I’m in San Diego for a few days.  Every time I go to California I wonder if I need to exchange money.

I called my neighbor who is watching my cat and checking on my mom while I’m away.

“How’s everything?”  I asked.

He paused f or a second…”Your cat died,” he said softly.

“Aw jeez. Don’t tell me that.  At least break it to me gently.”

“Like how?”

“Well you could say, the cat got out, and then climbed a tree, and you couldn’t get her down so you called the firs department, and the cat got on the roof, and when they were trying to get it down it fell and died.”

“Oh.”

“So, anything else?  How’s mom?”

“Your mom’s on the roof.”

(I made that up, the part about the cat.)

Anyway, so when someone asks you about the EHR project, what do you say?  “The EHR’s on the roof?”

Didn't I used to be on Bullwinkle?

It’s not like I wake up this way.

I’ve tried to provide opportunities for ‘them’ to assuage the fear surrounding EHR.  (By the way, why does Word constantly inform me that EHR is actually HER—isn’t that taking being PC a little too far?)

Shall I explain?  Yes, please.

I’ve posited the following questions on public forums whose combined members exceed 100,000 professionals.  Most of those professionals, as we know, are professional sales people, sales persons, sales humans—are we humans, or are we dancers?—I’m not sure what’s considered to be the most acceptable term, and you’ve learned I probably don’t care.  Sorry for the digression—I get this way every time I see wall-to-wall TV coverage of…I won’t go there.

The questions I posed are:

What are the biggest EHR implementation problems?

What are the ‘best’ EHR systems?

What is a ‘ballpark’ cost estimate for HER for a 500 bed hospital?

I understand all the legitimate disclaimers that need to be offered.  However, a summary of the answers I received reads as follows:

The biggest problems are caused by the healthcare providers.

No vendor stepped forward with an explanation as to why they believe their system is the best.

Most answers about having to do with cost had to do with why it isn’t possible to provide an answer about costs.

You better have your best interests at heart, it’s pretty clear others won’t

Field of Dreams.  Best guy movie of all times?  Forgive me, but I don’t usually start my day being PC.  (I don’t end it that way either.)  Pardon me as I wipe a tear.  Want to have a catch Dad?  For those of you whose minds don’t immediately shift to the shooting of Old Yellar, you’re on the wrong blog.

First there’s the field.  It’s green.  The same green God made when he made green.  There’s a cross-hatched pattern to the cut, the white lines brilliantly juxtaposed.  The air smells of peanuts and dogs.

Baseball, as spoken by James Earl Jones:

“Ray. People will come, Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn into your driveway, not knowing for sure why they’re doing it. They’ll arrive at your door, as innocent as children, longing for the past. Of course, we won’t mind if you look around, you’ll say. It’s only $20 per person. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack…And they’ll walk off to the bleachers and sit in their short sleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines where they sat when they were children, and cheered their heroes. And they’ll watch the game, and it’ll be as if they’d dipped themselves in magic waters. The memories will be so thick, they’ll have to brush them away from their faces… People will come, Ray…The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers; it has been erased like a blackboard, rebuilt, and erased again. But baseball has marked the time. This field, this game, is a part of our past, Ray. It reminds us of all that once was good, and it could be again. Ohhhh, people will come, Ray. People will most definitely come…”

This is the twelve step nightmare for anyone who had a father.  At the end of the movie there is a dialog between Ray Kinsella and Shoeless Joe Jackson:

Ray Kinsella: I did it all. I listened to the voices, I did what they told me, and not once did I ask what’s in it for me.
Shoeless Joe Jackson: What are you saying, Ray?
Ray Kinsella: I’m saying? What’s in it for me?

Amidst all the confusion, amidst all the regulation, where does that leave you?  Ask, “What’s in it for me?”  What’s in it is whatever you put into it.  Drive this process to your benefit.  Build an EHR because it benefits you, not because it’s forced upon you.

Dreams.  All intelligent beings dream.  Remember the one where you don’t pass your college final, or when you can float above your friends in the hallway in high school, or when you show up in class naked?

No?  Just me?  I guess that whole twelve-step thing isn’t working as well as I hoped.

Here’s the one I had last night–when reform is complete, nobody will be able to reform it.

In case you might be interested, http://www.slideshare.net/paulroemer/ehr-as-we-see-it

I begin with a disclaimer—this is an illustration, it is not meant to be disrespectful.  The infinite monkey theorem states that monkeys hitting keys at random on a typewriter for an infinite amount of time will almost surely type a given text, such as the complete healthcare bill—that’s not where I’m going with this even though that’s not too bad an idea.

When I think about this, the illustration is about what could happen, however improbable, not what will happen.  It requires a situation, tools, actors, and no direction—sort of like deism—no divine intervention.

