To read and complete this post, you may use the following tools; graph paper, compass, protractor, slide ruler, a number two pencil, and a bag of Gummy Bears from which to snack. The following problem was on the final exam in my 11th grade physics class. Let us give this a shot and then see if we can tie it into anything relevant.
A Rhesus monkey is in the branch of a tree 37 feet above the ground. The monkey weights eight pounds. You are hunting in Africa, and are 320 yards from the monkey. You have a bolt-action, reverse-bore (spins the shell counter-clockwise as it leaves the gun barrel) Huntington rifle capable of delivering a projectile at 644 feet per second. The bullet weighs 45 grams. The humidity is seventy percent, and the temperature in Scotland is 12 degrees Celsius.
At the exact moment the monkey hears the rifle fire, it will jump off the branch and begin to fall. Using this information, exactly where do you have to aim to make sure you hit the monkey?
I used every piece of information available to try to solve this. I made graphs and ran calculations until there was no more data left to crunch, computing angles and developing new formulas. I calculated the curvature of the earth, and the effect Pluto’s gravitational pull had on the bullet.
The one thing that never occurred to me was that since the monkey was falling to the ground, so was the bullet — gravity. The bullet and the monkey both fall at the same rate because gravity acts on both the same way. So, where to aim to hit the monkey? Aim at the monkey.
All of the other information was irrelevant, extraneous. The funny thing about extraneous information is that it causes us to look at it; to focus on it. We think it must be important, and so we divert attention and resources to it, even when the right answer is staring us in the eye.
Attempting to implement an EHR is a lot like hunting monkeys. We know what we need to do and yet we are distracted by all of this extraneous information that will hamper our chances of being successful with the EHR. The overarching goal of EHR is EHR; one that does what you need it to do. If the EHR does not do that, everything else has no meaning.
When the EHR does not perform the way we were told it would by the man wearing a suit made of live squirrels, we panic. Not only do we panic, we start believing every irrelevant suggestion tossed our way — the implementation was not done correctly, the training needs to be redone. A note to all of the training aficionados moving their lips as they read along — the trained users are the same users whose productivity dropped; retraining them will yield the same result. Training is nothing more than teaching the users how to work around the idiosyncrasies of a poorly designed system.
You spend weeks going through the EHR’s project plan trying to discover the step you missed. Well, here is the step. If you can answer this question, your EHR works just fine. Did we review and design the user interface with the doctors and nurses before we implemented the system?
The good news? You can still perform this step. And, the cost to correct an underperforming EHR is less than what it cost you to train the users.