Most managers think an IT project follows this sequence:

• Demonstrations
• Software Acquisition
• Implementation

We have to beat this out of them. OK, we need to educate them. But we need to beat the vendors who reinforce this mindset.

I go ballistic when I am invited (along with a list of others) to attend software demonstrations for the purpose of choosing some new computer system. To accomplish what? Much more time needs to be spent setting goals and criteria for choosing said system (if it is needed at all).

Just as importantly, we fail to spend time putting the plans together before the software is purchased. One can easily spend 6 months planning an average size IT project before the software even arrives. There are processes to re-design, interfaces to spec, conversion extracts to write, training plans to develop. Why start this after the software contract is signed? So the software can sit on the shelf and the vendors can spend our money while we do the prep work?

Every project is going to be different. But a better model is:

• Develop goals, success metrics and required features/functions to achieve the goals
• Demonstrations
• Software Selection
• Intense, detailed planning
• Acquisition
• Implementation
• Success

In my years as a consultant I observed that most projects failed to accomplish their business goals. As a CIO one of my most important charges is to keep projects from failing. My observation is that projects fail for two reasons.

Firstly, projects fail because they don’t have any clear business goals. These projects are easy to spot because they typically begin with someone coming to me and asking to buy a computer system. When the computer system is the focus, and not solving a particular business problem, then we are in trouble (see the Barbie Syndrome post).

But even when project goals are clearly defined and success measures are in place projects can fail. This typically happens when the project becomes so burdensome the focus changes to just getting the project done.

In my consulting engagements I remember attending meetings toward the end of a long project where the clients were trying to figure out what went wrong. Their observation was generally that over time they lost sight of the project goals because there was too much work.

I now realize that this is not something that happens gradually. Instead, there is a point in time when an in influential member of the project or senior management will state that it is OK to forget the goals and just get done. It turns out that this happens as fast as a “click.”

Of course the best way to guard against this is to develop plans that accurately estimate the resources and total effort. This is easier said than done. Most organizations are terrible project planners. There is always a push to buy the software and get started.

Today, If someone ever asserts that it is time to let go of the business goals I will say “click” . Most of the people here know what that means. If not, they will by the end of the meeting.

I know Cam Jansen does the “click” thing too, but I think I did it first.

Like many, we are trying to automate the release of some records to patients and parents/legal guardians. Unfortunately, MEDITECH (and every other vendor I know) do a poor job of tracking who has legal access records. There is no way to setup an electronic linkage to say one person (identified by a key field) has legal acess to another person’s records.

Even if that existed it really is not granular enough to manage the complexities or HIPAA and other privacy laws. For example, in Wisconsin, children 12 and older have additional rights relating to behavioral health, reporoductive health and HIV status. All of this is tracked manually because there is no way to manage this with the systems we have.

Ideally a system would allow a child’s record to be linked to legal guardians. Also, there would be the capability to create additional linkages to support a person’t legal right to provide access to their spouse.

As we make health information available to people over the web, parents will also want to see their children’s records. Unfortunately, we don’t have a systemized way of identifying their children. We know which babies were born to which mothers, but even that falls short since the child could have gone to an adoptive home.

Of course the computer system changes to link patients with legal guardian would need to be followed with process changes in the registration and medical records areas.

In my 10+ years as a CIO it is painful to see how many IT purchases turn into shelfware. It is difficult to keep management focused on realizing the benefit of investments made.

I believe this is human behavior. I have tried to create an analogy so our business leaders can see this behavior in ourselves. In my attempt to change our culture I have begun to preach about the “Barbie Syndrome.”

As a father of two girls I have observed that when they are in a toy store they seem to forget the closet full of Barbies® and accessories back home. The Barbie on the store shelf is always more desirable than the one in their closet. Like those girls, we seem to think that the systems we don’t own are much more appealing than those we already own.

Unlike those Barbies, new systems are not ready to use out of the box. These systems require a great deal of coordination during implementation to ensure they begin useful life without negatively impacting operations. Just as importantly they require a great deal of effort after implementation to ensure that they provide the benefits that were envisioned when they were purchased.

I am not looking down on my co-workers. I am guilty of this as well (and there isn’t anyone there to remind me that I am under the influence of the Barbie Syndrome). I have purchased a couple of systems over the last few years because I thought they would be the quick answer to a problem. Of course it was just software and I still had to do all of the hard work I was trying to avoid.

Too often we are lured to purchase new systems, somehow forgetting the closet of systems that we already own that are awaiting our attention.

I realize I am not using the word “syndrome” properly. But the phrase reminds me of the Pepsi Syndrome skit from Saturday Night Live, so I am sticking with it.

Truthfully, I have always enjoyed the perks of being a CIO. Having the second most capital to spend (behind construction) gets you lots of attention.

