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Friday, September 25, 2015

Developing Standards is like building a deck

... or any other complex project.  Except that all too often missing a deadline (especially in the prime years of Meaningful Use) is considered to be such a failure that shortcuts are often taken which can have a dramatic impact on quality.  I'd much rather do the job right than do it over.

I just recently had a deck put on my house, and it's about a month late (100% schedule overrun).  But I'm happy with the work that has been done. What were the delays?

Labor: Sometimes people simply weren't available (e.g., subcontractors for plumbing and electrical). When the electrician failed to show up the third time, I did the job myself in about 3 hours.  It was a small enough job that getting him to show up was difficult.  Fortunately, I could make do with my own skills.  In standards, this often happens when a specialist isn't available to review some critical work (as happened recently in some revisions to the Claims Attachments work).  The first problem is in understanding that you need a specialist, and the second is finding one who is available on your schedule, or adjusting your schedule.

At other times (especially during holidays), labor simply isn't available, and you have to deal with the down-time.  Or other higher priority work (to the laborers) gets in the way of your priorities.  Once again, you have to get the work done when the labor is available.

Materials: Sometimes the material runs out before the job does, and more needs to be acquired.  In standards development, we often aren't dependent on materials, but we are often dependent on either data, or other projects to provide materials that we need.  You either have to make do without, or take your best guess, or wait until the right stuff is there.  Frankly, I don't want a tri-colored deck with different planks, so I waited it out.  We did expedite the reorder, and sometimes there are ways that you can expedite the delivery of dependencies, for example, the DAF project needed some materials from FHIR DSTU 2 and CDA on FHIR, so they chipped in to help where applicable.

Review: We were at the mercy of the building inspector's schedule on the deck project, although I live in a small enough town that it usually meant a delay of only a day or two.  However, sometimes that messed up other schedules (I'm about a month behind on another project due to delays on the deck).  In the C-CDA 2.1 DSTU Update project, review was critical, and so we made sure to plan ahead for how long that would take, and I set aside that next week for my own review. Unfortunately, that's not always the case in other standards projects, and frankly, one of the problems with standards development is that we often don't know what will work until we try it.  This is a place where engineering is different from software development (which is still more art than science) [and standards development is very much like software development in many places].  DICOM has an excellent review process for its standards development, but it also induces delays that others would find difficult to accept.

Change orders, a.k.a. scope creep.  My electrical challenges were a result of a change order late in the project.  The electrician could have done most of the work anytime, with the final finish [installing the exterior fixture] taking no more than a half hour.  However, because I added this near the finish of the job, we were at the mercy of the electrician's schedule.  Having your scope nailed down well at the beginning if great, but when you don't, expect delays.  The Relevant and Pertinent project didn't originally have a short physician survey in its scope, but after project review, we decided that we needed to do it anyway.  That's caused several delays, but we aren't going to sacrifice on quality to make up for lost time.

In any project management, there's a triangle of resources, scope and quality.  One of your resources is time, and if you cannot afford to give up time, you may well be trading off quality or scope.  I'd much rather reduce scope and produce a high quality project, but even that is not always a possibility. All too often I've seen government contractors push to hit a schedule because either their lords and masters demand it, or because if they don't finish on time, they don't get paid for any additional time.

When you budget a project, you should always leave yourself a reserve (in time or money) to deal with change.  All too often, when we initiate a standards project, we don't allow for that.  I'm grateful my deck is finally done (or very near so, we are still waiting for the building inspector), and I'm also grateful that most of the projects that I've been involved with this year are similarly close or beyond the stage of being done.

Of course that means that I'm about ready to start the next set of projects, both at the house, and in HL7 and IHE.  IHE's call for proposals for PCC, ITI and QRPH went out a while back and that deadline is looming (tomorrow).  I'm presently working on a PSS in Clinical Decision Support to propose adoption of an IHE profile for Guideline Appropriate Ordering as a FHIR Profile in HL7. The reward as always for a job well done... is another job.  That's just as true in standards as it is in contracting.



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