In the last few days, I’ve been meeting different IS professionals and talking to different consultants about the work that is out there and what is the demand of the market. I realized, with pre-implementations, we had to mesh the current workflows with the given systems and because of the time constraints, we had to draw some hard lines in the sand, telling end-users what can be done and what cannot be done. During the implementation phase again we had go-lives to match, and we all were busy getting the build part done and making everything sync and work. After that we had to make sure, we got our upgrade workflow perfected with as few hurdles as possible. The hard part is done, even though changes are hard, we trained our end-users, helping them get used to the changes within limits and now because of that training they are more accepting of changes. Now the fun part is starting, we have a little more time to think about those hard lines we had drawn in the sand during our pre-implementation phase. After a few years of experience we started seeing the effect of those hard drawn lines and we need to see what can be done to bend our applications to make them more ours. You might think we went through this phase and we called it an optimization phase. No I’m not talking about that, our industry calls it an optimization phase, which is making sure we are JCAHO compliant. We are up to date with our ICDs and things of that nature. The things, I am talking about, are things like we used to charge our medications per unit, and now because of the system limitation we have to charge them per dose, and that made us change our budget. We used to get certain alerts but now because of the system limitation, it is all or nothing, which gives us either alert fatigue or not enough information. We used to maintain our CPT codes in a certain way, that used to work more efficiently but now we have to do it totally different, and this may be less efficient, but because of system limitations we have to accept that. Our Bar-code scanning used to work in a certain way and maybe it was the best way for our work-flow but because of these system changes and system connections that’s not the case anymore. If we try to make bar-coding work, our alert may not work. So what is this exciting phase am I talking about? With these issues and new curves, we have to become more creative. An executive recently told me, “I can train some high-school kid on these applications and have them maintain it.” I agree as far as maintaining goes but what about challenging those hard-lines I mentioned above, can you really train someone to think out-of-the-box and be creative and fix the above issues? I think that’s where creative minds come into the picture, and having a person who can look beyond these system limitations and challenge the pro-quo given by applications support. So far, in two different facilities, we were able to challenge this pro-quo and make significant changes and it was the most fulfilling feeling I have had in my professional life. However, at the same time, I realized we were able to do that because the facility’s employees were involved and excited about it. Are we paying attention to those out-of-the-box thinkers? In Health care IT, their time is now! It’s going to be a hard sale because every out-of-the-box idea gets knocked down before it gets accepted, but I’m hoping our industry will see the need of these out-of-the-box thinkers and award them as we awarded consultants during pre-implementation and implementation phases and honored their talents. It’s our time now, so let’s get going out-of-the-box thinkers!