Spinning Sensation of IT Projects

It seems like IT departments go round in circles revisiting the same issues of projects over and over again. As you go around again and recognize the same issues, will you have enough energy to tighten the circle so that next time and issues are less? The spinning of project issue repetition is a symptom of lack of a comprehensive understanding of information and technology interaction. This spinning does not happen overnight, it builds up slowly as more projects are retrofitted into system as a whole.

More integration headaches equal less vision of information architecture. Why is this? Because someone said we need to consolidate system X with system Y without thinking through the issues of having corrupt information. Information’s worth is how well it is connected, but what happens when connections change leaving orphaned content and obsolete metadata? Nothing happens until someone says, “Let’s safe money by consolidating” or integrating or adding functionality, etc.

How does IT stop the spinning of issues?

At the core of any spiral, you don’t spin, but you see everything that is. With this perspective you can understand the forces at work, for example, a department that is feeding the spin by adding content that is not described accurately and extensively enough-rotation is increased. At the core, you can see this by analyzing reports which show trends. Also, anytime you think through how to export a cross section of your content and information you will expose the issues which cause your dizziness. The export exercise can be a low cost way to analyze how well the information architecture is designed. For example, does the information make sense on its own, are standard descriptive terms used to describe the content, are there accurate dates of execution of the information, could it be accurately imported into another system?

Techniques to pitch your innovative ideas in IT

You have an approach to an issue with the design or flaw in a system. You brought up the idea with your project manager who dismissed it immediately without considering the whole possible solution. You know your idea has merit. You know your idea could work, but how do you convince your peers and managers, how do you persuade them?

Persuasion is a skill that, when coupled with perseverance, will help implement your idea. Of course, your idea has to be good and well thought out. Many people have better persuasion skills than ideas and that’s part of the problem with IT these days: many project managers have other agendas that diminish the technical integrity of the solution. Solution flaws come back to haunt you if you let them slide because of the pressures of timelines in the present. Have some guts and make your case now or suffer the consequences!

Plant the seed, add water

Bring up your idea and be aware of the reaction. If the reaction is dismissive, don’t try to convince at that point. Let the idea work its way into the doubting minds. In the meantime, build your argument. Let’s say a few other ideas are brought up and tried, but ultimately fail. Your idea may be brought up by the person who dismissed it a few days ago. If this happens, try not to feel discouraged as ideas are cumulative and no one person deserves full credit.

Try/Buy

If the idea you have involves software, see if it is available on a trial basis. If so, install the software and configure it. Build a proof of concept. The best way to convince your management that your idea is a good one is to show it in action.
 

Gather consensus

Your ability to persuade individual members of the team could be crucial to getting your point across. The more team members that are convinced, the better chance of actually getting your innovative idea recognized.

Let other ideas fizzle out, be patient

If you are patient the inferior ideas will eventually be proven faulty. Reintroduce your idea and witness how it is accepted. There are many reasons that folks reject ideas at first. It would take all your energy to figure them out. Your job is to know that your idea is the best and to persevere.

Some Myths of Big Data

After Lawrence Hart recommended "The Myths of Innovation" by Scott Berkun, I was curious to find out what Mr. Berkun's ideas were on innovation. The book starts out with the concept of the years of hard work it takes for our innovative breakthroughs to occur; that the moment of genius is a surprise after many long hours and infinite combinations of possibilities.

As we consider "Big Data" and its promises of indexing and searching "innovation", I wonder how of this is marketing and how much is making a "significant positive change"? Big Data in healthcare has a long way to go before it can truly state that it works. What the Big Data push is doing is forcing the architects of the first generation of EMR designs to rethink how their data is designed, OCR for scanned results and forms, metadata of content, designs of the forms online and on paper, merging of transfer patient encounters, and the use of acronyms, keywords in forms. This is just a short list of hurdles that will need to be dealt with before Big Data can be fully useful.

Bad Data in EMRs

Indexing inconsistent and spotty information makes it easier to search, but the results would still need a lot of clean up. In other words, EMRs will need to be fully combed through and corrected to produce accurately results. One issue with EMRs is that the underlying organizational structures are hard to change because of the audits and regulations that control these changes. Also, when hospitals merge, older record numbers get merged in with newer one; at the master database level the numbers are unique, however at the patient record level all sorts of interesting things can happen where duplicates number occur and short term fixes are put in place...

