Sunday, March 27, 2011

Incompetence--Just Deal With It

I'm working on a big project right now, implementing Knowledge-Based Charting (KBC) within our inpatient EMR. For those not familiar, it's basically pre-fab clinical documentation for everyone but Physicians and Pharmacists. The idea is that if you don't want to spend 5 years building customized clinical documentation for stuff like Vital Signs, I&O, and Assessments yourself, you can just buy this product from the vendor (if you use EPIC and not Sunrise Clinical Manager like UPHS, you may be familiar with the product).

In concept, it's a great idea. Take the content out of the box, teach the clinicians how to use it, add any custom content necessitated by regulatory bodies or site-specific practice, and you're good to go. Implementations usually take about 2 years, with a team of approximately 6 analysts and a Project Manager to do the work.

Penn doesn't have that kind of time--we need documentation, and we need it yesterday to meet Meaningful Use. So they re-tasked me from general release cycle work (more on that in later posts) to KBC full-time, and hired a Senior Clinical Analyst with 10 years of experience in health IT to help me out, along with a Project Manager (PM). We needed to be fully implemented within a year at all facilities, and required extensive customization to meet content gaps for Inpatient Rehabilitation, Skilled Nursing, Behavioral Health, and Long-Term Acute Care within the system, on top of the usual work. To close the gap in resources, we decided to take on a raft of CPM consultants to do the design of the custom build and an Implementation Consultant (IC) from our vendor to get the whole thing going on a smooth timeline.

I've learned a lot from this project, and become a local expert in Sunrise documentation. That's great--you can't ask more from a job than to do important work and get paid for it. Unfortunately, the road there has been paved with more blood, sweat, and tears than one could possibly anticipate. Highlights:

1) CPM screwed the design specifications to hell and back, forcing us to completely rebuild the content...twice, and send their specifications back three times, only to discover that we were better off doing it ourselves anyway.

2) People working on the project have fled like rats from a sinking ship. We've lost our original Allscripts IC, our CPM Clinical Practice Director, and the partner we hired about 7 months ago to help me on the project. Hell, I tried to leave to, but she beat me to it.

3) My Team Lead and I discovered that we're the resident experts on key functionality within the product, and have ended up teaching our consultants how to do their own jobs.

The scale of the incompetence demonstrated by people we hired specifically to help us and who represented themselves as experts on the product has been staggering. I've been working 60+ hour weeks for the last month, and my partner in the project is leaving this Friday for a new job, and no relief is in sight. I'm stressed, stretched thin, and on a hair trigger.

I knew there were going to be rough times on this thing--it's hard to imagine an implementation that forces us to re-train 12,000 people going off without a hitch. I'd like to say I've handled it well, but I haven't. I snipe at our consultants constantly, tried to quit and saddle my partner with the rest of the config work, and even sparred with my management over the project's direction. I don't like being this person, and I don't think it's a good face to show to my superiors.

The fundamental problem I'm faced with is one of expectations--mine were too high. I thought most problems would be generated internally, but in fact the opposite has been the case. Our external partners have repeatedly delayed and damaged our efforts, and yet remain unaccountable as a consequence of their role. I take out my frustrations on them, but it just makes me look like an asshole, and I'm trying to stop. At the end of the day, it's my project and my health system, and I have to bring it home. If these people offer some amount of help, that's cool. If not, well, they're as temporary as the project, and I have to learn to live in this workplace post go-live, and they just move on to the next site.

If there's a point to this parallel, it's that incompetence in the workplace is something you have to learn to live with gracefully. Yes, it's ridiculous that they bill 3 times my salary to do a terrible job, deflect responsibility whenever possible and fail to deliver on any deadline set. When two people have an argument though, from far away it's impossible to tell who's right, and the aggressor always comes out as the villain. So if you're on a project and getting screwed, put the War Face away and just deal--it's only a job anyway.


  1. Being a Consultant - specifically an Implementation Consultant - what's hilarious is that I see a lot of these issues from the other side of table. Constantly changing requirements, a customer who does not know what s/he wants, and training (and retraining!) customers for whom knowledge doesn't stick.

    At the end of the day, for me it seems that large projects exist to make everyone look like morons. It's absolutely frustrating to sit and bill a customer insane amounts to redo simple tasks they should be capable of doing themselves. It makes us look bad because of the exact issues you raise and it means they're more likely to just suffer through pain going forward instead of attempting to re-engage us.

    So how have you been anyway? Saw you on twitter and realized - holy crap. It's been years. Sounds like you've been having fun?

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