Today, my perspective changed–I’m going to start selling T-shirts printed with the phrase, “SRS-Soft Rocks my Docs.”

You may ask, ‘Who is SRSSoft’?  Fair question.  I could not have given an adequate response to that question prior to today.

I spent some time with them, ran their demo–I played doctor but they stopped me before I was able to insert a chest tube.  I ran the demo.  Why is that important?  It went like this.

“So, if you were a doctor, what would you do?”

With enthusiastic anticipation, I searched for my scalpel–that wasn’t what he meant.  ”I’d see who my next patient is.”

“Do it.”  (Mind you, all of what I am doing happens on one screen faster than a sneeze.)  I clicked the schedule and up popped all the patient’s information.

“Next?”

“I’d probably want to review their chart.”

“Do it.”  (Don’t try this at home unless you are a devotee of Scrubs or other medical training.

Same screen, up pops the chart.

“Next?”

I click on the notes from their last visit, compare their labs by pulling up a comparison chart–new versus old; scan the X-RAY, and review their list of medications.  I did this all on one page and figured out in less time than it took you to read this.  We did the demo using two screens.  That way, if I am describing what I am seeing to the patient on their X-RAY, instead of holding the film up at the ceiling and hoping my patient understand what I am talking about, I point to it with my mouse and let the patient see it one their screen.

Tomorrow I was going to issue an EHR RFP for a small clinic.  Not any more.  No point in having them pay me to hunt down a solution when I’ve already found one.  Did I mention you can also get it with a world-class practice management system?

So what makes me think this EMR can handle a practice size of up to a few hundred doctors?  Let me try to summarize its benefits with the following.  If we separate healthcare into two arenas–the business of healthcare (the business side) and the healthcare business (the clinical side)–this EMR is so well designed, it makes the mundane business tasks almost invisible to the doctor.  Instead of spending twenty percent of each day moving charts, filling out forms, sending faxes, dictating and transcribing notes, the clinical team can either spend more time with their patients or see more patients.

Now, let me tell you about their secret sauce, part of what makes it so special.  You are going to think I’ve lost my mind when you read this.

One of the first questions most doctors are going to ask a vendor is whether or not the system is certified.  (Do not repeat this to anyone–that is why I am writing in parentheses–this system is not certified.  They have no plans to get it certified.)  Why?  Because certification is as relevant to the value of an EMR as agriculture is to bull fighting.  Certification will not improve care, will not enhance the doctor patient relationship, it will not improve the patient experience, it will not increase productivity.  Certification does one thing.  It enables you to get a check provided that your EMR implementation does not fail, provided that you pass the Meaningful Use audit, and provided you are willing to upgrade your existing system to your vendor’s new and improved certifiable version.  That certifiably makes little to no business sense.

Anyway, if you want a system that makes the stuff you hate doing go away, take a look at this.

I’ve also written about way hospital EHRs fail.  A big reason for their failure is the drop in productivity they experience, and a lack of acceptance from the doctors.  Sort of makes me wonder if they could use this tool as a front-end for those big pricey EHRs.

Me, I printing T-shirts.  PayPal accepted.

I owned almost everything North Face made, including a down sleeping bag with thermal protection which would have made me sweat on the moon and a one-burner propane stove which cranked out enough BTUs to smelt aluminum.  Two of my friends and felt we needed a bigger challenge than what Colorado’s peaks offered.

The dot in the photo is me.

We decided on a pair of volcanoes in Mexico, Pico de Orizaba and Popocatépetl—both over 18,000’.  We trained hard because we knew that people who didn’t died.  We trained with ropes, ice axes, carabineers, and crampons.  One day in early May we arrived at the base ofPico de Orizaba.  The man who drove us to the mountain made us sign the log book, that way they’d know who they were burying.  After a six hour ride from a town with less people than a K-Mart, we were deposited at a cinder-block hut—four walls, tin roof, dirt floor.  Base camp.