Some EMRs allow for free text to be entered as metadata which describes the electronic or scanned in form; great, but have you ever tried to pull any type of consistent meaning out of these free text fields? What were they thinking??

Optical Character Recognition (yep, ICR and OMR too)

For hospitals that are not fully electronic, most of them, the issue of scanning and OCR'ing their forms and results is an ongoing struggle in that the forms and inconsistently filled out, doctors and nurse hand write their notes, and the design of the forms paper oriented. The technology behind ICR for hand writing is not good enough for recognition unless the hand written letters have boxes around them.

So, as Big Data permeates healthcare systems, at what point will it really help to bring about "significant positive change"? There are many years of hard work to get this point. If you drink the koolaid, index agents can intelligently sift through all of the noise and help find and report on the information that is required for upper management dashboards, however, I believe there will be many cycles of "reforecasting" Big Data effectiveness before it is ready for primetime. 

When ECM's “How” gets in the way of the “What”

It's one of those golden rules of IT projects to collect the business requirements with an open perspective, unshackled by technical or operational concerns. But, what happens when this rule is broken? What are are some of the symptoms of putting the how ahead of the what? Here are a few categories (out of many):

Over funded with small scope

Capital projects are structured in such as way as to be viable for certain period of time. These projects can have moneys which are over allocated. This creates a “bucket” to use on other, related projects, which can benefit from the “shared” software application or servers. There's a time limit, so the deadline of spending approaches, management will get creative and spend money on more innovative projects.

Project over scoped with not enough resources

This where the time-line of initiatives and ROI objectives get delayed and pushed back to the point where the original project sponsors loose faith in IT's ability to deliver. Sometimes years will go by with nothing happening, meanwhile the business is forced to find alternatives. Shadow or cloud projects are developed on the side, within the view of IT, but without consequences. That is until a system goes down and someone begs IT for help. Then IT takes it over and begins the journey back to standardization and optimization, and lest we forget, shared services.

Assumptions are not coordinated with other systems: other systems solve their own issues

The larger the IT project, the more integrated it is going to be. Without a concerted effort at understanding the full breadth of requirements and assumptions at the beginning of the project, the project will falter each time an integration step is needed. Why? Because the time and effort was not taken to include the key players of integration during the planning and funding phases of the project. The assumptions were glossed over by the deadlines to get a budget in place.

OnBase VBScript to Export a File

Updated script: VBScript and API to export all image pages

Link to other Onbase scripts.

I spent too much time looking for a script example for exporting from OnBase the other day, so I wrote one that works within OnBase. It can be run as a script hook. The key to figuring this out was to find the table with the “file path” values in it. After rummaging around for a while I found the “itemdatapage” table which has part of the path in it. The other part (the diskgroup) has to be included in the path, plus the share drive value.

The following are the parameters that need to be set in order for the script to run correctly.

·         Database connection

o   Const CONNECTSTRING = "DSN=onbase;UID=hsi;PWD=xxxxxx"

·         Destination of copy

o   DestinationFolder = “\\\”

o   DestinationFile = DestinationFolder & oDoc.Handle & ".TIF"

·         Source of file

o   FileSystemPath = Trim(oRecordSet(0)) & Trim(oRecordSet(1))

o   SourceFile =  "\\

Script Code

Test

Sub Main35()

Const CONNECTSTRING = "DSN=onbase;UID=hsi;PWD=xxxxxxx"

' Root level OnBase Automation object

  Dim oApp

  Set oApp = CreateObject("OnBase.Application")

  Dim oDoc

  Dim cKWs

  Set oDoc = oApp.CurrentDocument

  Set cKWs = oDoc.Keywords

  Dim sSQL

  Dim oRecordSet

  Dim oConn

  Dim i

  Dim FileSystemPath

 'MsgBox "oDoc.Handle:" & oDoc.Handle

  'open connection

  Set oConn = CreateObject("ADODB.Connection")

  oConn.Open CONNECTSTRING

  sSQL = "SELECT b.diskgroupname, a.filepath FROM HSI.itemdatapage a, hsi.diskgroup b WHERE itemnum =  "& oDoc.Handle &"  AND a.diskgroupnum = b.diskgroupnum"

