The point of this entire discussion is the following:  It’s not about the EHR, it never was.  It’s about healthcare reform and how to transform the business.  The EHR is a healthcare tool.  Its singular purpose is to enable your hospital or clinic to radically transform its business.  If it can’t do that, it’s time to select another tool, or retool the one you have.

The purpose of this blog is to incite discussion around the topics of EHR, EMR, HIT, RHIOs, and NHIN.  Our intent is to see what we can do to further the discussion, and to drive solutions in the areas of risk, implementation, interoperability, and funding. There are plenty of sites that regurgitate facts on every aspect of EHR, and even more sites vying for your dollars.  Here, we’re vying for your opinion–what works, what doesn’t, and what can be done about it.

Please refrain from solicitations.  I’d like this to be a place where healthcare providers feel free to drop in without worrying that they will be asked to buy something.

I should note that I find most blogs rather stale and tedious to read.  I like to write as though we’re in conversation.  I enjoy an occasional rant and muse, and believe there’s always room for a little humor in everyone’s day.  I’ve also been known to be a stickler for good grammar.  I’m a left brained consultant in a right brained world, dishing out my own form of logic as the mood strikes.

Bear in mind, we’re professionals–don’t try this at home.  I look forward to your input, perhaps you’ll look forward to mine.

Paul

On one of the LinkedIn healcthcare groups someone inquired rather indelicately about the source of the data I posted.  I replied with the same degree of indelicacy with the following.

My “curious combination of exact figures and sweeping generalizations” comes from several places including HIT.gov and the New England Journal of Medicine. I posted a PowerPoint presentation on slideshare.com entitled, “EHR-Why Should I be Worried.” Unfortunately, the charts and data in the presentation were pasted directly from these same specious sources. “Things just get curiouser and cuiouser”—Lewis Carroll. Hopefully I’ve addressed the first question.

The second posted opinion questioned my perspective on having writtenthat EHR implementations are difficult and tend to fail.  I wrote from the perspective of a hospital that is required to pass the tests of certifiable, meaningful use, and interoperability. Someone in the computer hardware industry (the holder of the second opinion is an EHR hardware vendor–I peaked at his profile) would see the situation from a different perspective,and would have more of a “what’s in it for me bias.”

Today the feds announced that the standards under which the CCHIT has issued certification should be expected to change significantly, therefore installations passing as certified today shouldn’t assume they will pass once standards are finalized.

The pain from EHR which we will all be facing is my opinion, part of which comes from doing my homework and talking with healthcare providers, some of which comes from being someone not known for drinking the Kool Aid.

Here’s my reasoning:

1. Only half the required HC IT people are in place.

2. None of the products (according to the government) passes the connect or interoperability test.

3. To be of any value, the EMR must connect to the EHR. The EHR must connect to other EHRs via the continuity of care record (CCR) and to the Rhio. The Rhios must connect to the NHIN. This house of cards doesn’t even exist.

4. There is no EHR czar. Can anyone answer this? Who is in charge, who has the authority, who can stand up and say, “I am the decider?”

5. The vendors each want their own standards (big surprise)

6. To me, we have a battle somewhat akin to the one between VHS and Betamax, only with many more technologies in play

7. EHR communicating with EHR ambulatory is worse than when I tried to get by on Spanish in Brazil (before someone feels the need to correct me on this–as they did in the LinkedIn discussion–the error is deliberate and is made to illustrate the point that 2 languages are being spoken.)

8. We are in the middle of a nationwide rollout of EHR.

9. The EHR vendors do not have the staff needed to perform the required number of installations.

10. In-house IT departments that still need an EHR have:
a. never acquired an EHR
b. never installed an EHR
c. never designed processes to support an EHR
d. etc.

I’ll close with this. If I have the only phone in the country, apart from its value to me, my phone is worth nothing. If you and I have the only 2 phones, it’s still worth about nothing. If there are a million phones interconnected then you have something of value.

I use this illustration because I did a fair amount of telco consulting, and a lot of that was with interconnects. When a call goes from point A to point B, more often than not the call passes through the networks of several phone companies. Each company must capture and report call detail records (these are much simpler than healthcare records) for the point of origin and the departure point. They aggregate this data to bill the customer for the call and then to mediate the bills amongst themselves. When was the last time you agreed with your phone bill?

The point is, this example is just telephone billing. Medical billing is much more complex, and EMRs and PHRs add another magnitude of complexity.

Do I think EHRs are complex? Yes. Do I think they will be ready in time? No. Will a working nationwide interconnect be in place in time. No. That’s my opinion, and I base it on my own curious and sweeping data.

What do you think?

Like anyone needs my advice as to how to do that. Go ahead, have at it. Go shopping. Shop to you drop. How much do you need? Suppose we open the coffers. How much; another million? Ten Million? Twenty-five, fifty? $100,000,000? This is a one-time offer, so make sure you ask for everything you need.

What if I told you this money is available provided you correctly answer a few basic questions. Reasonable? I’d hope so for a hundred million dollars.

1. What will you do with the money that you haven’t already done?

2. Has anyone else ever done that?

3. If yes, did it work for them?

4. If no, why not, and what makes you think it will work for you?

5. Will these additional funds;

a. Allow you to connect to your external providers?

b. Allow you to install something that connects to other EHRs?

c. Pass the meaningful use test?

6. What is your mission and objective for EHR?

7. Why isn’t your mission the questions raised in 5.a-5.c?

8. Have other hospitals spent the amount you are requesting?

9. Did that amount of funding allow them to meet the criteria specified in question 5?

10. If no, what makes you think you can do it?

If your CFO asked these questions, could you answer them? If not, prepare 3 envelopes (see Google)

New wireless mouse-$50. New plasma monitors-$1,200. Upgrade the coffee to Starbucks-$5. Working EHR–Priceless.

Below are some summary points I’ve pulled together which highlight the magnitude of the effort for which funding is sought.

• EHR is going to be the Y2K of the next 5 years.
• EHR is at the beginning of a national rollout
• Studies suggest that 200,000 healthcare IT professionals are needed for EHR. The total number it healthcare IT professionals today is 100,000
• It’s not known which EHRs qualify for incentives under ARRA
• Less than 8% of non-VA hospitals have EHR in even a single department (this does not mean these pass meaningful use test)
• Only 1.5% have them in all departments
• Studies state that 1/3 to 2/3’s of implementations fail
• Implementation by small practices has been almost non-existent
• One approach is for small and individual practices will need a full service “wrap around” solutions encompassing the following services
o Project management
o Selection
o Implementation
o Adapting workflows
o Training
o Support
• Major reasons for not doing EHR are
o Up-front costs
o Lack of IT skills
o Ongoing support costs
• Hospitals and large providers usually use their own IT departments for EHR, none of which has ever implemented EHR. Hence for the most important project undertaken by a provider, they elect to do it with people with no experience, relying on the vendor
• Where will the EHR vendors find the IT expertise and project management resources to staff a national roll out?

For those of you following EHR, here are two groups I just started which may hold some interest, Healthcare IT, HIT, EHR : Obtaining Stimulus Grant & Incentive $, and, HIT EHR Advice/Discussions for Hospitals & Physicians