Healthcare IT Strategy

This help clarify the situation.

http://ow.ly/pQhI

The decision to do EMR/EHR should be made independently of Washington. There either is or isn’t a valid business reason for going forward.  ARRA funds and penalties are not valid business reasons unless perhaps you operate a very small practice.

I believe there are valid reasons. I also believe that without knowing which of those reasons suite your organization there is a strong possibility of selecting the wrong system.

Here’s a nicely written piece by Elyse of AntiClue.  http://www.anticlue.net/archives/000970.htm 

I look at the need from the perspective of the path not traveled. For most, the task of selecting the correct EHR and managing the effort would be like me buying a spaceship–never been there, never done that.

Providers are well-staffed on the clinical side, and on the IT side. The problem is that none of them has the high cost, high risk, high visibility PMO (project management officer) skills that are required to buy something that can cost more than a new hospital wing.

So what do they do? They pull someone out of IT or clinical and hand her the keys. Most large IT projects will fail. MOre EHR projects will fail.

That’s my opinion, but nobody has talked me out of it.

It’s time to quit tiptoeing around 2011 and HIT and Meaningful Use and Certification, acting like they are relevant. Since the unspoken general consensus is that their relevancy has passed shouldn’t we be using our efforts to formulate a plan to make them relevant?

Robert Connely in the HIE blog makes some bery sound points about how the enite EHR intergration could and should work.  Note, could and should are not closely aligned at this point.

http://infosite.medicity.com/thehieblog/post/The-Practical-Reality-of-Hospital-and-EHR-Integration-Challenges-in-the-Trenches.aspx#comment

He writes, :This is not to say that the “standards and stimulus” approach isn’t a good thing – it’s just that the day-to-day problems we really deal with may not be adequately addressed by the current approach.”

I think he’s being generous to the extent of the words, “may not be adequaltely addressed.”  I can’t prove my statement, however I think that the mere fact that more than one group are working on standards is not standard.

How much more difficult will interoperability be, my guess is at least one more order of magnitude that what’s planned.

And as for interfaces?  I think Jimmy Weeks recently wrote having 400 he needed to meet.

My best – Paul

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I borrowed the following paragraph from the August 31 post of the Healthcare Blog.

August 20th, HHS Secretary Kathleen Sebelius and ONC head David Blumenthal announced $598 million in grants to set up about 70 “regional extension centers” (RECs) that will help physicians select and implement EHR technologies. Another $564 million will be dedicated to developing a nationwide system of health information networks.

It goes on to state that the RECs are based on the federal agricultural extension offices of the early 1900’s.

Do you ever get the sense that some days the topics just walk up and slap you in the face?  I may have deciphered the difference between the federal sector and the private sector—for those of you who were thinking I was going to write competency, it crossed my mind, just couldn’t decide to which group.  I think it’s speed and planning.  The private sector travels at the speed of the Dow and plans at speeds approaching the half-life of a fruit fly.  The federal sector travels at the speed of a ten-year-old eating broccoli and plan around the life span of a black hole.

They plan, and then plan and then write the backup plan, and then back that up.  It’s like the healthcare version of the movie Fail Safe.  Only this time it’s not done ‘in case’ the plan fails, it’s done for ‘when’ the plan fails.  Here’s my take on all of this as relates to EHR.

• Certification—a backup in case EHR doesn’t looks like it will work
• Meaningful Use—backup in case certification looks like it won’t work
• Speaking in parentheses—as I’m wont to do—at this point, neither matter, because under the current schema, interoperability won’t work.
• Did I mention we still don’t have a set of standards?
• Next comes RECs
• And, another half billion for nationwide system of health information networks—HIEs?
• Does the last point mean we are done with the notion of RHIOs and HIEs, or are HINs their backups?

What to do?  Set up another backup plan—REC centers.  The first time I read about this I thought REC centers were something like the Police Athletic League—if EHR failed, let’s play basketball.

Since you asked, here’s what I think we should do with this billion.  Give it to the EHR vendors—I can’t even believe I wrote that.  This is the same group of businesses who haven’t learned how to share their toys and play nicely in the sand box.  Ready?

1. Some small number of EHR vendors (let’s label them Group A) does account or will account for a percentage of the installed base in the upper nineties.  The also-rans are Group B.
2. It can be argued that not having a single set of standards is the reason we must have all of the intermediary non value-add strictures which make interoperability insurmountable.
3. It can further be argued that not having a single set of standards causes the need for certification and Meaningful Use which would otherwise have no meaningful use.
4. Give Group A the following mandate:
   1. Agree upon a set of standards to which you will modify your systems
   2. Modify your systems to those standards
   3. Provide that version to your installed base
   4. Agree that all future install will be of the standards-meeting application
5. Group B may continue to market provided they meet the standards.

This could work.  It would fix a lot of the current problems and make a lot of the upstream ones disappear.  What do you think?

CMIO invited me to write a regular article for them.  Below is the link to the first.

http://www.cmiomagazine.com/?p=220

Thanks.