 'MsgBox "sSQL: " & sSQL

  'Get recordset by executin query

  Set oRecordSet = CreateObject("ADODB.Recordset")

  Set oRecordSet = oConn.Execute(sSQL)

  If Not oRecordSet.EOF Then

       'MsgBox "Trim(oRecordSet(0)): " & Trim(oRecordSet(0))

       'MsgBox "Trim(oRecordSet(1)): " & Trim(oRecordSet(1))

      FileSystemPath = Trim(oRecordSet(0)) & "117" & Trim(oRecordSet(1))

  End If

 'MsgBox FileSystemPath

 ' Call oDoc.StoreKeywords()

  oRecordSet.Close

  Set oRecordSet = Nothing 

  oConn.Close

Dim DestinationFolder

DestinationFolder = "\\destination share drive\"

'MsgBox DestinationFolder

Dim DestinationFile

DestinationFile = DestinationFolder & oDoc.Handle & ".TIF"

'MsgBox DestinationFile

Dim SourceFile

SourceFile =  "\\

'MsgBox SourceFile

Set fso = CreateObject("Scripting.FileSystemObject")

    'Check to see if the file already exists in the destination folder

    If fso.FileExists(DestinationFile) Then

      'Check to see if the file is read-only

      If Not fso.GetFile(DestinationFile).Attributes And 1 Then

            'The file exists and is not read-only.  Safe to replace the file.

            fso.CopyFile SourceFile, DestinationFolder, True

      Else

            'The file exists and is read-only.

            'Remove the read-only attribute

            fso.GetFile(DestinationFile).Attributes = fso.GetFile(DestinationFile).Attributes - 1

            'Replace the file

            fso.CopyFile SourceFile, DestinationFolder, True

            'Reapply the read-only attribute

            fso.GetFile(DestinationFile).Attributes = fso.GetFile(DestinationFile).Attributes + 1

      End If

    Else

      'The file does not exist in the destination folder.  Safe to copy file to this folder.

      fso.CopyFile SourceFile, DestinationFolder, True

            'MsgBox "file copied"

    End If

Set objFSO = CreateObject("Scripting.FileSystemObject")

Set objFile = objFSO.GetFile(SourceFile)

Dim SourceCopiedFile

SourceCopiedFile = DestinationFolder & objFSO.GetFileName(objFile)

fso.MoveFile SourceCopiedFile, DestinationFile

     

Set fso = Nothing

Set objFSO = Nothing

  Set oConn = Nothing

  Set cKWs = Nothing

  Set oDoc = Nothing

  Set oApp = Nothing

End Sub 'Main35()

Scanning Forms can be Tricky

When scanning into batches and selecting document types to index, there are many issues that cause misfiling. Below is a list of findings from a typical set of scan queues across different departments and facilities:

·         Forms with Exact Name as Doc Type are more accurately filed.

o   Exception: Admission Orders: Bariatric Surgery Procedures                   

·         It helps to have a standard form across practices and checkbox to distinguish the location

·         Forms with labels are more consistently filed

·         General doc type names get all of the misfit forms

·         Some misfiles are from changes to doc types which leave the old docs in general types and the new ones go to the newer more specific types

·         Inconsistent form headers and footers cause misfiles

·         Machine printed forms are more accurately filed

·         Some Doc Types have less than 10 scans in them

·         Very specific names gather all forms of that name whether they are correct or not, for example: “pH” or “Esophageal”

·         Barcoding for doc types is very accurate, however, the form names need to be consistent and sometimes the barcode doc type is manually re-indexed to a different doc type

·         General Form Names as a Heading (large type) with specific names as sub heads underneath sometimes get misfiled

·         Some Doc Types were created for a specific facility and are misfiled against because they don’t have the same form names as other facilities, ex. HIV Informed Consent

·         Regardless of language, the forms should have the same template layout

·         Forms should be consistently scanned, for example, the same front page, number of pages, layout, etc.

