Some things in this universe will confound me until the day we are sucked into a black hole. I can’t explain why my wife, an intelligent person by anyone’s standards, reads People Magazine, or why some people like to listen to Celine Deon. Exchanging ideas with you about how to go about using EHR to help transform healthcare seems much simpler.
Sometimes I have an idea and I start to noodle on it. The Brits call it “Having a think.” It’s the kind of idea that makes me wonder where I left my crayons because I like to doodle while I noodle—I should mention that I find value in being someone who colors outside the lines. It’s the type of idea that I know will be made better by the insight of others.
Here’s today’s crayon-induced idea. We all know there is no bespoke business model for healthcare. Each service provider’s business model is different, a difference mostly attributable to varied business processes. If we’re in general agreement that there is no bespoke model, then we should be even more convinced that there is no bespoke EHR application—it goes without saying that vendors will try to convince you otherwise.
For those who thought healthcare was complex, look where it’s headed. It’s going to get even uglier before it gets better. Complexity can be measured a number of ways. To keep it simple, let’s assign a value of ‘1’ to represent the complexity of a single healthcare provider. So, how might we measure the additional marginal complexity created by having a national network of interoperable healthcare providers? One way is to take the number of providers and multiply them by the number of relationships in the network—X number of providers times Y number of RHIOs equals the added degree of complexity.
It doesn’t matter what the real complexity is. Whatever the actual complexity, it’s greater than ‘1’, and since your institution will be part of the connected network, your organization’s complexity has also increased.
Is there a way to manage the complexity? To lower it? To lower the risk to your organization? Let’s discuss that in the next few iterations of this blog. I look forward to hearing how you are managing it.
Pale Rhino Consulting 
Based on my experience, both working with many enterprises and with EHRs, the bottom line is who will benefit, how will they benefit, and are the benefits quantifiable for the primary individuals (stakeholders) who will use the systems? Complexity will be great because no manual has been written on the subject that tells all on how to implement, integration, interoperate among these systems. We are all in learning mode, despite the political rhetoric on the subject and the advertising among vendors indicating their experience and capabilities.
I’m not certain of your objective in terms of representing complexity according to a measure and its increase (whether monatomic, geometric, exponential, etc.) I’m also not sure what benefit is of doing so. Perhaps the best measure is cost and increased effectiveness vice workflow complexity to those stakeholders (physicians, nurses, allied health professionals, and the “back office”). Indeed, my main concern is over whether in the process of “fixing” the system we are going to make it untenable and even destroy the best of what we have.
To me, the best measure of effectiveness is the number of lives saved, time saved, $$$ saved. If any of these go up (with emphasis on the first), then, regardless of the spin placed on it by the administration, the media, and the vendors, we will have achieved failure.
Regards,
JZ
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Thanks for your comment.
The point regarding complexity is that by anyone’s measure, I believe when we have reached the time where hindsight is available we will see that complexity was grossly underestimated at all levels; within a service provider, between service providers, among EMRs and EHRs, throughout the RHIOs, and most of all nationally. Therein lies the rub. The advantage, if there is one, is that we have not reached the point of no return. There is time to define the risks and to develop a plan to ameliorate them. The difficulty is that so many of the risks that will beset providers will be outside their sphere of influence.
Part of the risk is drinking too much vendor Kool Aid. There is merit in continuing to ask why, what if. I met with a chief medical information officer today and we discussed risk mitigation. He commented that perhaps on 20% of the risk/complexity could be attributed to the EHR technology (hardware and software). The other 80% is ongoing and deals with work flows, outside influences, internal politics and fiefdoms, and standards that may as well be written on an Etch-a-Sketch–my term, not his.
There’s always a chance that this is a Chicken Little or Boy Who Cried Wolf argument. Others with whom I’ve spoken suggest otherwise. I think there is merit in defining the gotchas now while there is time to deal with them.
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