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Government Technology, Efficiency, and Complexity

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Bobby Lilly
08-20-2003
11:29 AM ET (US)
Jon,

you wrote, "I agree that the use of Open Source tools can cut costs, I think that's a different question than the one of outsourcing vs internal development by coders that are closer to the problems needing solution."

my first experience with computerized record keeping came in the early 70's when the Visiting Nurse Association, a United Foundation Agency I worked for, decided to computerize their record keeping instead of having the various branch offices manually compiling stats.

Punch cards were the big thing then and the daily tally sheet summarizing all the possible activities of a visiting nurse during a visit to an assigned home-bound patient needed to be modified for that format. Many nursing meetings were spent deciding what the nurses wanted to count and they worked long hours on creating the necessary codes used to classify and differentiate various nursing activities.

The business manager, was new to the Agency but a hot-shot who knew all about the process of "computerization." It had been my job up until then to compile those stats so I was the one person who really KNEW what was being counted. I helped him create a one-page form on which all the details for each visit were to be recorded before it was sent out for punching.

Because of the limited space available on the punch cards, not everything the nurses wanted to count could continue to be counted after the switch. But, he was under pressure from the Agency's administration to finalize matters and wanted to wrap up the project. So he didn't bother to consult any of the nursing administration about any cuts - he knew just how long they could take. So, he just decided to eliminate one relatively insignificant bit of information that was routinely being kept.

With all the other information the nurses wanted, there was no place left on the card he thought to count additional patients who were provided health education in the various households visited by a nurse and it sounded relatively unimportant in the scheme of things. I tried to warn him that I knew the administration was interested in that count but I did not know why. Unfortunately, I was just a clerk so he dismissed my concerns and didn't bother to check any further and the project was finalized and that bit of information stopped being compiled.

That was, until after the first of the next year when the head of the agency asked where the additional count was in the annual statistical summary of the year's activity. It was only then that he learned that the annual United Foundation grant for the agency depended on that bit of information and without it there would be no funding for the upcoming year.

We needed to scramble fast to come up with something, old fashioned, seat-of-the pants guess-timates based on the levels of previous years activity eventually provided top administration with a figure that, if not accurate, was at least plausible.

Of course the whole project had to be rethought to find some way to accomodate that one small, but not really insignificant detail. I was close to the source and knew it was important but unable to explain WHY, and although he was in-house he did not have the necessary experience with the agency to KNOW what was important. Unfortunately, top administration had turned it ALL over to him because he was the expert and he didn't want to ask too many questions or ruffle any feathers and just wanted to get the job DONE.

From my perspective, its not just a matter of out-sourcing or internal development that's important, it's a matter of understanding the REAL needs of those involved before going ahead. Careful planning and attention to details and making sure all parties involved have their concerns addressed BEFORE final decisions are made are all vital components of any project whether public or private.
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