A whimsical solution to illegal immigration

Another week of conventions got me thinking.  What is all this discussion concerning illegal migration and Borders?

Some people want to build a wall; some want to be the wall.  On one end, Mexico, the problem is illegal immigration.  On the other, Canada, the problem that is not being addressed is legal migration.  However, if not for Canada, we would have fewer comedians and television news anchors.

Here’s my take on the matter, an approach I think that has been overlooked.  If the problem is too difficult, reframe the problem to make it easier to solve.  The government defines the problem as one requiring the US to defend five thousand miles of borders.  Their idea—build a wall.  Perhaps we could outsource the solution to the Chinese, have them build The Great Wall, Version 2.0,  turn it into a sight-seeing opportunity, sort of a destination hot spot, and use the tourism dollars to pay back the Chinese.  This way, English-speaking people from around the world could come see the Wall, take in the Grand Canyon, and Hoover Dam, and leave their tourism dollars in the US.

Instead of wrestling with how to defend five thousand miles of border, what if the border was shorter?  How?  Buy Mexico, and bring the troops home from Afghanistan and overthrow Canada.  If we owned Mexico, it solves two problems.  One, the border we would then need to defend becomes just a few hundred miles, Guatemala and Belize.  They could get all the supplies needed for that wall from Home Depot.

Second, why do people from Mexico sneak into the US?  Because they want to come to America.  If we bought Mexico, Mexicans would already be in America, hence, there would be no need to come to America.  I realize this argument is a bit existential, but the argument might work.

Looking north, if Canada became the fifty-first state—of course we would try to force France to take Quebec—the northern border becomes the Arctic Circle.  At that point, the only people we would need to defend against would be the Intuits and Santa Claus.   If we were to get Canada, our petroleum reserves would increase, and we’d be able to purchase prescription medicines for less money. Heh?

Maybe the feds could learn a few things about security from Borders, the bookstore.  The security at their stores far outstrips the security at our borders.

Why Some Firms Plan to Fail: 4 Warning Signs

I have always felt there is much to be learned from the mistakes of others, like knowing when a spate of trouble is heading to town like a flock of pigeons to strafe your statue.  Take for example coal miners.  Coal miners use canaries as safety measures; when the canary dies, the pigeons cannot be far behind.

Given the poor leadership skills demonstrated by of some of today’s business leaders, maybe businesses should invest in canaries. Build a little arboretum in the lobby. When the canary dies plan on taking the next decade off.

The Wall Street Journal published predictions of ten businesses that will fail in 2013.  Included on their list are American Airlines and RIM (Blackberry).  Another article suggests Dell, Sears and Rite Aid may want to hold their Christmas parties earlier this year.  Those of us with our fingers crossed are hopeful that Facebook will soon join the list.

Did the clairvoyants forget a firm or two?  Perhaps.

Some businesses fail from no fault of their own.  The economy tanks, the price of raw materials goes through the roof, or a competitor develops a less costly way to deliver a product or service.

Other businesses fail simply due to their own ineptitude—hubris born of arrogance, leadership with a self-imbued apotheosis.

Some businesses work hard to fail.  Hypothetically, assume a certain firm is the market leader in its field.  Market conditions are normal, and the firm is not set upon by any of its competitors.  In any given year the firm’s leadership knows it should expect to make a small profit.  But its leadership, which is incapable of hiding their own Easter eggs, knows from experience that nothing they do seems to be able to grow revenues significantly.

A segue.

Permit me to foment a notion—any firm having a self-labeled “leadership committee” should already begin covering its statuary to protect it from the guano.  To move away from the pigeon metaphor momentarily, leaders who believe they need to label themselves as leaders already have two strikes against them.  Real leadership is observed, it is apparent; it does not require a label.  Leadership does not a consistory—an ecclesiastical council—make.  H. Norman Schwarzkopf and Jack Welch didn’t need a leadership committee to attest to their raison d’être.

At one time or another we have all seen this scenario played out in our offices.  Sally asks.  “Have you seen Mr. Metcalf?”