Here’s my take on how this applies.  The situation—healthcare reform.  The tools—money.  The actors—providers, vendors, transformers, regulators.  Who’s in charge?  Nobody—unless of course you count Pelosi and Reid—but who are we kidding?

The only thing that makes the infinite monkey theorem even plausible is the fact that the monkeys are given infinite time.  Washington is not giving reform infinite time.  In fact, there’s a real sense of urgency.  That urgency, coupled with no leadership, none, makes the task unachievable.  All that has been offered is money.  Money without a decider will not yield reform.

Twenty-ish billion for healthcare IT sounded like a lot.  It’s not.  AIG got $79 billion.  Canada estimated HIT would cost $450 per person—they were low.  Our $20 billion is less than $60 a person.

Nobody is in charge, which means everybody is in charge.  Without AIG money and a leader, I believe we’re better off waiting to see what the monkeys build.

Ever start feeling that way in the middle of a meeting?  Is somebody trying to sell you something in the meeting?

Ever have a meeting that went something like this?

“Sure, you could go ahead and define your requirements and pay a big firm hundreds of thousands of dollars to write and RFP, but after all that time and money, you’d still come back to us.”

Or…

“We are implementing the exact same EHR system at OLPIH (Our Lady of Perpetual Implementation Hospital), and we didn’t have to change a single workflow.”

Or…

“That’s why we’re here, so you don’t have to learn about all that technical stuff.”

Is there a ‘best’ EHR for you?  Quite possibly.  You’ve looked at a lot of the ongoing discussions.  I’ve repeatedly asked the question as to which solution is the best.  Asked it in open forums—vendors and healthcare providers—people not known for being reluctant to share their opinion.

Know what the response was?  Nothing.  Nada.  Zip.  Ignore who’s sold the most.  Nothing bubbles to the top.  There’s nothing that can even claim to be the flavor of the month.  (Ben & Jerry’s Chunky Monkey.)

So, where does that leave you?  Actually, you’re in an okay position.  Since the target is ill-defined, you have the luxury of figuring out which solution best fits your business problems.  Once you’ve done that, have some ice cream.

I feel like I’ve contributed something any time I google a phrase and get zero hits.  I’m trying to recall if we’ve conjugated Google yet—I google, you google, he/she or it googles.  Failing to recognize it in its verb form, Word wants me to use a capital ‘G’.

Where were we?  I was asked to share my thoughts about all of the healthcare certifications, especially those that are used within healthcare IT, and to offer my opinion as to whether they add value or cost.  This is the type of open-ended question that can get less grounded consultants all a twitter.

Most of you can answer this for me, but I’ll push forward.  Remember, what follows is the opinion of a trained professional—don’t try this at home.

Clearly, certifications are of value, but not necessarily in the way one might think.  It depends in part on where they lay.  For the provider to go through the exercise of being certified in one realm or another probably means they’ve tightened their ship—a good thing.  Can you have too much of a good thing?  Probably—that’s a rather milquetoast answer.  Maybe it’s just me, but healthcare seems to attract or collect tiny alphabetical collections of letters like others collect fine wines—the thrill is in the collection, not necessarily in how utilitarian they are.

If we’re honest, healthcare has not been noted as an industry viewed as being on the leading edge of IT—if you happen to be an exception, that’s great, this isn’t meant to be all encompassing.  That being the case, since we are looking at a five year stretch where healthcare and healthcare IT are going to transform themselves one way or another from version 0.2 to version 2.0, I think there’s plenty to pay attention to without worrying about what certificates are stapled to everyone’s cubical.

Ask, what is it your organization must have in place to transform?  What IT skills?  What project management skills?  Everything that lays under the umbrella of HIT is the most visible, costly, and risky undertaking the organization has faced.  Do you need someone to lead it who has a certificate?  Maybe.  Do you need someone with ninja project management skills?  Absolutely.

On the non-provider side, certifications will always cost you more.  Nobody gives them away for free.  Be careful what you pay for.

What’s the most valuable certificate?  Thanks for asking.  I think it’s the one that certifies that you’re not drinking the Kool Aid.

I was looking at a job posting for a CMIO.  The first requirement is that the person must be a physician and a degree in healthcare infomatics.  Good start.  All of the other requirements read more like those one would expect to find in a receptionist–works and plays well with others, is kind to small animals.

You want someone whose name nobody will remember in five years–sort of like the umpire of a baseball game.  If they do their job right, nobody will know they were even there.

So what’s missing?  This is a been there done that job.  Battle hardened.  At what?  EHR?  I don’t think that has to be the case.  There aren’t many of those, and even fewer who have been successful.  Does it need to be a doctor?  I don’t think so.  There are plenty of docs, and there are enough medical infomatics.  I think it’s worth looking at a solution whereby you staff the project with those skills, but as far as having someone lead the charge, I respectfully suggest considering finding someone with big project experience.

Watching some work with EHR is a lot like watching a chimp trying to use tools for the first time.