Friday, June 29, 2007

My New Mission Statement

Karyn Romeis was kind enough to point me to the Dilbert Mission Statement generator.

At random, it came up with this:

It is our mission to seamlessly provide access to quality infrastructured so that we may endeavor to globally foster multimedia based deliverables while promoting personal employee growth.

If anyone asks my career goals - this is it in a jargonized nutshell.

I think I'll get cards made up.....

Another favorite, generated at random:

Our challenge is to completely supply long-term high-impact materials as well as to competently disseminate economically sound methods of empowerment because that is what the customer expects Oh yeah - and make 'em pretty...

Fiddling with Facebook

I'm not entirely sure why certain types of social networking technologies make me nervous.

Maybe because technologies like Twitter and MySpace, with their emphasis on "friends" make me feel exposed. Unpopular.

These technologies remind me of wandering into a party where you don't know a soul, you feel out of place and you pray that you don't make a fool out of yourself.

I find myself at a loss for what to do in these environments. Do I reach out to people I barely know that I've talked to through the blogs? Do I try to recruit my friends? Family? Co-workers? How will my reaching out be received?

Brent Schlenker invited me into Facebook. I finally got around to opening an account. There's lots of stuff in there - photos, video, etc. I'm not entirely sure how this thing is supposed to work or what to do with it yet.

I suspect this is because Facebook does not solve any particular problem I currently have. Blogging, thus far, fills my need to reach out to the greater professional learning community.

There are groups that I can join. I went digging around for some eLearning groups and didn't find anyone I recognized. Again - wandering into a party where you don't know a soul and you're not certain that you're welcome....

Still - if I'm gonna keep up to date with this Web 2.0 thing - I gotta be willing to experiment. Even if it makes me uncomfortable. Even if I have no pressing NEED to.

The only thing I've figured out to date is how to add people. Thanks Harold Jarche and Cammy Bean for being willing to play with me. I hesitate to spam the other people on my e-mail address book if they are not already in Facebook. If you are willing to play - drop me a line with an e-mail address and I will send you an invite. We can figure out this beast together....

I'm finding that the social software thing really brings my social anxieties to the forefront. The habits that I demonstrate in real life (as dysfunctional as they are) seem to make an appearance in these environments too. Hopefully, as I play in these environments, I may be able to mitigate my natural tendencies towards introversion.

Wednesday, June 27, 2007

The Importance of Caddies

A signature view from Grandview Golf Course - North Braddock,PA. Believe it or not, it was much clearer the day we went. The pictures on the site don't do the place justice.

The boyfriend and I spent a long weekend in Pittsburgh visiting friends. Saturday, we played at Grandview Golf Course. This place strikes me as the epitome of "Pittsburgh golf." Very hilly, very tight. Beautiful view of the river valley and the industry surrounding the area. For the cost (about 50 bucks) the course was beautifully maintained.

The starter paired us with 2 brothers in law - Greg and Jeffy. This is their home course. These two had a great time serving as caddies - those invaluable folks who tell you the ins and outs of the course as you play it.

Grandview has a lot of "hidden" holes where you can't see the flag and where you can't see where you should shoot the ball. Throughout the round, Greg and Jeffy gave fantastic advice. Of course, applying the advice was a different story.... Nevertheless, they seemed to have a blast showing the tourists around. The 5.5 hours went by quickly.

My experience with them got me thinking about the value of caddies. People who are familiar with the terrain, who can tell you how to stay out of trouble or, if you get in trouble, how to get out of it. They may not be the best at what they do (I think all of us shot well over 100), but they are intelligent, observant and willing to help. They have also been there many times before....

If Greg and Jeffy were hyper-competitive golfers we wouldn't have learned as much about the course and the history of the area as we did on Sunday. More importantly, the experience would not have been nearly as much fun.

I sense we don't listen to those who can serve as caddies. We look for "experts." But the experts generally spend more time working on their expertise. Think of the big-name professors you sat through. How much did you actually gain from sitting through their lectures vs. the time you spent with their teaching assistant? In the States, it's a rare professor who enjoys teaching as much as they enjoy research - and it shows.

The caddies have a unique perspective on their environment. They've seen people hit the trouble zones. Chances are, they have been there themselves. They've observed what works and what doesn't. Most importantly, they enjoy sharing that knowledge with others.

Greg, Jeffy - if for whatever reason you read edublogs...thanks for a fantastic round.