Before the sun rose we were hiking up ankle-deep volcanic ash; gritty, coarse, black sand.  The sand soon turned in to thigh-deep snow.  We took turns breaking trail, stopping only long enough to refill our water bottles by hand-pumping glacier melt from the runoff in the bottom of cobalt blue ice caverns carved from solid glacier.

Ice Cave we used to collect drinking water

Throughout the trek we passed crude wooden crosses that were stuck into the ash and snow, serving as grim reminders of those who’d gone before us.

We knew the signs of pulmonary edema, but were reluctant to acknowledge them when we first saw it.  It was about one the following morning when we decided to make camp.  My roommate was having trouble concentrating, and his speech was slightly slurred.  When we asked him if he was ill, he responded much like one would expect an alcoholic would respond when asked if he was okay to drive.  “I’m fine.”

We were at about 16,000’.  The slope seemed to be at about forty-five degrees.  The sheet of ice upon which we stood glistened from what little light the stars emitted.  I removed my tent pole from my pack and placed it on the ground—we were going to camp for the night.  We watched in awe as the pole gained speed and hurtled down the side of the volcano, quickly lost in the darkness.

Realizing my friend wasn’t doing well, and that I was now feeling somewhat punkish, we made the difficult decision to turn back.  The only survival for edema is to lose enough altitude until you reach an altitude where there is enough air pressure to force the oxygen into the blood.  Eighteen hours of climbing.  Pitch black.  And then it started to snow.  Any other time the view would have been awesome.  We headed down, me carrying my pack and his, he with our friend.

We arrived at the block hut around four that morning.  By then I was no longer making any sense.  My roommate had recovered, but I had become somewhat delirious—at least that’s what they told me later.  Not knowing right from left or wrong, I was determined to keep walking.  The two of them took turns laying on me to prevent me from sneaking out during the night.

A little knowledge almost killed us.  The scary thing is that we knew what we were doing.  We had trained at altitude, had a plan, worked the plan.  The plan shifted.  Sometimes shift happens.

It happens more with IT.  Much more.  Do you know what the chances are of any IT project ‘working’ that costs more than$7-10 million?  (Working is defined as having a positive ROI, a project that was delivered on time, withing the budget, and delivered the expected results.) (IT includes workflows, change management, training, etc.)  Two in ten.  Twenty percent.  That’s below the Mendosa Line—non baseball fans may have to look up that one.  Remember the last industry conference you attended?  Was it about EHR?  Pretty scary knowing most of them were planning for a failure.

Put your best efforts, your brightest people on planning the EHR.  Make them plan it, then make them plan it again, and then make them defend it, every piece of it.  If they don’t convince you they can do it in their sleep, you had better redo it.  Do they know what they’re planning to do?  Do they know why they’re planning to do it that way?  If they haven’t done it before, this may not be the best time for them to practice.  EHR is not a good project for stretching someone’s capabilities.

Planning is difficult to defend twice during the life of a large program.  First, at the beginning of the program when the C-Suite is in a hurry to see people doing things and signing contracts.  The second time planning is difficult to defend is the moment the C-I-Told-You-Sos are calling for your head for having such an inadequate plan.

How would I approach planning an EHR program for a hospital?  If we started in September, my goal would be to;

• Have a dedicated and qualified PMO in place in four weeks
• Begin defining workflows and requirements by October (I’m curious.  For those who have done or are doing this piece, how many FTE’s participated?  I ask because i think chances are good that your number is far fewer than I think would be needed.)
• Issue a requirements document by mid-January.
• Be able to recommend a vendor by the end of March.

That seems like a lot of time.  There are plenty who will tell you they can do ‘it’ quicker.  Good for them.  The best factor in your favor right now is time.

Reread this in a year and see where you are…

…See, I told you so.  Anyone want to go hiking?

Thanks, Paul

A perfect problem, in its existing state, is unsolvable.  The way most of us handle it is to click our heels together three times and hope it goes away.  We tend to work on imperfect problems, those that can be solved.

What is the difference between the two?  The first step is the ability to understand what makes the perfect problem uniquely unfixable.  Perhaps a few examples would help.

