My High Horse

I forgot to mention that a recruiter I spoke with several months ago recently called me on my cell phone. She had originally contacted me about the job in Alabama but I was already interviewing for that position. Anyway, apparently the position is still open and she had thought I was the best qualified fit for that position and wondered why I wasn’t there already…I told her that they had indeed made an offer and then recinded it and wouldn’t say why. She was surprised. Maybe that’ll make her think twice before sending in a recruit in the future. I mean, who wants to work hard to place someone only to have them accept a job there and then have the job taken away? I mean, really it would look bad for the hospital and the recruiter.

I know that job wasn’t right for me. I kind of knew when I took it but I just wanted to work.

I’m not too sure about the job I took. I know it’s the kind of work I had hoped to do. I’m not sure it’s everything I dreamed of. I’m certainly not sure that I’ll be the miracle worker here that I was back in the day at the “other” place.

I have spoken to a few people from back “there”. Things just seem to get more and more frustrating and sad from the front line there. The good innovative people are either leaving because they’re frustrated with how they are being managed and how restrictive the job is or they’re being forced to leave because their creativity and inquisitiveness gets in the way of people who just want to do work and get paid and go home. And when I hear about what management is up to there, I really believe that management just sabatogues itself and makes more busy work for itself and it’s underlings. I don’t know if they do it on purpose — though I do believe that I was sabatogued and on purpose. I feel like a lot of the decisions they make are anti-productive and certainly not in the best interests of the department or the employees there. I think that they are in over their heads and are desperately trying to keep afloat by pushing others down into the quicksand to try to crawl up.

The people who were there during the outsourcing aren’t exactly being included in the work on the conversion from the old system to the new one and most of them seem to feel resentful that no one seems to be telling them anything. What happens when the conversion is finished and none of the current employees have any knowledge about how to work with it or how to fill the same roles they had with the old system now that that system has been replaced?

Meanwhile, shortly after I got here, I recieved a copy of a proposal to review and give my opinion on. One of the consulting firms, that I am familiar with from the outsourcing selection process prior to the six month extra-scary nightmare, was paid a lot to write a proposal to convert one of the interface engines which has not been supported for the last 3 years to a “new and improved” interface engine that is not eLink/WebLink/eWebIt/whatever-Eclipsys-is-calling-it-this-week. This site uses two interface engines. Rather than do like the old hospital (OH) and convert everything from OpenHub (Eclipsys’ version of SeeBeyond’s old Datagate) to eLink/WebLink/eWebIt/whatever-Eclipsys-is-calling-it-this-week when Eclipsys insisted because it was no longer going to be supported, the New Hospital (NH) just started creating new interfaces on the new engine, which means that there are two interface engines here and that’s not even the most complicated part of it. There is an Eclipsys out-of-date, but still supported, mainframe based HIS system which currently no longer has ordering or medical records in it. Ordering is done through Eclipsys’ Sunrise Clinical Manager (SCM) and Medical Records is handled through Sunrise Record Manager (SRM). Meds are ordered through SCM but processing is done in the HIS and then dispenced through PYXIS and a robot of some sort for Nursing. E.D. has it’s own application, so does Lab, Radiology, Transcription, Dietary, Radiation Therapy, the television system, and a plethora of others. Some of these just get ADT (Admission/Discharge/Transfer) information out of the HIS (and even that’s complicated because medical records are actually created in SRM and some systems only want the first 8 digits and some want 13 and some want the 13 broken into two fields for medical record number and account/visit number — and don’t get me started on merging accounts) and some applications actually get orders and order process messages from SCM, process the orders (Which involves sending status messages back to SCM), and send results (again back to SCM and also SRM). Some interfaces through OpenHub are just tunnels of information from the eLink/WebLink/eWebIt/whatever-Eclipsys-is-calling-it-this-week engine that has already processed and translated the message but the receiving application will only speak to one engine and the ADT was already going through OpenHub.

Anyway, so the proposal is for this consultanting group to do several things:

• Convert OpenHub to SeeBeyond’s new eGate (which actually isn’t getting great reviews compared to Cloverleaf and ironically the horribly designed eLink/WebLink/eWebIt/whatever-Eclipsys-is-calling-it-this-week).
• Teach IT some methodology that will help us get our work done faster.
• Write 5 interfaces in eGate — this will be done by a team of employees in India — this consulting groups swears they don’t support outsourcing to India; instead these Indians are full-time employees that they acquired when the bought out another business.