·         Redundant doc types should be consolidated: “Consent for Participation in Pet Visitation Program” and “Consent for Participation in Animal-Assisted Therapy Program”

·         Non-company forms are mixed in with company forms

·         Some redundant doc types are used by different scan queues, for example one facility uses both “Peripherally Inserted Central Catheter (PICC) Consent Form” and “Peripherally Inserted Catheters Consent”, while the other facility uses “Peripherally Inserted Catheters Consent”

·         There are clusters of doc types that are close to the same definition that should be considered for consolidation, for example,

o   HIV Informed Consent

o   HIV Testing Consent Form

o   HIV Testing Informed Consent, Health Care Worker Exposure

·         Doc Types no longer in use should be taken out of the scan queues

·         Some doc types have names that are too limiting: ex: “Sterilization Consent Form Ages 21 or Older”, where some of the forms are for ages 18-21…

·         Some doc types have “or” instead of “and”: ex:  doc type is  “Consent for Surgical or Diagnostic Procedure”, while the form’s name is “Consent for Surgical and Diagnostic Procedure”. The “or” suggests that this could be for either surgical or diagnostic procedures, not both…

·         Groupings of types should start with the same label value

·                         Example: consents should all start with “Consent”, then the second defining label

·         General types should be further detailed

·         Specific department types overlap general types

The road to no paper in healthcare

Of course the end goal of any paper in your organization is full conversion of paper to online forms, however, scanning paper is an intermediate step toward this goal.

According to Seth Godin, this should not be a “finite game” where there are winners and losers, this should be an “infinite game” where we implement a strategy to become more connected and raise all Users’ ability to serve.

Outline of Steps and Considerations

IT Strategy Component

At the highest levels in IT, there should be a healthy understanding of the positive effect of rules for publishing and presenting information. What I mean by this is that the information on paper is priceless and yet the techniques of gathering, collating and aggregating are from twenty years ago. Even with paper, rules need to be created and disseminated on form templates, fixed information boxes, choices instead of free text, etc. These will have to be decided at some point, why not get it started now...

IT stability

There will need to be a fallback Plan for unexpected outages and routine maintenance downtimes for when the system changes and evolves. This will most likely be paper forms or local backups on the network which could get synced up later.                        

Information Integrity

Need to clean up the metadata of the paper and scan types: naming conventions of form types, folders, metadata: look for implicit hierarchy in names

To Barcode or Not

If you don’t have advance capture to train on fixed forms which are controlled within the organization, then you should use barcoding to reduce indexing times and inaccuracies. That said, you might want a bar code available to add to forms when printing for patient information requests or transfers so that the form type can be read from other sources.

Centralize vs. Distributed (hospital content)

Centralize

• Pro: Easier standardization, less configuration, thus easier change management
• Con: Less location specific knowledge

Distributed

• Pro: Easier transition to electronic forms?
• Con:
• Registration
•  First system which Patient information is entered
• Forms and Signatures
• eSignature possibilities
• eForms and HL7 messages

Form Origin: within or outside of company

Docs within control

•  Information quality assurance
• Form standardization (across locations)
• Predictable Format
• Scan/Index standard forms
• General OCR
• Zonal OCR
• Template recognition
• Systems of origin
• Registration
• EMR
• Billing
• Building eForms from standard forms
• Form Differentiation
• identify and categorize the forms by functional groups to have scope and front load the system with abilities to convert to eForms in the future
• Patient Forms
• Signature required
• Patient and Witness signature required
• Other information added and signature required
• Other information added
• Types of information required?
• Clinical Forms
• Medical signature required
• Medical signature required and Patient signature required
• Other information and Medical signature required
• Other information and Medical signature required and Patient signature required
• Other information added
• Other Forms

Doc outside of control

• Unpredictable format
• Collect paper samples by categorization from groups responsible for scanning them
• Determine patterns of categories across all document types and sources
• Ask for style guidelines from outside sources
• Predictable Format
• Standard Form Scanning
• Standard barcodes
• Standard information interoperability