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I don't normally cross-post but a short week and a medical issue has me focused on design vs. production and the value of the things we do and don't do.

Almost every IT shop has an inventory of projects. Some have been on the shelf for a long time and curiously, some pop into inventory and immediately get addressed. What causes one project to leap ahead of 10 or 20 others? Well, it might be an executive sponsor. It might be a pressing regulatory need. It might be a staffing change. Sometimes, it’s not logical. We are reexamining our priorities this summer for all these reasons. I’ve been at this a long time so I take change in stride. So far, nothing has ever stopped the show from going on.

Ironically, I started thinking about what drives technology projects not from the perspective of a producer of technology, not even as a consumer, but as an innocent bystander.

I had to see a doctor this week. I hurt my shoulder and I needed the advice of an Orthopedic specialist. My primary care physician has recently added an Orthopedic PA (Physician’s Assistant) to his staff so that made scheduling easy. No referral required. Unfortunately, when I sustained a similar injury to my other shoulder several years ago, I was under the care of a different PA who was working with a different physician. Those records were “transmitted” verbally by me during my exam. Later, my wife quizzed me – “did you tell her about the…?” How nice it would have been for all of that information to have been available during my exam. “Oh, it’s in the works” I’m told, but it’s probably a long way off.

Fortunately, this PA did have access to my medical allergies and knew better than to prescribe any form of NSAID in the Propionic Acid class, to which I am allergic. She prescribed a topical gel from a class that those records indicated that I am not allergic to. Yay for accurate and complete, albeit isolated records!

An hour later, I was at the drug store trying to get that prescription filled. The ointment she wanted me to use is not an approved medication according to my medical insurance provider. The drug store has that information because they have access to my insurance provider’s database. They have access because having access allows them to charge me the right amount and get paid faster. My doctor, who might have prescribed something different had she known what was approved, has no such access.

I explained why my doctor had prescribed this medicine. I explained my allergies and how this stuff is in the Acetic Acid class rather than the Propionic class. They, the clerk and the pharmacist, both felt that that explanation would convince my insurance provider to agree to pay for it, but only if it came from my doctor. Not wanting to wait for the wheels of medical deliberation to turn, I agreed to pay the “retail” price instead.

Once the clerk confirmed the price and my willingness to pay the price, she handed the script to the pharmacist who had been at her side during the entire discussion. Before I got to the waiting area, the pharmacist called me back to the window.

“Our records indicate that you are allergic to NSAIDs.”

Without being snarky to the last human being standing between me and relief from pain, I recalled the conversation we had just finished. I explained again that I appear to tolerate a specific class of NSAIDs and that this gel was in that class. He apologized and then he explained.

“I heard your explanation and it makes sense. Our system doesn’t differentiate by NSAID class; I wish it did because this is common. As for making you provide the information again, I am only following protocol. I have to check a box that says you provided this information to me in response to my question about your allergy.”

Oh, it’s a liability issue. If I were to end up in an Emergency Room, this drug store doesn’t want to be in court having their employee say “well, I overheard him say to our clerk that…”  I get it.

I get all of this:

Having accurate and complete information helps people make better decisions.

Having access to information can sometimes save money.

Information is good but authoritative information is better.

Protocols are important and should be followed.

I also understand that the systems that exist and the connections that have been made are the ones that either save money or reduce liability. The ones that would merely benefit the people involved are still sitting in inventory. ROI, whether you prefer ‘return on investment’ or ‘risk of incarceration’ can’t be the only driver when deciding what system to build. Sooner or later, we have to find a way to place value on the information that would simply help people do a better job.