Friday, June 22, 2007

Classroom v. Technology

Table from Zhang,D., Zhao, J.l., Zhou, L., and Nunamaker Jr., J.F. Can e-learning replace classroom learning? Communications of the ACM 47, 5 (May 2004), pg 75-79.

Warning: the link may not work outside of an academic institution.

I read Stephen Downes' musings on the relative advantages of technology vs. the classroom with great interest. Especially the reaction of his audience - since it mirrors the reaction I get every day when I talk about my plans for online training.

My personal learning preferences mirror Mr. Downes': give me the book / paper / powerpoint / movie / tutorial to work with in the comfort of my own home and on my own time. If I need to talk to someone or do things that must be done in a group - we can do the face-to-face thing if it is appropriate.

Many of my students don't feel the same way. Neither do my fellow instructors. I have always wondered why the classroom model continues to hold such sway, even when it is not the best solution for learning a particular topic.

Here are my half-baked thoughts on the matter:

Student Expectation - Adults expect a classroom experience with a "teacher" in front of the room telling them what to think / do. It doesn't seem like "real learning" if it's not.

Over the past 2 years, I've seen a slight change in this attitude with the incoming residents. These folks are about 24-25 years old and have been brought though an educational system that has at least some computer-based instruction. Many have taken online courses. Their first question to me, when they ask about training, is "Do you have any online tutorials?" I'm hoping this is a harbinger of at least some change in the expectation of what "learning" looks like.

Teacher Expectation - Standing in front of the classroom lends an automatic authority to the person standing there. Developing an online class requires letting go of some of that authority to subject-matter experts, tech-savvy developers, and, in the best cases, to the student. Who wants to give up that power?

I also think it may be a matter of personality. Many of the trainers and teachers I know are social folks who adore the give and take of the classroom. They feed off the energy of the crowd. They enjoy being on stage. The best pick up subtle cues from the body language and energy of the students - allowing them to adapt their material on the fly. Many of these trainers thrive on the instantaneous feedback.

Most forms of technology-based training do not allow the flex in timing or words or learning style that you have face-to-face. With classroom training, you can wing-it if you need to.

Another perceived disadvantage of technology-based training for the trainer/instructional designer - people can quickly analyze the strength (and weakness) of your instruction. The instructor is exposed. In the classroom, it's easy to get sloppy and get away with it. If you are entertaining, you can get away with murder.

Many classroom instructors won't give up that flexibility willingly.
Developing training materials (particularly online training materials) requires a certain level of discipline. Technology-based training (either synchronous or asynchronous) requires lengthier preparation. Testing the equipment, timing the delivery, checking for bugs in the tutorials, piloting the instruction.

The advantage (in my mind) to developing online materials, especially asynchronous ones - all training on that topic is the same. The information is the same. The delivery is the same. The quality of the instruction is not dependent upon the instructor's mood, or successes and failures in classroom management, or the personalities of the students in the class.

Anyone who's spent time in a classroom teaching the same information ad nauseum can tell you which classes went well, which didn't, and why (if they're honest).

I don't know about other instructors, but having stood in front of various classes over 11 years - I find the variation in experience between the different classes unsettling. I suspect the discomfort is a result of my introversion. I'd much rather hide out and develop training than deliver it. 11 years in and I still get stage fright...

The other advantage to online instruction, the student can adapt the pace of the training to their needs rather than the teacher having to adapt his or her delivery. Of course, the teacher can only adjust within the confines of the material they have to get through during that session. And we know how outside stakeholders love to pile on the information....

Responsibility - Mr. Downes linked to Stephen Sylvester's post arguing that students are less inclined to take responsibility for their learning than before.

My proposition is simple. Students no longer understand that education is their own responsibility. They have not arrived at this unfortunate conclusion alone. Student support mechanisms friends, parents, college administrators, college student support services, even sympathetic (emphasis on pathetic) faculty, American presidents have joined together to blame virtually everyone and everything else for students' failure to learn. It is a complicated process, often unconscious, always self-serving, and extremely damaging to intellectual freedom.

I have found that online asynchronous education requires a level of personal discipline that face-to-face does not. There is immediate accountability if you don't show up to class. You have to be more pro-active about asking questions and finding answers in the online environment. You have to have the discipline to do the work without someone watching all the time.