“He’s in the leadership meeting,” replied Bill.  “I’ve heard he’s toast.”

Metcalf was the senior vice president of sales.  Traditionally, the CEO, who chairs the leadership committee, taps his victim three times on the head with a hammer to signify the individual has been fired.  Bill held Sally’s hand and they waited to see if the smoke coming from the chimney of the conclave was white or black.  White smoke would mean Metcalf’s successor had been chosen.

Yahoo’s new CEO just did the hammer tap on their CMO yesterday.  She had to do it by phone because the CMO was on vacation—the CEO told the woman she was relieved of her role only ten minutes prior to the press release announcing the CMO’s replacement.  In an attempt to appear human, or to assuage her guilt, the CEO then asked to former CMO to remain at Yahoo.

I digressed, did I not?

To boost revenues, said firm, the one with the leadership committee, was in the market for a savior, someone all too willing to tell leadership what they wanted to hear.  Leadership wants to double revenues, and lo-and-behold they find the one person on the planet capable of convincing them that he can do what they were unable to do.  It never occurs to the leadership that hiring a hand-picked, self-anointed savior flies right in the face of the premise “there ain’t no free lunch.”  It just goes to show you that if you go looking for trouble you are sure to find it.

Cue the white smoke.

“Please welcome to the firm Vlad the Impaler, our new Jekyll and Hyde turnaround agent and part-time bon vivant,” implores the firm’s short-lived CEO.

The underlings, who dubbed the savior Skippy, learned quickly what Skippy had in his bag of tricks.  Trick number one is that every email sent by Skippy began with the word ‘team.’  There is no “I” in team, but there is “me”, as in “This is Entirely About Me”.  There was no team, but Skippy knew that by using the word he would be viewed by leadership as having created a team.

I am here to help.”  Trick number two.  Say anything enough times and people will believe it.  The cynics in the group are keeping a tally sheet of all of the revenues created by Skippy.  Total additional revenues created by tricks one and two—zero.  But leadership was happy.  They now had a ‘team’ and they had someone who could ‘help’.

Trick three; be wary of anyone who claims to “have your back”.  More than likely this means they are standing behind you.  Anyone who has ever used a garrote knows it works best when applied from behind.

Skippy’s best trick was his ability to perform remarkable feats of prestidigitation with spreadsheets.  Skippy’s use of color and his ability to use the text-wrapping feature was known to elicit tears during the leadership meetings.  What Skippy knew that none of the leaders knew is that by overloading the chart with numbers, and by splashing generous amounts of color in the rows and columns, he could create the illusion of success—visually perceived images that distorted objective reality.  Trick the eye and the executives by making them look where you want them to look.

One way to spot whether failure is alive and thriving in your organization is to look at the other employees.  If half of them look like they are going to a funeral and the other half look like they just came from one, things are not well.  When your colleagues stand around the coffee room intermingling like strangers at a wake, the time has come to send someone to the lobby to check on the health of the canary.  Unfortunately, sometimes narcissists shoot the canary just to brighten their day.

Your EHR Works As Designed, And That’s The Problem

This is my newest contribution to HealthsystemCIO.com.

What could we have done differently, is the question I hear from many of the healthcare executives with whom I speak about the productivity loss resulting from their EHR.

My answer, nothing. I am willing to bet that in most cases your EHR was implemented correctly. I am just as willing to bet that the training was executed well. “If we did everything correctly, then why is the EHR performing so poorly?”

Fair question. The EHR is not performing poorly. It is performing exactly as it was written to perform. If that is true, why is there such a dichotomy between how it is working and how we need it to work? That is the perfect question to be asking. Here is why. If you interviewed your EHR vendor and asked them to tell you how the system is supposed to work when a nurse or doctor is with a patient they will tell you something like this:

We wrote the system to mimic what doctors and nurses need to do during an examination. Start with getting a history of the present illness (HPI). Then get vital signs, list of allergies, significant events, medical history, current meds, and lab and test results. Then write any prescriptions, order tests, and end the visit.

