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Archive for October, 2006

Deja vu all over again

Am deeply involved in another go-live of an Electronic Medical Record and am beginning to be convinced that all organizations must go through the same steps, experiencing the same pain and cultural shock. Preparation simply offers the ability to compress the duration of the pain. There doesn’t seem to be a way to leap-frog or skip processes and avoid the mistakes that others who have preceded make. Very much like growing up. Can’t skip adolescence no matter how much we’d like to.
Most individuals do not want to invest in training, even though they know it’ll help them. They all will accept some basic training but often will go no further. It’s very hard to create the time, space and interest to repetitively learn tasks before they are actually needed. This isn’t unusual. The number of golfers who actually practice is miniscule, even though practice is the only way to really seriously prepare for the week-end round of golf. Very few people actually read the manuals or take the tutorials that come with most software. They just plunge in and begin floundering away.
This approach results in people applying previously learned processes to the new application or task. Usually the new task or application cannot support other work-flows and predictably everything slows down. Many examples can be made but one would be that of the way one draws on paper is quite different than drawing on a computer. The process of creating a sketch is very frustrating until new techniques and processes are learned.
So trying to apply paper workflows and processes to a computerized system, especially in a busy clinical environment, is almost impossible. The computer system doesn’t support many of the paper workflows and those who do feel as if they’re trying to cram a square plug into a round hole. Eveything slows down to a crawl. Eventually people crawl their way out of their old ways of doing things and beginning learning how to use and then exploit the new system to improve their work. It’s fun to watch this but also very aggravating because no matter how much preparation everyone goes through the same processes over and over again.
In short, every implementation is just like the previous one and those who are involved in them have the deja vu experience all over again.