Many of my students don't want to take this responsibility. Interestingly, it seems that the more educated they are - the less they want to learn stuff for themselves. I sincerely wonder if our educational system, at all levels, actively beats natural curiosity and interest out of people. The more education, the more opportunity for beatings.....

Inertia - Change is messy and painful. If generations have done the same thing in the same way - it is much easier to keep doing it that way than it is to change practices. I see that every single day as medicine (the last bastion of paper) finally drags itself kicking and screaming into the information age.

As I've mentioned in a recent post, change is a process and you can't skip the steps. The edubloggers seem to be further ahead than most of their colleagues. These are the folks who see the vision of what can be. I have a feeling many teachers and trainers, if they are thinking about new educational technologies and theories at all, are still in phase 1 - "How do I get this thing to do what I am currently doing with the least amount of change on my part?"

Sadly, the revolutionaries among us have the inertia of generations of habit and unconscious resistance to overcome - on the individual, professional, and societal level.

After the experiences of this year, I still think that quiet subversion is the way to go. Work from within the system, quietly dig out the foundation, build new tunnels, make sure the damage is done before anyone notices.....

Thursday, June 21, 2007

It's All Practice with Feedback!

Cammy Bean gave me some fantastic feedback about some of my ideas for the tutorials I am building in the comments for my last post.

What if it's all practice with feedback? Donald Clark's post pointed to some recent research on this.

Of course, provide some of the context/instruction the docs will need, but embed that right into your practice exercises using realistic scenarios.

That's the direction I am attempting to head. A comment within Mr. Clark's post by Clive Shepherd summarizes one of the primary concerns of my end-users:

If you don't receive at least some information and/or a model (example), how do you know what to practice?

Right now - I am building the model. Mostly for something my boss can show at the vendor conference August 1.


There are still arguments in my organization regarding the need for practice.

The only way I am going to learn this is by using it in the clinic. I don't want to waste my time "practicing" things.

So you want to waste your time figuring it out in the clinic with the patient in front of you?

You are going to be hanging out with me my first day, aren't you?

Multiply that by 1500.

Thanks Cammie for some research ammunition.

The Importance of Reinforcement

I have been having arguments about the importance of reinforcement recently. Mostly because, once again, I find myself in a situation where I have lots of tutorials to build and next to no time to build them. The other concern: how long I will have the end-user's attention. No one wants the tutorial set for full new user training to go over a couple of hours.

So we have to decide what we can logically eliminate.

One thought - eliminate interactivity. Just have them watch movies. The docs want to sit and eat their lunch anyway.

I don't know about you - but I've never learned much watching a movie. Especially not how to use a piece of software.

A second thought - eliminate practice exercises. Educationally, I think it is a bad idea. Practically, I know they will be getting practice as soon as they hit the clinic. Creating practice exercises can be 2nd priority - once we get the nuts and bolts of the tutorials created. But we can't eliminate them

A third thought - eliminate feedback. Just give instruction and have them walk through the exercise. Not worry about providing feedback on danger areas or best practices. Not worry about explaining why they should do things in a particular way.

Cognitive Daily just published a paper on the importance of external reinforcement in learning. Their general, if uncertain, conclusion: we need external reinforcement to learn.

In the course of their argument, the authors bring up an interesting point about context:

The discrimination tasks were quite tricky in that many of the dots and bars presented were below the threshold of detection of the participants. When asked about their performance, participants reported low confidence; perhaps they were so frustrated with the difficulty of the task that they lost interest and simply were not reinforced by the task itself.

Fundamentally - the participants had no real reason to master the task outside of the experiment.

Without a deeper exploration of the tasks used in these types of experiments and a comparison of how the results vary based on the characteristics of each task, no great conclusions can be made about whether or not external reinforcement is absolutely necessary for perceptual learning to occur.

Maybe the most important type of external reinforcement is how the learner can use the skill/knowledge in "real life." Since most educators don't have control of the learner's environment outside of the classroom/online learning space - we have to rely on outside influences (policy changes, parental encouragement, monetary punishment, etc) to generate truly useful external reinforcement.

I figure if I keep following the general medical and educational rule of "First, do no harm" I should be OK.

With the lack of concrete conclusions - I'm going to follow my formal training and guts when designing instruction. That means pithy feedback captions and sounds. At least until I see research that this type of feedback prevents learning....

Wednesday, June 20, 2007

EHR Upgrade: One Month Later

I've been keeping track of what has stuck and what has been forgotten during the past month as the new application settles in a bit.