• The CEO imposed a deadline for the implementation of EHR.
• CMS Meaningful Use rules do not fit with our operational strategy.
• If we do not implement EHR by this date, we do not get the money.
• We must meet Meaningful Use
• We do not have enough resources from the EHR users to understand their processes.
• We cannot continue to support these low-margin services
• We do not have enough time to define our requirements
• We cannot afford to spend the time required to assess our processes before we bring in the EHR vendor.

What can be done?  The easy answer is to plan for failure and do your best to minimize it.

What is another way to describe the above examples?  They are constraints.  They can all be rewritten using the word “can’t”.  Rewritten, we might say, “We had a chance to succeed, but because of X, Y, and Z we can’t.”  If that assessment is correct, you will fail, or at least under-deliver at a level that will be remembered for years to come.  That’s a legacy none of us wants.

There are a few solutions to this scenario.  You can eliminate the seemingly intractable constraints; the organization can determine to re-implement EHR and hope for different results; or they can simply find someone else to solve the perfect problem.

Experience teaches good leaders really want reasoned advice.  They want the members of the C-suite to tell them what must be done to be successful.  Good leaders do not accept “can’t”—not on the receiving end, not on the delivering end.

Some will argue, “This is the way our organization works.”  Even if that is true one must consider what is needed to make an exception to the constraint.  Would you accept this logic from a subordinate?  Of course not.  You’d demand a viable solution.  If you are being constrained in your efforts to solve a perfect problem, perhaps it is time to restate the constraints.

One of my college professors—way back when we still had inkwells on our desks—told me that if you cannot solve the problem the way it is stated, it is to your advantage to restate the problem.  Maybe the solution to the perfect problem is to restate it in a manner that makes it imperfect—solvable.

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

Parents can be shattered when for the first time they learn that little Johnny or Sally is not the apple of everyone’s eye.  As a child, I hated report cards—it seemed to me like tattling.  I already knew if I had underperformed, and I did not need or want somebody telling me or my parents.

I am still that way.  Criticism stings, no matter what your age.  That is why when your significant other asks what you think of her new shoes, if you want to maintain the relationship, there is only one correct answer.  Asking how those black pumps differ from the other twenty pairs of black pumps would be a waste of oxygen.

What if we got report cards at work and they were sent home to your children?  What if someone watched our performance every day of the year, and four times a year that person issued a report card on our performance?  Not simply an annual review over lunch to get a nominal pay boost, but a real report card.

Report Card:

Analysis & Probability                                                    Approaching grade level

Understands how to solve problems                       At a fifth grade level

Works and plays well with others                             On par with Kim Il-sung

Communication skills                                                     He’s no Ronald Regan

Predicts likelihood of events                                        he will never be on the Psychic Hotline

Solves two-digit addition problems                          Proficient if supplied with a calculator

Identifies problems                                                         Usually right after they occur

Writes in complete sentences                                      Proficient with crayons

Just because nobody is issuing a written report card does not mean one is not being compiled.  The compilation occurs in the break room, over lunch, and at an informal office gathering.

Do you ever awaken wishing you were all you used to think you were before you figured out you weren’t?  Me either.  I’m someone who has these kind of days when it’s best to keep me away from shiny objects.

During college, I spent several summers volunteering for a group called Young Life at their camps throughout the US.  Silver Cliff was one of their camps in the mountains of Colorado.  Each week we’d take in a few hundred high school kids from throughout the US, and give them the opportunity to do things and challenge themselves in new ways; everything from riding horses to rappelling.

The prior summer I was the head wrangler at one of their camps—I had never ridden a horse prior to being placed in charge of the riding program.  This summer is was the person running the rappelling program.  Needless to say, I had never done that before either.

We received a day’s worth of instruction before we were turned loose on the kids.  One of the first things we had to learn was that the ropes and harness, if properly secured to the carabineers and figure eight, would actually keep you from falling to your death.  The first test was jumping from a platform way up in a tree while on belay.  After a few moments of white-knuckle panic, I stepped over the edge and was belayed safely to the ground.

