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Conservation of Aggravation

January 15, 2007 (Computerworld) -- The first law of thermodynamics tells us that energy is neither created nor destroyed; it is simply converted from one form to another.

For IT professionals, I believe in the first law of project dynamics: Aggravation is neither created nor destroyed; it is simply converted from one project to another.

As CIO of Harvard Medical School and Beth Israel Deaconess Medical Center, I oversee 200 projects a year. Here are a few examples of the Law of Conservation of Aggravation.

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In 2006, we implemented electronic prescribing for our clinicians. We replaced unreadable, handwritten and free-text typed instructions (“Take some Tylenol”) with structured, standards-based, secure electronic messaging from doctor to pharmacy. Clinicians welcomed the idea of more accurate, safer medication practices that would require fewer callbacks from pharmacists with questions about handwritten prescriptions.

However, clinicians rapidly discovered that older prescriptions that had been written before the new system was implemented with its requirements for structured prescribing had to be retyped. The computer couldn’t automatically convert “Take some Tylenol” to “Take Tylenol 1-2 tabs every 4-6 hours as needed for pain.” The clinicians wanted both accuracy and ambiguity to be acceptable simultaneously. Aggravation has been conserved.

Writing this has made me feel much better. But will the catharsis of having shared the challenges of being an IT professional lead to less aggravation? Nope. Within 48 hours of this column being published, 25 salespeople will call or e-mail me (note that my e-mail address is published as well) to tell me about their companies’ antispam applications, which can block all bad e-mails while allowing the e-mail of the eBay/sports/casual variety to get through; or about their highly reliable infrastructure components, which require no maintenance; or about e-prescription systems that do everything for everyone. Some of these e-mailed sales offers will make it through the spam filter. (Do these folks believe that CIOs have the time to read unsolicited sales e-mails?) Some salespeople will pester my assistant on the phone to the point that she will whimper in frustration. I have no doubt that aggravation will be conserved!

John D. Halamka is CIO at CareGroup Healthcare System, CIO and associate dean for educational technology at Harvard Medical School, chairman of the New England Health Electronic Data Interchange Network, CIO of the Harvard Clinical Research Institute and a practicing emergency physician. Contact him at jhalamka@caregroup.harvard.edu.

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