Here's what I've learned:

1) I've found that people only remember their most immediate concern. In an electronic medical record implementation - the most immediate concern is "How am I going to survive the clinic day?" Anything above and beyond that is forgotten.

2)I think our attempts to bring all of the departments onto the same page didn't work particularly well. I suspect it was a problem of context. First - they never did certain things (such as prescription order entry) in the old system so some baseline human workflow decisions (who was going to deal with what) were never made. Second - they were more concerned with surviving the clinic day.

3) Related to #2 - Trying to incorporate new functions when the product is so dramatically different from what the end-user is used to (and the product is still in beta) doesn't work. People are in survival mode the first couple of weeks. Anything new got lost in the shuffle. We are going to have to go back and re-train these new functions to each of the departments.

4)If I had to do this over again (and I pray I never do), I would spread the training out over 3 weeks rather than 2. 1 week for introduction to the user interface, 1 week for advanced clinic work, 1 week for administrative tasks (that training occuring during the go-live week so they can practice the information from #1 and not have their administrative items hanging out too long).

5) If we had more time, we really needed to have online materials available - particularly for the residents. Thankfully, the residents are fast learners.

6) I have no control over this - but having everyone do full clinics that week did no one any favors and proved nothing. Most of the docs were lucky to get some cancellations. It could have been much worse.

I'm hoping that if I have to do this type of project again - it is with a more fully realized application.

I'm not a huge fan of being the early adopter. Hence the name of my blog.
If you want to read my diary about this implementation, see my archives for May.

Tuesday, June 19, 2007

Xbox v. Wii - Tiger Woods

Don't do this with the Wii remote.....

Picture from - instructor Tim Mahoney and his proper backswing.

This weekend, I introduced my Xbox fanboys to Tiger Woods on the Wii.

A few observations:

- The graphics on Tiger Woods 2007 Wii version are similar to to Tiger Woods 2006 on the Xbox (NOT the 360). The fanboys did not understand what the hoopla about graphics was all about.

- Since they had mastered the Xbox Tiger Woods - they found getting used to the swing style on the Wii both frustrating and fascinating. One of the fanboys fired up the Wii while the boyfriend and I were out in an attempt to master it before either of us did. Again - thank goodness for reporting. These people think I don't know how to find audit trails....

- Don't try to use a real "full swing" on the Wii. If you do a real full golf swing - the motion sensor thinks you are ready to hit the ball because it senses the top of the Wii remote. You also have to move a bit slower than you might with a real golf swing in order for the swing to register correctly. We found a variation of a half-swing (like a pitch) was most useful for full power.

- We still haven't quite figured out how to adjust the spin of the ball. We think it has to do with hitting the directional keys and shaking the remote while the ball is in flight.

- Though the putting seems a bit flaky - to us it seemed successfully simulate the difficulty of real putting. The Xbox allows you to cheat a bit more since you are only using your thumb to control the putter rather than the whole body. Putting in the Wii is more sensitive.

- I found that playing Tiger Woods on the Wii did a number on my real golf game. Which is saying something since I am a terrible golfer to begin with..... I had hoped that my swing would improve since the Wii has you mimicking the motions. That's true, to a certain extent. Since a successful Tiger Woods Wii stroke is more like a pitch, and the putting is comparable to real life, I found that my pitching and putting improved. Sadly, my full swing is now a shambles. Just when I was starting to get close to 200 yard drives and 1 stroke away from greens in regulation....

The Xbox fanboys didn't WANT to like the Wii. They especially did not want to like Tiger Woods on the Wii. Yet the next day they called me...

Hey Wendy....can we play with your new toy again?

Monday, June 18, 2007

Mom, Dad....Meet Wii

I dragged the Wii over to my parent's house this weekend.

My parents are in their 60s. The last games either of them played were on the Atari 2600. Mom was a big fan of Circus Atari (something about the way the little clowns fell head first amused her). Both will very occasionally play solitaire on their respective PCs. Otherwise - they have had little exposure to gaming.

I built a couple of Miis for them and introduced them to Wii Bowling. Understand that neither parent has been bowling since the early 1970s.

It took Dad a few frames to figure out the feel of the Wii remote and how it reacts. Mom was a faster read (especially since she was watching and listening to Dad's comments as he played). Both of them were impressed by the motion control on this game.

