This is the time of year in the east when cinerescent caterpillar nests hang thickly from the trees, peppered tufts of cotton candy. During these long, flavorless August days, the sky is a similar achromatic color. My nine-year-old is concerned because I told her we are having caterpillar soup for dinner tonight—watch out for the crunchy bits. Once again, it seems I’ve gotten off message.
I wonder how much of the difficulty surrounding EHR has to do with getting off message, much like we seem to have done with the reform discussion. What difficulties? Got time? You can name more of them than can I.
What is off message? It’s that the day-to-day tactics of implementing EHR office by office, and hospital by hospital have overshadowed the strategy, have displaced the business driver behind the mandate. The focus became internal, not national. Bits and bytes have overshadowed charts.
I doubt few, if any, can articulate a believable explanation of how a few years from now your medical records will accurately and expeditiously be delivered from where you live to the lone clinic on Main Street, Small Town, USA, to the nurse practitioner who at midnight is giving you an EKG.
It’s that fact, that we are not able to define how we get from A to B, let alone do so with multitudes of A’s and B’s, that to me suggests we are building something of which we have little comfort will do what we set out for it do.
Clearly, there are hundreds if not thousands of very talented and dedicated professionals focused on finding a solution. However, it seems their efforts remain handcuffed by hundreds of competing products, no well-defined overriding set of requirements that would enable anyone to say with certainty, “Yes, that is it. That captures what we need to do. When we have done that, we are done.”
Until that time, I think we all need to be concerned about the crunchy bits.
What do you think?
Pale Rhino Consulting 
… no well-defined overriding set of requirements that would enable anyone to say with certainty, “Yes, that is it. That captures what we need to do. When we have done that, we are done.”
I think you are confusing process with project. Like the Internet, EMR will never be “done.”
We need a different way of thinking than standard System Development Life Cycle (SDLC) that serves a limited universe. We need ways to “chunk” what we are doing to we can say when we do this (including incorporating x, y, and z that already exists) we will be finished with this and ready to do whatever is next. If what we are doing is very big, we may not be able to see what is next in any useful way because by the time we get there there will be new tools from others that we can incorporate or others may have done what we thought would be next.
I’m still playing with these ideas.
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I agree and disagree–I’m sure that clarifies it for both of us. Here’s my issue with this–if it remains confusing, the fault lies with my inability to express myself in English. The very fact that at this point in the process we continue to discuss this as though it is ill-defined makes it somewhat self-fulfilling.
Who is leading the charge? Who will set the standards? That I decree that the EHR process is broken does not imply I am smarter than those who work so hard to make it happen. There is no basis for listening to me than to anyone else speaking their mind on the issue.
What is missing is this, and of someone convinces me that my perspective is wrong, I will stop writing–the current approach to EHR (not at the provider level) will not work.
This is such an easy statement for people to argue, yet none of the pseudo leaders argue. Given that, let those of us on the other side of the fence lead, let us find and articulate a defensible position, and let us facilitate change which will help the providers.
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Can you count from infinity twice or must you do it an infinite number of times?
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You interrupted me, now I have to start over
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