Very neat, very orderly. Linear. Move from Task 1, to Task 2. Just the way the EHR was written, just the way doctors were trained to conduct an exam.

Unfortunately, most exams do not follow that flow. Why? Patients. Somebody forgot to tell the patients and the clinicians that, in order for the EHR to work in anything that could be construed to be an effective and efficient manner, the exam must be conducted according to the EHR’s script. In order to minimize the number of screen navigations and clicks, you must complete all of Task 1 before moving on to Task 2. Linear. Front to back.

Exams are not linear. Patients generally dictate much of the order of an exam. They move indiscriminately and randomly from one task to the other. This randomness causes the clinician to hop about the screens in the EHR in an ad-hoc manner. Data entry and screen navigation are neither orderly nor complete. Nor are they front to back. The patient may start the exam with a question about lab result or about a side-effect of a medication.

All of this jumping around adds time, more time than what was allotted for the exam. Imagine that on your desktop you have several programs running; PowerPoint, Word, Excel, and email. Instead of completing what you hoped to accomplish in one program, closing it, and moving on to your next task, you were forced after each minute to stop what you were doing in one program and go work on something different in the next program.

Is there anyone who doubts that it would have taken less time to complete all your tasks if you were allowed to complete one before starting the other?

You EHR was not designed to work efficiently in an non-linear exam. Chances are good that your EHR was never really designed at all. Were designers, professionals with advanced degrees in human factors — cognitive psychology, heuristics, taxonomy, and anthropology — asked to determine how the EHR would need to work? Did they watch users work prior to writing code? Did the EHR firm iteratively build prototypes and then measure how users used it in a research lab that tracked hand and eye movements? If not, that is why I think it is fair to characterize EHRs as having been built, not designed.

The good news is that even at this point, even as you continue to watch productivity drop, you can choose to bring design in to solve the problem. Retraining will not solve the problem. After all, it was trained users who helped bring about the productivity loss.

EHR: How Important is Due Diligence?

What was your first car?  Mine was a 60’ something Corvair–$300.  Four doors, black vinyl bench seating that required hours of hand-stitching to hide the slash marks made by the serial killer who was the prior owner, an AM and a radio, push-button transmission located on the dash.  Maroon-ish.  Fifty miles to the quart of oil—I carried a case of oil in the trunk.  One bonus feature was the smoke screen it provided to help me elude potential terrorists.

I am far from mechanically inclined.  In high school I failed the ASVAB, Armed Services Vocational Aptitude Battery—the put the round peg in the round hole test.  Just to understand how un-complex the Corvair was, I, who hardly knows how to work the radio in a new car, rebuilt the Corvair’s alternator—must not have had many working parts.  Due the the excessive amount of rusting I could see the street from the driver’s side foot well.

However, it had one thing going for it; turning the key often made it go—at least for the first three or four months.  Serves me right.  The guy selling the car pitched it as a date-mobile, alluding to the bench front seat.  Not wanting to look stupid, I bought it.  Pretty poor due diligence.  An impulse purchase to meet what I felt was a social imperative—a lean, mean, dating machine.

The last time I made a good impulse purchase was an ice cream sandwich on a hundred degree day.  Most of my other impulse decisions could have used some good data.  The lack of good data falls on one person, me.

How good is the data you have for deciding to implement an EHR?  In selecting an EHR?  Did you perform the necessary due diligence?  How do you know?  Gathering good data is tedious, and it can lack intellectual stimulation.  I think it affects the same side of our brain as when our better half asks us to stop and ask someone for directions; we like being impulsive, and have built a career based on having made decisions on good hunches.

The difference between you buying and EHR and me buying a clunker is that when I learned I’d made a poor decision I was able to buy a different car.  You can’t do that with an EHR that has more zeros in the price tag than the national deficit.  Plenty of hospitals are on EHR 2.0–they also happen to be on CIO 2.0. while CIO 1.0 is out shopping for a Corvair.

EHR–WWOD (What would Oprah do?)