I can really see some neat applications for this.

Dad and I also spent quality time playing the other Wii Sports games - just so he can see.

Game he liked least - golf. He's not a golfer anyway and he had a very difficult time getting the feel of the game. Also - of all the games there seemed to be the least amount of synchronicity between his actions and the motion on the screen.

Game he was most intrigued by - boxing. He spent quite a bit of time trying to optimize how to beat up my character. Nothing like a little father/daughter bloodshed to encourage bonding.

Game he snuck downstairs to play more of when Mom and I went shopping - bowling. He thinks I can't tell through the reporting mechanism :' )

My brother called the house while I was there since he heard I brought the new toy over. Dad's comments to my brother:

I'm not much of a gamer - and I probably won't race out to buy one - but it is a really neat thing. I really see an application for that motion control - especially for things like physical therapy and such. And I think Nintendo is on the right track.

My brother then called his friend. The friend promptly called me.

My brother is jealous. It's nice to get one up on my gadget-head brother.

Wednesday, June 13, 2007

Working out with the Wii

In my post on the new toy, Cammy Bean commented

I did about 4 rounds of Wii Boxing on Sunday and I'm still sore (which is sort of embarrassing).

I'm with ya girlfriend!

I did the exact same thing on Sunday morning. By the end of it:

- Sweat soaked my clothes.

- I managed to get my Mii up to 513 points. I'm frighteningly good at this game. I wonder what this means......

- I thought I had spent 30 minutes. I really spent 90 minutes!!!!

- My shoulders and back hurt the next day. I guess this meant I got a good workout.

I still haven't gotten around to the other games I purchased.

More Web 2.0 Food for Thought

The Britannica Blog has started a forum on the impact of web 2.0 technologies on knowledge, learning, and authority.

To date - the crux of the articles bemoan the disappearance of the authoritative expert.

Nicholas Carr has an interesting point - the issue is not about amateur vs. professionalism. Or even about how information is produced. It is about information CONSUMPTION.

The millions of people who consult Wikipedia every day are not pursuing any kind of anti-expert or anti-scholar agenda. Their interest is practical, not ideological. They go to Wikipedia because it’s free and convenient. They know its quality and reliability are imperfect, but that’s a tradeoff they’re willing to make as they hurriedly fill their market baskets with information. It’s our mode of consumption that is going to shape our intellectual lives and even, in time, our intellects. And that mode is shifting, rapidly and inexorably, from page to web.

I'm not entirely certain it then follows that people become dumber as a result. Less contemplative - yes. But maybe we are seeing an increased emphasis on a different type of intelligence. One that allows us to process multiple inputs, make decisions on "authority" and produce new forms of information with whatever media we have handy.

I still wonder what impact this new technology will have on how we educate.

Should we focus on what constitutes "reliable" information? Is "authority" really any more reliable than the "hive mind" or the opinionated individual?

Do we need to do more to emphasize information processing and production rather than consumption?

Tuesday, June 12, 2007

One Letter of ADDIE

Christy Tucker asks whether Instructional Designers NEED Technology skills. (emphasis mine)

Read the comments and conversation carefully in her post. Quite eye-opening.
I occasionally envy those folks whose world is so compartmentalized. Who have the luxury of being able to focus on one letter of ADDIE. Who are able to let go after they have finished their Design piece.

Realistically, I'm probably too much of a control freak to thrive in that situation.

That said - whenever I start dreaming of a work life of relative ease where I can focus on one skillset, I think of my friend the Graphic Designer.

The Graphic Designer REALLY wants to find a new job. She's very good at the nuts and bolts of graphic design. She created beautiful things on paper and has an impressive portfolio of work.

But she continues to run into the same problem.

All of her potential employers ask about her computer skills. Does she have a web site and web development experience? What desktop publishing tools does she use? Is she skilled in Photoshop? Illustrator? Quark XPress?

The change happened slowly...imperceptibly....

She keeps arguing that her current skill set is enough.....yet she still hasn't found new work after 2 years of searching.

Her field has changed. Folks are looking for people who can design in multiple media. And our world is becoming more computer-dependent by the day.

I look at Help Wanted ads and find that more employers (especially corporate employers) expect their trainers to have baseline computer skills (mostly Office and PowerPoint) and their instructional developers to be familiar with a wide array of educational technologies.

