They came in waves from just over the horizon, each wave approaching from different elevations, and different points on the compass. They were legion; too many to count, too many for which to be able to set a winning defense. We marshaled our forces, knowing we were helpless. As I sat there awaiting the final assault I was reminded of some of the great World War II black and white movies; Midway, Twelve O’clock High, Tora, Tora, Tora. Wave after wave of Japanese and German fighters attacking the apparently helpless US forces.

Our defense perimeter established, we waited and watched. The first wave circled twice above the cellophane covered bowl. Tiny holes were cut into the cellophane allowing the fumes from the apple cider vinegar to waft upwards. The lead fruit-fly banked left and made his assault on the target. He bounced off the cellophane, as did most of the initial flight. One by one, they recovered and made their way through the pin-prick holes. The second and third waves approached the half-covered Tupperware that held the pineapple slices. After several minutes passed we slapped the lid onto the container, trapping scores of them.

“It’s those Concord grapes,” my wife asserted, implicating the helpless grapes.

“Don’t blame the fruit,” I replied. “They’re just fruit.”  Here’s the segue, try to stay with me.

If you’ve ever flown into Chicago’s O’Hare airport you may have witnessed scores of planes stacked in the air space awaiting permission to land.  I recently made reservations for a trip to Chicago. I used Southwest’s web site to make my flight to Midway—they don’t fly into O’Hare but the illustration still works. I’m the type of person who is more suited to using a well-functioning online service to complete my business. Even so, it would not be unusual for me to be having an animated one-way conversation with my computer. I started talking to the website after having to enter the same data time after time. Don’t get me wrong; I got a great deal on the airfare—three tickets for less than I paid for one last time. The site’s design allowed me to book a hotel. I entered data to reserve three rooms to coincide with the dates of my flights. A nanosecond later, I had a confirmation code for one non-refundable, no cancellation allowed room for the night before my plane even went to Chicago. By now I was speaking to my computer in tongues.

Like with the fruit, don’t blame the computer. The software did as it was programmed.  A lot of healthcare providers are going to be amazed by what they do and don’t see from their EHR system.  The system will do exactly what it programmed to do.  That’s great news if your organization’s work flows are an exact match for those built into the code.  We both know they aren’t.  That when it becomes necessary to build work arounds.  Unfortunately, you’re building them to match your work flows to their code.  For those new to the process, you are now designing your organization to move even further away from how it presently runs.  The further away you move, the more you will require change management.  Unless you budgeted correctly months earlier, you have probably already run out of funds for work arounds and change management.  If that’s the case, your EHR system is approaching its do-over point.   For each dollar of IT spend, it probably makes sense to budget at least two dollars for these tasks.  I guess you can budget those dollars for EHR 2.0, but it may be someone else whose running the implementation.