So, I’m watching a football game on television and it suddenly strikes me, there are probably a lot of people trying to understand what it is a consultant does that we can’t do for ourselves.

For those who have a life, those who missed the game, Alabama opens the game with several well-scripted opening plays and grabbed an early lead.

Their first ‘n’ offensive plays were brilliant.  They were planned perfectly.

It became apparent they had not planned the however many of the ‘n + 1′ plays.  Their plan failed to go beyond what they’d already accomplished.

How does that apply to what you do, what I do, and why I think I can help you?  It is best described by comparing your brain to a consultant’s brain.  Your work brain functions exactly as it should.  It’s comprised of little boxes of integrated work activities, one for admissions and registration, one for diagnosis, another for care.  There’s probably another box for whatever it is the newsletter stated IT was doing three months ago and how that impacts what you do.  That’s your job.

Your boxes interface in some form or fashion with the boxes of the person next to you in the hospital’s basement cafeteria who is paying for her chicken, broccoli, and rice dish that reminds you of what you ate at crazy Uncle Bob’s wedding reception.  That interface is the glue that makes the hospital work.  It’s also the synapse, the connective tissue—I know it’s a weak metaphor, but it’s a holiday weekend—give me some slack—that tries to keep healthcare functioning in an 0.2 business model.

There are names for the connective tissue, you know it and I know it.  It’s called politics.  It’s derived from antiquated notions like, “this is how we’ve always done it”, “that’s radiology’s problem”, and “nobody asked me”,

At some point over the next week or two the inevitable happens; the need arises for you to add some tidbit of information.  Do you add it to an existing box, put it in an empty box, or ignore it?  This is where you must separate the wheat from the albumen—just checking to see how closely you’re following.

Your personal warehouse of boxes looks like the final scene in Raiders of the Lost Ark—acre after acre of dusty, full boxes, no Dewy-decimal filing system, and no empty box.  There are two rules at the hospital; one, bits of information must go somewhere, and two, nobody can change rule one.

The difference, and it’s a big one, is that consultants have an empty box.  It’s our Al Gore lockbox.  We were born that way.  It’s like having a cleft chin.  We also have no connective tissue to your organization.  No groupthink.  No Stepford Wives. No Invasion of the Body Snatchers to turn us into mindless pods.  Consultants may be the only people who don’t care.  Let me rephrase that.  We don’t care about the politics.  We don’t care that the reason the hospital has four IT departments is because the hospital’s leadership was afraid to tell the siloed docs that they couldn’t buy or build whatever they wanted.

Sometimes it comes down to your WWOD (what would Oprah do) moment.  Not ‘what do they want me to do’, not ‘what would they do’, not ‘what is the least disruptive’, not ‘what goes best with what the other hospital did’.

At some point it comes down to, what is the right thing to do; what should we do.

Big, hairy healthcare IT projects come out of the shoot looking like Alabama did.  The first however many moves are scripted perfectly.  Heck, you can download them off Google.  Worse yet, you can get your EHR vendor to print them for you.

The wheat from the albumen moment comes when you have to come up with an answer to the questions, “What do we do next,” and “Why doesn’t it work like they said it would?”

That’s why consultants have an open box.  You know what we are doing when our brain takes us to the open box?  Thinking.  No company politics to sidetrack us.  Everybody knows the expected answers, but often the expected answer is not the best answer.  Almost everybody knows what comes after A, B, C, and D.

Sometimes…E is not the right answer or the best answer.

HIT/EHR: Adult supervision required

Among other things, EHR requires adult supervision–kind of like parenting.

My morning was moving along swimmingly.  The kids were almost out the door and I thought I’d get a batch of bread underway before heading out for my run.  I was at the step where you gradually add three cups of flour—I was in a hurry and dumped it all in at once.  This is when the eight-year-old hopped on the counter and turned on the mixer.  He didn’t just turn it on, he turned it ON—power level 10.

