Other than adding a wing to a hospital, properly implementing an Electronic Records System is undoubtedly the most complex, expensive, and far reaching undertaking with which you will be faced.

You have a “Pick me, pick me,” vendor mentalities—pay no attention to your requirements, they’ll only add to your confusion.

You have nobody making the rules; no decider—where’s George when you need him?

The targets are all fluid—don’t believe for a minute those selling meaningful use, certification, and interoperability.

There are a few hundred networks with their own standards hoping theirs will be the one chosen to drive the NHIN.

If you have more than one EHR at your facility—about half the hospitals do—by default you are building your own Rhio.

You have duplicate and dysfunctional workflows that are so far from best practices that it may not even be worth the effort to get to “best”—getting to a single practice may be more than sufficient.

And finally—let’s all take a collective sigh of relief—you are expected to transform an industry from version 0.2 to version 2.0.

So, what’s on tap for tomorrow?

If healthcare reform doesn’t work we have the luxury of calling it version 1.0

Are the standards for meaningful use and certification real? Maybe. Will they be changed? Likely. Do they mean much until we have a concrete reform package, have somebody who is the decider, and have absolutes on interoperability? I think not–others disagree.  Does interoperability throw everything out the window?  Count on it.

Should healthcare providers wait? No. Here’s what I recommend.

1. Work to define a precise and quantifiable set of business problems you want to solve with an EHR.
2. Make those requirements a part of a detailed functional RFP.
3. And so forth…

Make a decision on what it will do for you, not based on how well it fits a moving target.

After all, how much wood could a woodchuck chuck if a woodchuck could chuck?

To those of you wondering if I should be writing this piece or reading it, that makes 3 of us.

I’m the sort of fellow who when confronted with a fork in the road takes it.

There are a lot of people drinking the EHR Kool Aid.  It would be easier to take the conventional approach, rally around them, wave the flag, and take the Alfred E. Newman perspective of, “What, me worry?”

It’s not just that I think this is complex, it’s that I am convinced it’s orders of magnitude more complex and more expensive than anything healthcare providers have done.

I know it can be done to your advantage, but it depnds on who is steering the ship.

Triva-what are the names of Macbeth's witches?

Listen for a second.  the sound you here is the vaccuum created by the docs as they run from their EHR.  

 
There are a number of stats showing EHR adoption rates, and there are stats showing defections, but nobody seems to be publishing ‘net gains’ which by the way is a pretty small number.

You can’t walk along the internet these days without tripping over someone with an opinion about EHR.  Most of those opining are cheerleaders.  If you look closely, the loudest cheering is being done with people  who are trying to get you to buy the product.

When I asked him his opinion the other day, Macbeth offered, “I will not be afraid of death and bane,
Till Birnam forest come to Dunsinane.”

Not very helpful, but he’s dead–and make believe.  For the rest of us, be afraid, be very afraid.  Sort of a buyer beware on steroids.

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.