EHR: the uncertainty of certitude
Posted by Paul Roemer on February 3, 2010
When I was living in Colorado and much younger my friend and I decided that instead of running during our lunch break we would sit in on an aerobics class. Our plan was to hide away in the back of the class, watch the ladies, and then head back to the office. No sweat—literally, that was also part of the plan. Our thought process was that if women and other lower life forms could do it, how difficult could it be? We were mainly manly men; excuse the use of alliteration.
Within ten minutes we were peeling ourselves from the floor, barely able to lift our arms and legs. What we’d viewed as an hour of simple stretching coupled with an hour of looking like mainly manly men had reduced us to a pair of whimpering sissy boys. We also learned that if you sit in the back of the class that in order to exit you had to make it past all of the ladies as you dragged your carcass from the room.
Fast forward a few decades. I went to an exercise class called spinning. Sounds a little like ballet. It’s a stationary bike. A large TV hangs on a wall. Once again the room is packed with non-males, including my wife. My take on it is that it’s a bike class for women who’d rather watch Regis and pretend to exercise instead of actually breaking a sweat. What the heck; I was already there, why not humor her. The instructor smirked at me when I asked her to tune the TV to ESPN. She inserted a CD of The Killers, cranked it all the way up, and we started pedaling. Pyramids, intervals, uphill, more uphills. Twenty minutes into it my water bottle was empty, my towel soaked. The ladies, including my wife, were chatting away as though they were walking the dog.
Not everything changes with time. Sometimes it better to participate than to watch. Sometimes it’s better to watch. Sometimes, no matter how certain one is, sometimes certainty is meant to be changed. Sometimes certainty is based on bad data. Like the certainty that comes from knowing, “We’re doing just fine, thank you very much.” What is it that everyone holds with such certitude in your firm?
The certitude of certainty. Ain’t it grand being right? Hear the story of the CIO, the vendor and the consultant driving through Iowa—please don’t ask what they were doing in Iowa, perhaps Nebraska was closed. They see a black cow and the vendor says, “I never knew that the cows in Iowa were brown.” The CIO says, “You are over-generalizing from the evidence. All we can say is that some cows in Iowa are brown.” The consultant shakes his head and quips, “You’re both certain and both wrong. All we can infer logically is that there is at least one cow in Iowa, at least one side of which is brown.”
I return to the prior question. What is it that everyone holds with such certitude in your firm? The efficacy of throwing IT at a business problem? That through rigorous investigation you selected an outstanding EHR? That through minor due diligence you selected an EHR that may work okay if nobody looks too hard? Or did you select a bunch of cows?
A herd of cows? Of course I’ve heard of cows, there’s a bunch in Iowa.
This entry was posted on February 3, 2010 at 3:45 pm and is filed under EHR, Strategy, Vendors-What’s not to like?. Tagged: EHR, EHR vendors, electronic health record, Strategy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. Edit this entry.
Month: February 2010
What exactly is healthcare 2.0?
I tend to take a slightly different bent on Healthcare 2.0, a bent which does not intentionally tie to the notion of Internet 2.0, but rather to the notion of an industry desperately needing to reinvent itself.
A few definitions may bring some sense to the discussion. I find it helpful to distinguish the business of healthcare from the healthcare business. I think of the healthcare business as the clinical side, and the business of healthcare as what it takes to make dollars and sense of it all.
Although the healthcare business in the United States is world class in many areas, in many hospitals the business of healthcare is mired in a 0.2 business model. It is often run like a franchised fiefdom of duplicative and ineffective cost and revenue silos—I’m going to duck for a moment in case anyone disagrees strongly with me.
I’m back. This 0.2 business model is being forced into a 2.0 model whether it wants to go there or not. Whether it is capable of making the journey is debatable. The model is regulated, and is about to be reregulated—to what—nobody knows. What national leadership there is is busy waving the magic IT wand thinking that will facilitate the transition from the dark ages and support the business model of National Healthcare—which, by the way, has little if anything to do with the model providers need to run their business.
EHR, if done wrong will be nothing more than a multi-multi-million dollar scanner. Providers will indeed be paperless. However, paper is not the problem. The goal should not be the elimination of paper as though paper is a bad thing. If efficiency equates to speed, to doing something faster, the goal should not be efficiency. It is possible to streamline bad processes and do them faster.