If you’ve ever been in a blizzard, you are probably familiar with the term whiteout.   On either side of the mixer sat two of my children, the dog was on the floor.  In an instant the three of them looked like they had been flocked—like the white stuff sprayed on Christmas trees—those of you more politically astute would call them evergreens—to make them look snow-covered.  (I just em-dashed an em-dash, wonder how the AP Style Book likes that.)  So, the point I was going for is that sometimes, adult supervision is required.

What exactly is Health IT, or HIT?  It may be easier asking what HIT isn’t.  One way to look at it is to consider the iPhone.  For the most part the iPhone is a phone, an email client, a camera, a web browser, and an MP3 player.  The other 85,000 things it can be are things that happen to interact with or reside on the device.

In order for us to implement correctly (it sounds better when you spilt the infinitive) HIT and EHR, a little focus on blocking and tackling are in order.  Some write that EHR may be used to help with everything from preventing hip fractures to diagnosing the flu—you know what, so can doctors.  There are probably things EHR can be made to do, but that’s not what they were designed to do, not why you want one, and not why Washington wants you to want one.  No Meaningful Use bonus point will be awarded to providers who get ancillary benefits from their EHR especially if they don’t get it to do what it is supposed to do.

EHR, if done correctly, will be the most difficult, expensive, and far reaching project undertaken by a hospital.  It should prove to be at least as complicated as building a new hospital wing.  If it doesn’t, you’ve done something wrong.

EHR is not one of those efforts where one can apply tidbits of knowledge gleaned from bubblegum wrapper MBA advice like “Mongolian Horde Management” and “Everything I needed to know I learned playing dodge ball”.

There’s an expression in football that says when you pass the ball there are three possible outcomes and only one of them is good—a completion.  EHR sort of works the same, except the range of bad outcomes is much larger.

EHR: read before you buy

There is a first time for everything.  Sunday was the first time it occurred to me that there is a difference between being twenty and not being twenty.  A few days ago one of the women at the gym was bemoaning the fact that being forty wasn’t at all like being thirty–puhleeaasse.

My wife would have me point out her admonition of “You are not twenty anymore.”  Women do not understand that to men this phrase goes into our little brains and comes out reshuffled as the phrase “Just you wait and see.”

There are those who would have you believe that there is no single muscle that is connected to every other muscle, a muscle which if pulled will make every other muscle hurt.  I beg to differ.  I think I found it—I call it a my groinal—it’s connected to my adverse and inverse bent-egotudinals, the small transflexors located behind the mind’s eye.  I found the muscle while running back a kickoff during a Saturday morning game of flag football.

Call it an homage to the Kennedys.  Sort of made me fee like one of them—I think it was Ethyl.  Old guys versus new guys—I know it’s a poor word choice but you know what I mean which after all is why we’re both here.  Did I mention that everything aches, so much so that I tried dipping myself in Tylenol?

There are two types of people who play football, those who like to hit people and those who don’t like being hit.  I am clearly a member of the latter camp.  I used to be able to avoid being hit by being faster than the other guy.  This day I avoided getting hit by running away from the other guy.

The weird part is that my mind still pictures my body doing things just like the college kids on the field, and it feels the same, it just isn’t.  Two kids passed me–they were probably on steroids, and my only reaction was the parent in me wanting to ground the two of them.  Half the guys are moving at half the speed of the other guys.  At the end of each play, we find our side doubled over, our hands on our knees, our eyes scanning the sidelines for oxygen and wondering why the ground appears to be swaying.

As the game progresses, instead of running a deep curl pattern, I find myself saying things like, “I’ll take two steps across the line of scrimmage, hit me if I’m open.”  Thirty minutes later I’m trying to cut a deal with their safety, telling him, “I’m not in this play, I didn’t even go to the huddle.”  After that I’m telling the quarterback, “If you throw it to me, I’m not going to catch it, no matter what.”

All the parts are the same ones I’ve always had, but they aren’t functioning the way they should.  It’s a lot like assembling a gas grill and having a few pieces remaining—I speak from experience.  Unfortunately, implementing complex healthcare information technology systems can often result in things not functioning the way they should, even if you have all the pieces.  It helps to have a plan, have a better one than you thought you needed, have one written by people who plan nasty HIT systems, then have someone manage the plan, someone who can walk into the room and say, “This is what we are going to do on Tuesday, because this is what you should do on Tuesday on big hairy projects.”.

