Years ago I worked on one of those not so good software development projects. It was a 1-year job that turned into a 2-year job. The client kept changing requirements (or we kept capturing them wrong, depending on who you talk to). Tensions and stress levels were high. There was one person from the client’s side that was particularly stressed… we’ll call her Betty. She was in charge of billing and finance. If her part didn’t work the business was toast. As the launch date grew closer, Betty grew more fearful. It was common to hear her say things like: Is this right? Maybe we should test it again. Let’s push another month. I’m not sure. Etc. Etc.

We launched on a Monday. Days 1 and 2 were hectic (new system, hundreds of users, hectic), but things we’re checking out and Betty was feeling OK. The big test would come on Wednesday: 1 of her 2 finance staffers would be out of the office. Then the other one called in sick (a case of the “F that’s” I suspect). Betty was all alone and had daily billing plus a major financial reporting deliverable due that day. She thought she was screwed. Then, a funny thing happened… around 1 PM that day Betty came into our developer pit (a few of my staff we’re working on site to support the launch) and stood there with her arms up in disbelief.

Lead Developer: Uh oh. What’s wrong, Betty?

Betty: I’m… done.

Lead Developer: What do you mean?

Betty: All my work. It’s done. It’s 1 PM and I’m done for the day. It used to be a mad dash to get it done with 3 people working into the night. I just did all of it myself by 1 PM. I had no idea it would be like this.

Betty had gotten caught up in the stress of the transition and forgotten what we were doing. She longed for the good old days, where she could “just get her work done”. She had a way and it worked well for her and this stupid project had been preventing her from just doing her job. She forgot that we were going to make it better.

Sound familiar Health Care?

We’ve been in a mad dash to implement this “new system” in healthcare since 2009. We’re doing it on top of our existing jobs and it’s getting in the way. Sure, there are some benefits, but there’s a lot of drawbacks too and they’re real obvious.

This is a tough “project”.

Some people see the possibilities and are frustrated that we aren’t taking advantage of them yet. Just keep plugging away.

Others are like Betty. They had a way that worked for them and now they’re trying to do that alongside, or even in spite of, this new system. They just want the “project” to end so they can get back to their work. This post is for them.

Roy Smythe calls this Health Care’s Current Productivity Paradox. He acknowledges that a majority of recent EHR adopters believe productivity (moving patients through a health care experience and documenting the encounter) has gone down. When you look at EHR’s as a “General Purpose Technology” or “GPT”, this productivity slowdown makes a lot of sense.

A GPT is a technology that can affect an entire economy, and alter economic and social structures. These technologies also usually have three more specific characteristics — pervasiveness, an ability to improve over time and lower the costs of its users, and encourage the invention and production of new products and processes. As a GPT can be a product, process or system, some notable examples would include: domestication of plants and animals, the wheel, mass production, electricity, nuclear energy and the computer.

Based on that definition, I think we can all agree that the EHR qualifies as a GPT. Smythe cites a recent book called The Second Machine Age by Erik Brynjolfsson and Andrew McAfee to explain why the slowdown makes sense:

What they tell us is that there were two previous slowdowns in productivity that were not anticipated, and caused great consternation — the adoption of electricity and the computer. The issues at hand with both were the protracted time it took to diffuse the technology, the problem of trying to utilize the new technology alongside the pre-existing technology, and the misconception that the new technology should be used in the same context as the older one.

Again I ask, does that sound familiar Health Care?

So to all of you feeling like Betty… bear with us. Not only will you get back to doing your job, but you’ll be empowered beyond your highest expectations. Your “Aha” moment is coming.