To get to Healthcare 2.0 using my definition, to redefine the business of healthcare, providers must move towards being effective, towards solving business problems, eliminating waste and duplication, retaining doctors and patients, and running it like a real business.
My best – Paul
Why let your EHR vendor run your hospital?
Healthcare Failures Magazine (HFM) “It is not everyone who can finish dead last in the CIO of the Year competition. How do you account for your total lack of accomplishment?”
PR: “It was not as easy as it may appear. I think it had to do with believing that my EHR vendor knew more about running a hospital than did we.”
HFM “Why do you say that?”
PR: “They told me their EHR it had been implemented “As Is” at a number of hospitals and was running fine. I was convinced that all hospitals are basically the same; admissions, treatment, discharge. Besides, it saved a lot of money not having to customize it and do all that stuff about workflows.”
HFM “What about the change management?”
PR: “Yeah, well I guess you could say that part kind’a blew up on me. It didn’t take long to learn that our hospital didn’t function at all like their software. According to our doctors, they didn’t think this vendor had ever been in a hospital, let alone run one.”
Who defines your vision? Who is your chief imaginist, the person responsible for defining the type of hospital you hope to operate five years from now? Do you want it to be your EHR vendor? Probably not? Is it your vendor? It may well be. Why? Do you want to outsource your imagination and your future to your vendor?
Without a detailed and comprehensive work flow improvement and change management program the only thing you will implement is your EHR vendor’s vision of how a hospital should function. You’ll be just like each of their other clients. Is that what your business model calls for, is it satisfactory?
How hospitals should deploy EHR to attract Docs
This is a response I wrote to Brian Ahier’s post on HealthsystemCIO.com
Here’s an idea I raised a few months ago which discusses how to use EHR to your advantage in retaining ambulatory physicians. What prompted the idea was knowing of a hospital which spent nine figures on their EHR, only to find out that its functionality essentially ended inside its four walls. At the time nobody wrote that it wouldn’t pass muster. This idea may die before anyone finishes reading the comment; if not perhaps it merits at least a look-see.
From the perspective of the business model of the hospital, what do we know?
• Hospitals work at attracting and retaining good physicians
• In many markets, ambulatory physicians may choose to send their patients to any one of a number of hospitals
• The competition to attract patients and physicians is building
• The hospital and physicians both benefit if they are:
o On the same EHR
o On an EHR which interfaces easily
What if we change the question being asked, or at least change what constitutes a desirable answer from the perspective of the hospital? Let us go back to what we know.
• Non-hospital based doctors will not be part of the calculation to determine if the hospital meets Meaningful Use.
• Each of those doctors benefit from implementing and EHR system, and they will either qualify for stimulus money or be fined.
• Those same doctors and their patients benefit from having a seamless relationship with a hospital.
• None of those doctors has anything close to what can be considered an actual IT department.
o If 400 providers who practice at your hospital have to select an EHR, how many dozens of different EHRs will they select
o Not only do the providers lack the skills to select a good system, they lack the skills to implement it successfully.
o Most IPAs are not even offering a recommendation
What happens if we rephrase the question and ask, “What steps can a hospital take to:”
• Make ambulatory doctors want to send their patients to them
• Make it easy for the patient/physician/hospital relationship to appear seamless
• Possibly be paid for facilitating the EHR for their ambulatory physicians
If it were my hospital, here’s what I would do:
• Pull together a plan to figure out how a hospital could offer an EHR solution for each of the ambulatory doctors. This EHR solution could:
o Be the same EHR or one which can integrate with their EHR
o Be offered as a managed services solution
o Be offered as an outsourced solution
• Figure out what information is needed to determine the viability of offering its ambulatory doctors an EHR solution:
o Staffing
o Marketing
o Incentives
o Cost
o Roll-out
o Training
• Determine if the ambulatory doctors can somehow sign-over their incentive payments to the hospital.
o If yes, the incentive payment from 400 ambulatory doctors could fund about $18 million of the roll-out cost
o If not, there are still a number of great business reasons to think about helping the doctors get on the hospital’s EHR.
What is the long-term ROI, say five years and beyond, of having an ambulatory doctor send its patients to a given hospital? I bet it exceeds the cost of installing an ambulatory EHR.
Pale Rhino Consulting 