Quiz: What does the VA health record have in common with a Marine Corps T-shirt?

The government sweats the big things. It also sweats the small things. Sometimes with equal intensity.

In one case it sweats the sweat things. A Military.com story detailed efforts in the Marine Corps to field a new “PT” uniform — PT standing for physical training. The accompanying picture showed a man running in what looks like typical sports apparel you could buy in a running shop or any of the sports and fitness chain stores. Polyester-based materials that breathe and wick sweat. Mesh pockets. I know, I’ve got drawers and drawers full of similar gear from more than 27 years of running.

The only distinguishing thing in the picture, and in the Marine Corps’ plans for the PT uniforms, is the drab green color and Marine Corps insignia screen printed on.

Notwithstanding that the shirt-and-shorts combo, with running shoes, is not presumably what a Marine would sport while on patrol or in combat exercises (or combat), it would seem a simple thing to substitute a new PT uniform.

But no. According to the article, the Marines will have 500 members — men, women, enlisted, officers — test and evaluate the PT uniforms. Technicians will test 100 prototypes in a lab environment. The Marine Corps Uniform Board will, in August, hear the evaluations and read the test results.

I’ve got news for the brass. The prototypes are fine. It doesn’t make that much difference. Having run a dozen marathons, including that gem of a race known as the Marine Corps Marathon on four occasions, and thousands and thousands of miles otherwise, I can say this: Any basic athletic gear that’s not made of cotton will do fine. The modern textiles are excellent. More important for long runs: Two Band-Aids placed strategically on the chest.

A PT uniform is not a new pistol or rifle or troop-carrying VTOL aircraft. It’s not even a new meal system. I’m a little astonished at the amount of time and effort going into it. But who knows. Maybe they’ll find a chafing seam here, or a binding hem there, and thousands of future PT participants will be the better for it.

At the other extreme of sweat, that $16 billion, 10-year project to establish a new electronic health record system at the Department of Veterans Affairs. As Nicole Ogrysko has been reporting, the initial deployment of the new system, in Spokane, Washington, has problems.

Even while restating its commitment to the Cerner Corporation product and associated configuration services, VA’s new secretary, Denis McDonough ordered a stand-down and review. He wasn’t repudiating the whole project. New bosses normally pause big, costly projects so they can get a handle on them.

Compared to a PT uniform, replacing a mission-critical, agency-wide software application like an EHR really is complicated. If the EHR was a piece of clothing, compared to a pair of off-the-shelf basketball shorts, it would be a climate-controlled astronaut’s space walk suit.

In fact, if VA was installing merely a “record,” the project would be much simpler. But the way health care facilities work nowadays, the EHR functions more like an enterprise resource management system, with tentacles into functions including pharmacies, logistics and orders for procedures, and billing and accounting. It’s integral to clinical operations.

And here is where VA is running into challenges that have bedeviled modernization efforts across the government for decades, as long as there’s been software. How do you get the old data into the new system correctly? How do you get the new system to reflect all the possible workflows people are used to? What workflows do you change to accommodate the commercial software? How do you deploy so that productivity doesn’t crash while people deal with new software? How much custom configuration do you impose such that the commercial product is distorted out of recognition, and you introduce errors?

VA seems to have had trouble with all of these questions. Procedures that took three clicks now take 10. A doctor told Nicole that instructions the anonymous doc wrote into one workstation came out differently in another workstation down the hall, a snafu a nurse caught.

No one has had the wrong organ removed or been given a lethal prescription by accident, at least not because of the software, but you can sense the criticality of what is going on.

It may be the VA has a thorough change-management plan for the conversion and a training plan for the hundreds of thousands of people who will eventually use the software. Perhaps no one could have foreseen the number of moving bits the new EHR would entail. VA might well be trying to fit the Cerner system to the VA, when in fact it should bend itself a little to fit Cerner.

Systems like this typically have 20 or 30 year lifecycles. They’re like ships departing on long voyages. Sweat the details by correcting things a few inches here and now, and in three years you won’t be hundreds of miles off course out there.

Nearly Useless Factoid

By Alazar Moges

The reason New York City is known as the “Big Apple” is not because it is the nation’s second top apple growing state, it actually derives from local reporter John J. Fitz Gerald, who covered horse racing, hearing the phrase from Black stable hands in New Orleans who adopted the term in reference to its popular jazz venues. In fact, it was once known as the “Big Orange” once, which Dutch settlers nicknamed it in honor of William III of Orange.


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