From there, we scouted a place for the rappel, and found two suitable cliffs, each with about a hundred foot vertical drop.  Watching my first rappel must have reminded others of what it would have been like watching a chimp learn how to use tools for the first time.  After several tentative descents, I was able to make it safely to the bottom in a single jump.

Each day we’d run a few dozen kids through the course, ninety-nine percent of whom had never rappelled, or ever wanted to rappel.  To convince them that it was safe and that they could complete it, I would instruct them in the technique as I hung backwards over the chalk face of the limestone cliff.

Each day we’d have one or two kids who wanted nothing to do with my little course.  Occasionally, while on belay, one of them would freeze half way down the cliff, and I’d have to belay down and rescue them.

Once or twice I’d have an attractive female counselor on belay, her knowing that I was the only thing keeping her from being a Rorschach stain on the rocks below.  Scared, and looking for a boost of confidence, “She’d ask, how long have you been doing this?” I’d look at my watch and ask her how many days ago was Sunday.  I viewed it as an opportunity to have a little fun with her—sort of like turning to your friend in the checkout line in 7-eleven and saying loud enough for others to hear, “I thought we agreed we weren’t going to use our guns.” I also hoped maybe even having to go on a heroic rescue.

How long have you been doing this?  That’s seems like a fair question to ask of anyone in a clinical situation.  It’s more easily answered when you are in someone’s office and are facing multiple framed and matted attestations of their skills.  Seen any good EHR or HIT certificates on the walls of the people entrusted with the execution of the EHR endowment?  Me either.  I have a cardiologist and he has all sorts of paper hanging from his wall.  Helps to convince me he knows his stuff.  Now, if I were to pretend to be a cardiologist—I’ve been thinking of going to night school—I’d expect people would expect to see my bona fides.

Shouldn’t the same logic apply to spending millions of EHR dollars?  Imagine this discussion.

“What do you do?”

“I’m buying something for the hospital I’ve never bought.”

“Why?”

“The feds say we’ve got to have it.”

“Oh.  What’s it do?”

“Nobody really knows.”

“How long have you been doing this?”

“How many days ago was Sunday?”

“What’s it cost?”

“Somewhere between this much,” he stretches out his arms, “And this much,” stretching them further.

“Do the doctors want this?”

“Some do.  A lot don’t.”

“How will you know when you’re done if you got it right?”

“Beats me.”

“Sounds like fun,” she said, trying to fetter a laugh.

Sounds like fun to me too.

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

Again on the project failure?  Yes.  Why?  Trying to head it off at the pass.  Source, The Bull Report.

Fifty-seven percent of failures are due to bad communication.  What’s that?  Poor grammar?  No.  Not enough meetings?  Doubtful.

It’s about PMO.  A hired gun?  Perhaps.  An advocate who will manage the vendor on your behalf.  What’s the rest of the hired gun’s job description?  All the blue stuff in the graph..

The good news is that being a bad dresser will not hurt the project.

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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It has been a week of learning.  According to one of the thought leaders in healthcare, whom I’ve known for more than a year, he does not understand what services my firm offers hospitals, and he thinks others may have the same problem.

He suggested it would be helpful to spell it out, service by service.  So here goes.

Program Management:

We work with hospital CIOs and COOs as their advocate by serving as the program management officer (PMO).  We define functional requirements, select software, and manage IT applications vendors for enterprise applications like EHR, CRM, and ERP.

Operational Efficiency:

We work with the hospital C-suite to identify, define, and implement a unique set of business processes and business rules, eliminating duplicated processes and those which do not add value.  The output is a single set of best practices processes and rules.

Change Management:

Enterprise applications will alter business processes and impact most employees and patients.  Without a rigorous change management effort, the impact of the application on the hospital’s processes and people will be a disaster.  We figure out what must change, how it will change, and how to pull it off.

Patient Relationship Management (PEM):

This is the hospital equivalent of Customer Relationship Management (CRM).  On a PEM project we define the requirements, select an application vendor, define the processes, and manage the project to completion.

