near me were very excited about integrating this framework into their apps. This will raise all the healthcare apps to a new level, and greatly increase utility and innovation around these apps.

There is some very legitimate concern for providers, that this will enable an avalanche of data (on top of the tsunami we already are being washed by) from patients, and we will have to figure out how to cope with this. With easier access to sensor data, patients will have to be educated, that not all changes are pathologic. A million years of evolution has allowed your body to control things like heart rate robustly, so we will need to be very specific in our education to patients about what they should and should not get concerned about. For patients undergoing fitness programs, this is a superb way to track fitness and can report objective improvement metrics to their healthcare provider or trainer.

Now for some non-healthcare specific technologies, that are very useful in healthcare.

TouchId, the technology behind the fingerprint login on the iPhone, is now open to 3rd party applications. This means that instead of relentlessly typing a password (which of course gets longer/more complicated with each policy change) you could for instance sign orders or login to your EHR; I type my password well over 100 times per day into the EHRs that I use, which gets frustrating, and can probably be quantified in lost productivity over all the docs multiplied by all the time spent reentering passwords as a serious sum of money.

A tiny change is that you can now respond to text messages and accept/decline appointments without leaving your current application. Why is this significant? While for many users this is a convenience, in healthcare this may prevent medical errors. John has previously cited a case of distracted computing occurring in the middle of creating orders for a patient, and leaving the task without signing orders, etc. Staying in context makes this error much harder to do.

Finally I will talk about Swift. Apple has created a new object oriented language, called Swift, which as they phrased it “took the C out of Objective-C”. This excited me as it reduces many common programming errors that are easy to create in C (for non-programmers, C is a language where you can do anything you gosh-darned please; and with great power comes great responsibility). They seemed to have stuck in some of the automagic of a language like Python with some of the strictness of Java, and then added modern power features, all in a very fast compiled language (under the awesome LLVM compiler).

In summary, I think we will look back on the WWDC 2014 as a day when Apple really brought the healthcare app industry to a whole new level, especially on the consumer side, and also putting in a robust infrastructure for professional and consumer applications to exchange data. This is a 1.0 release, and undoubtedly it will grow over time, and we will see creative uses, which will inspire all of us to grow with it. Similar to digital music, we are at the beginning of a major shift, and we will have to see what develops out of this, but getting consumers excited about healthcare data, and getting vendors excited about sharing data with each other via the patient, has got to be a good thing.