Having the professional knowledge and experience of an instructional designer gives you a theoretical base. And, as has been documented in other educational blogs, the theoretical sands are shifting.

More importantly, as organizations and universities move towards computer-based education - either as the core of their educational strategy or as a supplement - our clients will expect instructional designers to be versed in the technological tools of our trade.

Are you ready?

The Organization Gets Serious

The new upgrade has finally settled in a bit and we can move on with life. In my case - it means spending a harried month building as many interactive tutorials as humanly possible by July 23rd.

Now that things have gotten quiet - the upper management (Chief Medical Officer and Chief Executive Officer) have decided that it is now time to put some real enforcement in place for this new system. i.e. hit 'em in the pocketbook.

I never thought I would see the day.....

They are starting with some basic tasks that leave the organization open to lawsuits - verifying results and signing notes. They are giving the docs 7 days to complete these tasks. IT runs reports to check whether this is happening.

The punishment: If the doc is leaving the organization - the final check will be withheld until the tasks are completed. If the doc has completed his or her tasks and new tasks come in after the departure date - a single provider will be held responsible for completing these tasks. With the new contracts - bonuses will be withheld if the doc does not do his or her tasks in a timely manner.

Most upper management in health care organizations are scared to confront their docs. Especially if they bring in "lots of money." These 2 have finally decided that everyone - including providers - is replaceable. They have also decided that the risks some of our highest-earning providers open the organization to outweigh the money they bring in.

Not a moment too soon......

Sunday, June 10, 2007

A Review from the Peanut Gallery

This weekend, I put together a travel pack and dragged the Wii over to my gamer friend's house.

I knew my A/V experience would come in handy sometime. The console is very portable and quite sturdy using an old laptop bag for my carrier. The only potentially fragile piece is the sensor bar - which you can protect by placing it in a separate pocket with the vertical Wii stand.

It took about 5 minutes to set up, 2 minutes to synch the other 2 remotes - and we were ready to go.

The 3 of us started with Wii Sports Bowling. I found that this game was the easiest to pick up with the controller. Sadly, I found that my natural bad bowling habits are starting to come through with this game. It's easy to develop a nasty curve that mimics the nasty curve in my real bowling throw.

They also enjoyed Wii Tennis. Of course the 1 who excelled at tennis kicked our butts. That simple fact leads me to believe that Nintendo really got that motion sensor down.

The general consensus after an hour of play with the Xbox fanatics - this is a very cool thing.

Eventually - I'll drag out the Tiger Woods.... I'll be curious to see how they react to this game. Especially since they are huge Xbox Tiger Woods fans.

Thursday, June 07, 2007

The New Toy

As a reward to myself for surviving the major upgrade - and not killing anyone or getting myself fired in the process - I finally got myself the Nintendo Wii.

(Santa came through late).

First impressions

- This thing is a lot smaller than I thought it would be. Understand - my last gaming console (actually - my only gaming console) was the Atari 2600. I've probably just dated myself.....

- First game I tried: Wii Sports Tennis. It helps to be somewhat familiar with the motions of real tennis (especially serving). If you think along those lines - it's easier to play. Just like in real tennis - I have a tough time switching from forehand to backhand.

- Second game I tried: Wii Sports Bowling. I am better at this than I am at real bowling. I suspect that's because the Wii remote is only 4.85 oz (yes, I'm a geek, I weighed it) vs. the bowling ball's 11 lbs. Much easier on my gimpy wrists...

- Third game: Wii Sports Baseball. I suck at this.

- In all of these games - I was amazed at how similar and natural the motions were. After a little trial and error, I figured out how to use the remote for each of the games. The instructions throughout the games help. Now if I only had better hand/eye coordination....

- I was also very impressed by the judicious use of rumble. It's real subtle - but you get a touch cue when you are firmly on a button or acting on a ball.

- The remote is much easier to use than I expected. Just a few buttons. Once you figure out what each button does, they are easy to locate during the course of the game. Nintendo put an amazing amount of thought into the ergonomics of their controls.

- the Miis (your avatars in the Wii) remind me of a combination of Playmobile people and Weebles. Especially when they lose their legs....

- this is a damn cool toy!!!!

I'm going to be doing lots of "learning research" with this toy (hahaha) over the next few weeks.

Tuesday, June 05, 2007

The Dog and Pony Show

Today's site visit was the reason why our organization went through the heartache and headache of rapid implementation of this upgrade.

