Just so you know, I'm making fun of me.

I’ve been a runner since high school except for the twenty year break I took to as a precursor to my heart attack six years ago.  Anyway, today I was running intervals on a local track.  During one sprint, I caught and passed another runner—that brought about an immediate flashback to a race I ran in high school.

I was anchoring our mile relay team, the last event of the day.  The runner in the lane next to me was fast, very fast.  He got the baton before I did and was ten to fifteen yards ahead of me as I began to run.  Defying all explanation, by the time we reached the first turn I had made up the entire distance and we were side by side.  I was having the race of my life, my fantasy come true.  Even the fans knew something was up.

I remember him glancing at me only long enough to notice me.  Stay with me here.  For those who have watched Star Trek you may recall the scene when the Enterprise shifts into warp speed.  The way they convey that on screen is the image jumps from that of their ship to a mere blur of light.  So there I was, living out my fantasy, 110 yards into a 440 yard race.  Something happened and he began to accelerate—I knew in two seconds that my fantasy had ended.  He was gaining speed at a rate where it was enjoyable to watch.  I lost by fifty yards.  (Four years later I learned that he was an alternate in the 440 on the US Olympic team.)

Here’s the segue in case you’re not paying close attention.  My sense is that a lot of the hospitals that have been engaged in the EHR process have been at EHR fantasy camp.  What on earth could he mean?  Well, let’s see if we can sort that out.  What’s the fantasy?  It’s probably a combination of several things, some of which are system related, some of which are tied to the healthcare provider.  The fantasy can include the belief that you:

• Knew what business problem you were trying to solve
• Selected a system capable of solving that problem
• Implemented it correctly
• Designed the workflows correctly
• Obtained user buy-in
• Have a solid training program
• Can deal with a massive change management effort
• Have selected a system and implemented it in a way that will meet the tests of certification, meaningful use, and interoperability even though those tests are not defined

I think if we listen very carefully we can hear a collected sigh of relief when a hospital goes live with their EHR, and the systems don’t collapse on themselves like a dying star forming a black hole.  That belief, believing that victory came early, is comparable to me thinking I had the race won at the first turn.  There’s plenty that can destroy the success fantasy after the system is live.  Some of those things are based on the choices you made, some are based on how you implemented it, and some are based on what you did after implementation.

The good news, if there is any, is that none of those things are immutable.