One way that vendors show their attention is to take you some place to talk business. As a CIO you have lots of opportunities to eat good meals and then get a case of short arms when the check arrives. Ethically I don’t have a problem with this, if it isn’t abused. I am probably treated to 10 or so vendor dinners a year. Sometimes it is a burger at the pub, but often it is a steak at Lombardi’s.

Some of the offers I receive are unbelievable. I don’t understand how any CIO can ethically accept some of the junkets that we are offered. Recently, I received an invitation that tops them all. Avaya (the telephony vendor) sent me a letter from the Chairman and CEO offering to fly me and a guest to Germany to watch the World Cup. This was the real deal. As the letter states (see attached) this is going to be a first class junket. Just, not for me. The mailing alone was impressive. The letterhead was the best paper I have ever seen (living in the Paper Valley I notice things like that).

As I get more offers I am going to post them here to show folks the lengths a vendor will go to get cozy with a CIO. If word gets out I suppose I will receive a lot fewer offers.

This entry was recently featured in an article by SearchCIO.com.

I could spend all day long participating in phone surveys. So, I don’t usually do any. More and more the surveyors are offering some incentive like a gift certificate or a donation to the hospital’s foundation. I appreciate that they value my time, but that generally isn’t going to change my mind.

I participated in a HIMSS Analytics survey today. This is the first survey that I have been subjected to in over a year. I consider HIMSS Analytics to be a respectable name, but this was a disaster. The surveyor had no understanding of the topic and had a difficult time reading her script. Worse, the questions were very poorly constructed.

They asked me which database platforms I used (SQL Server and MEDITECH MAGIC). Then they proceeded to ask me to rank other DBMS platforms on a number of different criteria (reliability, manageability, performance, etc.). Well, I don’t use those – so why would I have an opinion? The survey also asked me to rate the DBMS of my top three clinical applications. These are all MEDITECH applications so I answered the same questions three times.

I suspect that the survey was sponsored, I would guess by Cache.

One third of the way into the survey I lost respect for the methodology and began answering questions while reading email. That survey won’t be worth the paper it is printed on.

One more thought about surveys, I would much rather complete an online survey than a phone based survey.

I get a lot of business cards. Most of the time it is in the best interest of the person giving me the card to make it to my contacts. The problem I am the one that spends all of the time entering that information into Outlook, or my assistant. Either way it is not usually a good investment in time.

With Plaxo I put the burden of keying and maintaining that contact information of the person who gave me the card. I just enter their email address in the plaxo web site and they get an email with a link to a web page where they enter all their contact information. When that page is submitted it magically updates my contact list.

You should check out Plaxo (www.plaxo.com). It is free. It has resulted in a much better contact list and much less effort. It is also a great way to notify people when your contact information changes.

People seem to love using it. Interestingly, I accidentally sent out scores of invitation to people to update their contact information using Plaxo. Much to my surprise a surprisingly high number of those people decided to join Plaxo when they saw I was using it. The effect is still cascading as I see new people using it based on invitations from the people I invited.

I was amazed and frustrated by this. I spend a great deal of time trying to coax people into using new IT systems that will improve their life. Then I get this broad adoption of something that I sent out on accident. Go figure. Perhaps they saw that they would love Plaxo too.

I am not an expert in project planning, but at a minimum they should include:

• a list of tasks;
• details regarding what those tasks involved (not just one liners);
• a deliverable for each task;
• the accountable party;
• the dependencies between the tasks; and
• estimated durations of each task.

Some of the junk project plans that I see from vendors are very sad. I am not sure if they are poor planners or if they are just trying to keep things ambiguous to close their sale. I suspect it is both.

Notice: I mentioned that we are developing project plans before the sale. A detailed project plan and a detailed statement of work should be part of any significant IT contract. What I have traditionally seen take place for the first two months after a contract is signed would be better handled before the contract signing so both parties have a common understanding of the initiative.

Customer Service is much more complex in healthcare than in other industries because there are multiple customers that we serve. The primary customer are physicians that practice in our hospitals, payors that reimburse us for our services and that patients.

Often we speak of patients in non-customer service terms as well.

At Affinity we have coined a new term: Patomer. We use this when we are speaking of the patient in a customer service context. For example, we might say “allowing the patomer to pre-register online will eliminate wait times at the registration points.”

I wish I could take credit for this, but it was the brainchild of Paul Veregge, MD.

Can we all agree that HIPAA was a big ado over nothing and stop talking about it? I would be hard pressed to identify one thing that HIPAA has changed at my organization with regard to privacy and security. Sure, we had to some training, but we would normally do that. We produced a Notice of Privacy Practices, but does anyone read those? Are any of them written in a meaningful way?

While HIPAA has been well intended, it has had a negative impact. Where we used to talk about our concern for patient privacy and information security now we ask “are we HIPAA compliant?” I would argue that the later is a LOWER standard. We do much more to protect our patients’ privacy that HIPAA requires us. I think it is sad that we only focus on being compliant and not doing what is in the best interest of those we serve.

Let’s re-direct the conversation from “HIPAA” to privacy and security.