EHR: It is like herding cats

I spent a summer in Weaverville, North Carolina, just outside of Asheville. (I couldn’t find it on the map either.) That summer, I was the head wrangler at Windy Gap, a summer camp for high school kids. I’m not sure I’d ever seen a horse, much less ridden one, so I guess that’s why they put me in charge. I thought that maybe if I dressed the part that would help. I bought a hat and borrowed a pair of cowboy boots from a friend; the boots were a half size too small, and I spent the better part of the first night stuffing sticks of butter down them trying to get them off my swollen feet.

The ranch’s full-time hand taught us how saddle the horses and little bit about how to ride. In the mornings we had to herd the horses from the fields, bring them into the corral, and saddle them. The other wranglers would ride out to the field to bring in the horses, while I being the least experience of the wranglers would race after them in my running shoes trying to coax them back to the barn. We would take the children for a breakfast ride halfway up a mountain path where we would let them rest and cook them a breakfast of sausage and scrambled eggs. One morning there were a group of 15 high school girls sitting on the fence of the corral. I walked up behind them carrying two saddle bags filled with the breakfast fare. I slung the saddlebags over the top rail of the fence, and hoping to make a good impression I placed one hand on the rail and vaulted myself over. I landed flat on my back smack dab in the middle of the pile of what horses produce when they’re done eating—so much for the good impression.  That earned me the nick-name, “Poop Wrangler.”

I brushed myself off and saddled my horse. The moment I gripped the reins the horse reared, made a dash for the fence and jumped it in one motion. I could tell the high school girls were impressed as I flew by them. Both of my arms were wrapped around the horse’s neck, and I had my hands locked in a death grip. I yelled, “whoa” and stop”, only to learn that the horse didn’t speak English. We raced the 200 yards to the dining hall, stopped on a dime, and raced back to the corral, as the girls continued to cheer. One final leap, and I was back where I started; on the ground, in the corral, looking up at the girls. I took a bow and quickly remounted my steed. The full-time ranch hand came over and instructed me rather loudly, “You can’t let the horse do that. You have to show the horse that you’re in charge.” After that piece of wisdom he grabbed my horse by its bit, pulled its head down, and bit a hole in my horse’s ear. I’m not sure what kind of in an impression it made on my horse. I guarantee you it made an impression on me.

Horses aren’t very intelligent, but they know when you don’t know what you’re doing, when you’re bluffing—dressing like a cowboy didn’t even fool the girls, much less my horse—I guess he hadn’t seen many westerns. Here we go—you had to know where this was headed.

Selecting and implementing an EHR will be the most complex project your hospital will undertake.  If you do it wrong, you may not look any better than I did laying on my back in the corral.  You won’t have girls laughing at you, but you also may be looking for another line of work.

You don’t want to read this, but if your projected spend exceeds ten million dollars, your chances of success, even if you do everything right, is less than fifty percent.  I define success as on time, on budget, functioning at the desired level, and accepted by the users.  That’s reasonable, correct?  We don’t need to talk percentages if you don’t do everything right.

These figures come from the Bull Report—that’s really the name, honest.

The main IT project failure criteria identified by the IT and project managers were:

missed deadlines (75%)
exceeded budget (55%)
poor communications (40%)
inability to meet project requirements (37%).

The main success criteria identified were :

meeting milestones (51%)
maintaining the required quality levels (32%)
meeting the budget (31%)

How is yours matching against these?  Given a choice, sometimes I’d rather be the horse.

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