Please let me know if you need help with any of these.

I was listening to Imus the other day as he was interviewing the famous promoter, Jerry Weintraub.  The promoter relayed a story about one of his clients, John Denver.  Mr. Denver was constantly complaining about a number of things on one of his European tours, and he demanded the promoter come speak with him.  Here’s a replay of the conversation.

“Yes. Well, he was in Europe, and he was on tour. And everything was wrong. He hated everything. He hated the venues. He hated – the airplanes were no good. The sound systems were no good. Everything was no good. And he said to me, you know, I’m going to fire you; everything is wrong here. I said, yeah, I know, I know.

I sat down with him; I said, John, everything is going to be fine. He said, why? Why? I said, because I fired Ferguson. He said, why did you fire Ferguson? Why? What does firing him – going to do? I said, he’s been responsible for all the things that you’re troubled by: the hotels, the sound system, the venues, da, da, da, da. And he said, it’s going to be OK now? I said, yes, I’m putting other people in. Great.

And that evening, Denver and I went out to have something to eat. At dinner, I said to him, John, you know, I feel really terrible about firing Ferguson. He said, why? I said, because it’s not like you and it’s not like me. And John Denver said to me, I agree with you; it’s not like us. What can we do to help the guy? It’s really not like me. I got to help him. I said, I’ll put him in another area in the company. He’ll be fine. We’ll take good care of him. He said, that’s great, I feel so much better. Of course, there never was a Ferguson.”

Sometimes you need to shake things up a bit.  Do you need to fire Ferguson?

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

I agree with many of your points and disagree with a few of them, and regardless, it’s a compelling, buzz-worthy angle that gets a lot of re-tweets and what have you, but I think it’s worth considering how these positions are affecting your ability to land consulting gigs in HIT. People want to hire consultants that they think will help them succeed, that think positively and pragmatically, and that are problem solvers (as opposed to problem recognizers): “we can do this together…I’ve had success before and if you let me, I will help you succeed…” that kind of thing. Just my 2 cents. It’s a trade-off, I know. You want to be honest and forthcoming, so I see the dilemma.

This was like being hit by lightening twice in the same day, so I thought I should take time to consider their input.  The feedback led me to ask if there are others who share the same opinion.  Is it possible my ramblings are about as well received, as I would be if I were to walk the streets of Tehran wearing a Star-of-David t-shirt?  What portion of readers drag my postings to their email folder entitled, “Kill him Later”?

Some believe a more effective use of consultants would be to compost them and use the energy generated to power a weed-eater.

Please permit me a few lines to try to explain my thought process for writing in my particular style and tone.  Before I began expressing my opinions on healthcare, I began reading what I considered the best healthcare blogs and editorials.  The first thing I learned is that I had nothing to offer of value on the clinical side of healthcare, so I focused my efforts on discovering what business issues providers dealt with, and which ones might benefit from receiving professional help—a consultant’s twelve-step program for problem solving.

I did a lot of homework; in addition to reading, I interviewed more than a hundred healthcare executives.  What was my takeaway?  One CEO told me the most needed skill on the business side of healthcare was “adult supervision”.  I did not charge in with uncorroborated opinions.  I used LinkedIn discussion groups to pose hundreds of questions about possible problems, studied the responses, and used them as a basis to formulate ideas about what was broken and what needed to be done to fix it.

I should note many of the blogs I read shared two traits; they often stated the same facts available on other blogs, and they rarely seemed to question the efficacy of the impact many of the Healthcare IT initiatives would have on operating healthcare’s business model—ours is not to wonder why, ours is but to do or die.

Not wanting to be superfluous, when I came to the fork in the road, I chose not to take a me-too position.  Instead, I threw metaphorical tomatoes and tried to get people interested in looking at the business model in a more disruptive manner.  Often, I did this by taking extreme positions on issues in the hope I might hit a hot button, and someone would think, “Perhaps we ought to talk to the tomato thrower and see if he can help us”.

My approach may prove to be less than brilliant.  What’s your take?