I have a few issues with the proposal, naturally. First of all, my experience with consultants hasn’t been sterling. I’m going to ignore my outsourced experience which was a nightmare in itself. However, for the most part, groups of consultants that come in to get some particular project done generally come rushing in stirring everything up, get the employees that are already there to do all the work and then take the credit. I experienced that with the Y2K project first when they came in for 9 months to make sure everything was compliant, sat at our desks and had us do the work and they documented it. They weren’t even there by mid-Decemeber and I was the one sitting in the computer chair at 12:15am typing madly at my keyboard while the VP of Info Systems stood behind me eating snacks someone had brought in. For the most part, this pattern continued with other projects consultants were brought in to do. My one good experience was witha lone consulant and she wasn’t even that great — she taught me some stuff and definitely got the project rolling, but she was long gone before real headway was done.

The truth is that most consulants don’t have to spend 12 months going to meetings while the hospital staff tries to figure out what they really want out of this application they bought without consulting IT and without understanding how it really works or without knowing that the demo was really a non-working version of a possible future edition of the application and what they were buying can’t really do all the flashy things they’ve been promised. What consulants want (in fact, what all interface integration specialists want) is to be given two sets of specs, one set from each application being interfaced) and to sit down and code the the thing up. Really, if all the decisions were made before the interface specialist was ever brought into the mix, if all of the decisions were made before a project manager starting demanding things that can’t be done before a computer illiterate doctor or nurse or administrator actually makes a process decision, if all of that could happen ahead of time, then coding would maybe take a day or two and testing would take a week or two and wah-la! But it doesn’t work that way. So I have real doubt that this methodology they are toting like a wild-eyed motivational speaker in an informercial will work in a real hospital environment. The methodology would have to be taught to the whole hospital, not just to IT. For the most part, IT is rarely the real hold-up. I admit that we were the real hold-up back at OH when we were trying to build the bi-directional ADT interface for the new patient access/registration front end to the HIS, but our slowness was due to lack of support from both vendors and a complete lack of understanding on how to make the systems talk so that everything seemed seamless, especially since at that time no other hospital had succeeded in making the same interface work correctly.

O.K. The Five Interfaces. It was interesting how each time they were mentioned, the description got less general and more restrictive. We have, according to the documentation and thankfully for job security, a backlog of 100 interaces to be completed here at NH. Now of these, I don’t know how many are ADT but for the most part, ADT is the easiest interface to do because basically every external system requires some variant of an ADT interface and basically you just clone an existing, similar one, take out the stuff you don’t need and put in the stuff you do that wasn’t there. So, the consulting group went from saying they would do 5 interfaces to 5 priority, non-complex ADT interfaces within a couple of pages. I think, and the other interface folk here agree, that if they are going to show us their methodology, they should show us how to use it on something challenging, something we don’t know how to do.

And having the work done in India is a big issue with me. It’s one of my political issues for this coming Presidential election. I have a real problem outsourcing work out of the country (not just to India but anywhere) and taking jobs away from Americans. It’s even more close to my heart since in the last few years most of the jobs being outsourced are IT jobs. I just can’t see how this supports our economy in any way. I mean, O.K., the company gets the work done cheeper, but the service or product is to be sold in the U.S. If people are out of work because their jobs were given to people out of the country, then they cannot afford to pay for these services or products and then what does it matter that it’s getting made cheaper and sold at the same price when no one can afford to buy it?

In the last 3 years, all of the computer geeks in my immediate social circle were out of work anywhere from a few weeks to 18 months. At least 3 of us were replaced by less qualified, lower-paid individuals.

I just cannot support the idea of outsourcing to India, particularly when it’s work I could be doing right here rather easily, and I don’t know that I’d be all that excited even if they offered to do 5 of the really difficult, complex interfaces — particularly since one of us would still be doing all the work since I doubt anyone is going to commute from Bangalore to Maine for a weekly meeting to discuss the specs, needs, and issues.

However, though all of the interface geeks here agree this whole proposal is a bad thing, it has come down from high above that it is most likely going to happen. My new boss and one of the interface geeks is going to a meeting with the IT VP next week to discuss it and we’ve basically been told to give our opions with suggestions on how to make slight changes in the proposal to benefit us in the best way — like making them do 5 non-ADT interfaces and adding in education on how to use the new interface engine — yeah, bet you hadn’t noticed that there was nothing in the proposal on teaching the old employees how to use the new system so they can keep their jobs…

tags: outsourcing

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