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Author: Elyse, PMP, CPHIMS
June 14, 2010

Applications are not customized in a vacuum. We do not obtain a magical requirements listing which develops magically into a commercial off the shelf customized application suitable for the end users needs. Programmers, Business Analysts, Report writers, or database architects who follow this pattern are doomed to hear from the stakeholder. "That wasn't quite what I had in mind". It is time to break free and engage the stakeholders in the customization of their applications.

Requirement gaps or disconnect problems do not age well like a fine wine. In the best case scenario they cause rework, in the worse case they cause the cancellation of the project. To prevent these gaps from occurring or catch them early in the process, you need to reach out and talk things through with the stakeholders.

A couple of years ago, we were customizing a commercial solution for our health information management coding department. The previous application had 3 screens, one for patient and visit demographics, one for icd9 diagnosis, icd9 procedures, and cpt4 procedures, and finally one for all miscellaneous tracking. The screen flow was customized to the chart organization and how the coders extracted necessary information. Through brittle programming in the background which had been customized over the years, we had an extract ascertain the professional and facility er charges from the codes. The transparency brought issues, for which the best way was to remove the transparency and have the coder apply the correct charge code.

Unfortunately, the it focus when on bringing the ER charge coding forward for the coders to be able to review and change the system generated charge codes. The plethora of screens that were developed brought the solution to a grand total of 12 from the previous 3. It was not received well, and rework started to bring the screen flow more inline with the coder's workflow.

The Take Away

Having a joint review session throughout the customization of the application would have prevented this gap. Those who do the workflow often know the workflow best. It is best to set the stage for the desired business goals, and then collaborate with the stakeholders to achieve those goals!

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