Our organization has served as a primary reference site for the vendor for the past 3 years. We got our dog and pony show down to an art form with the previous version. The new upgrade required us to re-prepare all of our material. Much like preparing for a new class...

The group that came to visit us today is potentially the largest contract the vendor will win....if they can ever close the deal. This group has been holding committee meetings, working with consultants, arguing amongst themselves, and generally researching this EMR thing for over a year.

The message I walked away with after meeting with them today.... these people are scared to death. I know the feeling......

In preparation for the site visit, the visitors sent us an Excel spreadsheet with 100+ questions. After meeting with us, they made it clear that they intended to go back home and compare notes to make sure what we said was consistent.

They were a little disappointed that we weren't further along in the process. They were also disappointed that we did not have everything implemented yet.

The visiting Administrative Director for Medicine asked

So did you all change job descriptions and processes before or after you moved from paper to an electronic medical record.

I had to think about how to answer for a bit, then returned to him and said "The best roll-outs did both."

Major change is a process. It's good to plan and visualize exactly what needs to happen to optimize your new tool. But you will never truly "get it right" until after you bite the bullet and make the change.

There has to be a continual reevaluation of your workflow. And no fear to admitting that something flat out ain't working. Tweak it and try again.

The sales rep for the vendor had a more elegant way of describing this, but there seems to be 3 phases with any sort of EHR implementation or major upgrade.

- Phase 1: "How do I get this thing to do what I am currently doing with the least amount of change on my part?"

- Phase 2: "I didn't know I could do that!?!? How can I use some of the other spiffy tools attached to this thing?"

- Phase 3: "How can I optimize my practice using this thing?"

As much as we would like to rush it - you can't skip the phases. Otherwise, you've lost all but your early adopters.

This was not what the visitors wanted to hear. They wanted to hear that after the training - all becomes hunky dory and perfect. They wanted to hear that they would not have to change the way they work. They wanted to hear that people automatically jumped to phase 3 - that people automatically "got it."

At the end of the site visit, I overheard the vendor's sales rep muttering to the vendor's Chief Marketing Officer

They are definitely not making a decision anytime soon.

From what I can tell - the visitors have paralyzed themselves.

I'll be curious to hear what happens.....

Picture from Silk Road Camels. Just in case you ever need a trained camel to go with your dog and pony show.....

Monday, June 04, 2007

2 Weeks Later - Things Forgotten

My co-workers have been amazed by some of the stuff people have forgotten from the training.

"I can't believe they forgot that the little blue i takes you to the patient demographics. That was there in the last version!"

"I know you trained them on verifying results....TWICE!"

"Authorizing Orders is easy - why can't they figure it out!"

What I learned: people are only going to remember the information that is needed immediately. For the docs - the dominant concern was

"How am I going to make it through clinic on Monday."

Anything that fell outside of that issue - verifying results, authorizing orders, and finding patient demographics - is more likely to be forgotten. And was....

Heck - I'm amazed that after the guerilla training we did anyone remembered anything.

Friday, June 01, 2007

Post-Upgrade: Groundhog Day

I know I've been silent about the upgrade project over the past week. Partially because I've been just so dang tired. Partially because my days at work have seemed like a nightmarish version of Groundhog Day.

1)Drag myself into work at ungodly hour
2)Check to see if the system is still running
3)Receive panicky phone call / e-mail / visit from end user
4)Find "broken" computer
5)Report problem to the appropriate authorities (screenshots, steps before the problem occurred, etc)
6)Fix "broken" computer
7)Repeat steps 3 - 6 ad nauseum until 5pm
8)Repeat entire process the next day

Since I last reported - we have touched practically every public computer in the building at least twice. This after performing extensive testing on the machines the week before.

The sad realization we are coming to - this upgrade is just not stable.

1) The application itself has some twitchy areas that still don't work quite right. Unfortunately, the problems are inconsistent enough that we can't seem to replicate them on demand - therefore making it harder to fix the problem.

2) The Active X and .NET push to the office computers is getting corrupted by something in the user settings within our generic network users. The controls are more stable for users with administrative access to their machines. For an organization with a lot of public PCs (and patients waiting extended periods of time in exam rooms with these PCs) - requiring administrative access to work a core application is not acceptable.

The good news in all of this - at least people are remembering how to move around in the product. So the training wasn't a complete bust.

Excuse me...I have to take another call.