Then, if you pull your groinal muscle implementing EHR, try dipping yourself in Tylenol.

EHR’s Kitchen Table Amateurs (KTAs)

So I’m making dinner the other night and I’m reminded of a story I heard a while back on NPR. The narrator and his wife were telling stories about their 50 year marriage, some of the funny memories they shared which helped keep them together. One of the stories the husband related was about his wife’s meatloaf. Their recipe for meatloaf was one they had learned from his wife’s mother. Over the years they had been served meatloaf at the home of his in-laws on several occasions, and on most of those occasions his wife would help her mom prepare the meatloaf. She’d mix the ingredients in a large wooden bowl; 1 pound each of ground beef and ground pork, breadcrumbs, two eggs, some milk, salt, pepper, oregano, and a small can of tomato paste. She’d knead the mixture together, shape into a loaf, and place the loaf into the one-and-a-half pound pan, discarding the leftover mixture. She would then pour a mixture of tomato paste and water, along with diced carrots and onions on top of the two loaf, and then garnish it with strips of bacon.

He went on to say that meatloaf night at home was one of his favorite dinners. His wife always prepared the dish exactly as she had learned from her mother. One day he asked her why she threw away the extra instead of cooking it all. She replied that she was simply following her mother’s recipe.  The husband said, “The reason your mom throws away part of the meatloaf is because she doesn’t own a two-pound baking pan. We have a two pound pan. You’ve been throwing it away all of these years and I’ve never known why until now.”

Therein lays the dilemma. We get so used to doing things one way that we forget to question whether there may a better way to do the same thing. Several of you have inquired as to how to incorporate some of the EHR strategy ideas in your organization, how to get out of the trap of continuing to do something the same way it’s been done, simply because that’s the way things are done. It’s difficult to be the iconoclast, someone who attacks the cherished beliefs of the organization. It is especially difficult without a methodology and an approach. Without a decent methodology, and some experience to shake things up, we’re no better off than a kitchen table amateur (KTA). A KTA, no matter how well-intentioned, won’t be able to affect change. The end results would be no better than sacrificing three goats and a chicken.

So, think about how to define the problem, how to find a champion, and how to put together a plan to enable you to move the focus to developing a proper strategy, one that will be flexible enough to adapt to the changing requirements. But keep the goats and the chicken handy just in case this doesn’t work.

Help has arrived for your EHR productivity loss

I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school.  The camp was for high school students of varying backgrounds and their counselors.  On more than one occasion, the person on the other end of my rope would freeze and I would have to talk them down safely.

Late in the day, a thunderstorm broke quickly over the mountain, causing the counselor on my rope to panic.  No amount of talking was going to get her to move either up or down, so it was up to me to rescue her.  I may have mentioned in a prior post that my total amount of rappelling experience was probably no more than a few more hours than hers.  Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her.

The sky blackened, and the wind howled, raining bits of rock on us.  I remember that only after I locked her harness to mine did she begin to relax.  She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.

That episode reminds me of a story I heard about a man who fell in a hole—if you know how this turns out, don’t tell the others.  He continues to struggle but can’t find a way out.  A CFO walks by.  When the man pleads for help the CFO writes a check and drops it in the hole.  A while later the vendor walks by—I know this isn’t the real story, but it’s my blog and I’ll tell it any way I want.  Where were we?  The vendor.  The man pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.

I walk by and see the man in the hole.  “What are you doing there?”  I asked.

“I fell in the hole and don’t know how to get out.”

I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole.  “Why did you do that?  Now we’re both stuck.”

“I’ve been down here before” I said, “And I know the way out.”

I know that’s a little sappy and self-serving.  However, before you decide it’s more comfortable to stay in the hole with your EHR productivity loss and hope nobody notices, why not see if there’s someone who knows the way out?

Merely appointing someone to run your EHR effort doesn’t do anything other than add a name to an org chart.

EHR: I may have found a shortcut

How able are you to conjure up your most brainless moment—don’t worry, we aren’t on the EHR part yet.

As I was running in San Diego I was passed by a harem of seals—Navy Seals.  Some of them were in better shape than me, I couldn’t judge the fitness of the others as they ran by me too fast.  That got me thinking.  For those who having been regular readers, you’ll know this is where I have a tendency to drive myself over a cliff.

Seeing the Seals took me back to my wistful days as a cadet at the US Air Force Academy.  Coincidentally, my hair looked then a lot like it looks now.  One of the many pastimes they tossed our way for their amusement and our survival was orienteering; sort of map reading on steroids.  One night they took us to the foothills of the Colorado Rockies, paired off the doolies, gave us a set of map coordinates, a compass, map, and flashlight.  The way training worked, those who proved to be the fastest at mastering skills fared better than those who weren’t.  Hence, there was plenty of incentive to outperform everyone; including getting yourself to believe you could do things better than you could, sort of a confidence building program.

We were deposited in a large copse—I’ve always liked that word—of trees—I don’t know, but it seems adding trees to the phrase is somewhat redundant.  We had to orient ourselves and then figure out how to get to five consecutive locations.  The sun had long since set as we made our way through the treed canyon and back up a steep ravine.  After some moments of searching we found the marker indicating we were at point Able.  The group started to examine the information that would direct our journey to point Bravo.

While they honed their skills, I was examining the map, taking some bearings with the compass, and trying to judge the terrain via the moonlight.  My roommate, a tall lanky kid from Dothan, Alabama asked why I didn’t appear to be helping.

“Look at this,” I replied.  “Do you see that light over there, just to the right of that bluff?  I think I’ve found us a shortcut.”

“What about it?”  Asked Dothan.

“If my calculations are correct, that light is about here,” I said and showed them on my map.  “It can’t be more than a hundred yards from point Delta.”

“So?”

“So why go from Alpha to Bravo to Charlie to Delta, if we can go right to Delta from here?  That will knock off at least an hour.”  I had to show my calculations a few times to turn them into believers, but one by one they came aboard.  The moon disappeared behind an entire bank of thunderheads.  We were uniformly upbeat as we made our way in the growing blackness through the national forest.  Unlike the way most rains begin, that night the sky seemed to open upon us like a burst paper bag.

“Get our bearing,” I instructed Dothan.  As it was my idea, I was now the de facto leader.  As we were in a gully, getting our bearings required Dothan to climb a large evergreen.

“I don’t see it,” he hollered over the wind-swept rain squalls.  I scurried up, certain that he was either an idiot or blind.

“Do you see the light?”  They asked me.  I looked again.  Checked my map.  Checked my compass.  “It has to be there,” I yelled.

A voice floated up to me.  To me I thought it probably sounded a lot like the voice Moses heard from God as he was building the Ark.  (Just checking to see if you’re paying attention.)  “What if they turned off the light?”

I almost fell out of the tree like an apple testing the laws of gravity.  What if someone had turned off the light?  There was no ‘what if’ to consider.  That is exactly what happened.  Some inconsiderate homeowner had turned off their porch light and left us stranded.

Fast forward.  We were lost, real lost.  We didn’t finish last, but we did earn extra exercise the next day, penalized for being creative.  Who’da thunk it?

Short cuts.  When they work, you’re a headliner.  When they fail, chances are you’re also a headliner—writing the wrong kind of headlines.  I hate being redundant, but with EHR we may be dealing with the single largest expenditure in your organization.  It will cost twice as much to do it over as it will to do it right.  If you haven’t done this before—I won’t embarrass anyone by asking for a show of hands—every extra day you add to the planning process will come back to you several fold.  There may be short cuts you can take, but planning should not be one of them.  How much should we plan?  How long should it take?  Who should participate?  We will look at each of those questions in some detail.  For now, let’s answer those three questions with; more than you think, longer than you’ve planned for it to take, and different skills than you’re currently using.saint