EHR-the 40 chicken crocodile

Got a couple hundred million burning a hole in your pocket?  Why not buy an EHR?  Indeed.

Riddle me this Batman, “What is a 40 chicken crocodile?”

It is the number of chickens you have to feed it each day to keep it from eating you. What is the crocodile at your hospital?  Is it your EHR?

Let me recount to you a true story about the details of one of the EHR “success” stories.  A major hospital who selected their EHR from among one of what I like to call the oligopoly EHR Flavor of the Month Club.  You know the suspects.

Permit me to throw a wrench to those clairvoyants who think they know where this is going before I’ve even written it.  Admittedly, I have a tendency to throw metaphorical tomatoes in one direction—that of the vendors.  That’s because, they are often easy targets.  Slow down Pepito.

This hospital, and from what I was told, the vendor, did it right.  I am not sure I would have differed from the approach of either.  The hospital spent a few years in its vendor selection process, and they were very thorough.  They spent two years building their process maps, ensuring the vendor implemented the EHR to meet their needs, not the other way around.  Operations led the nine-figure project.

They implemented many of the support functions and a few of the specialty functions.  Here come the chickens.  After implementation, cash flow dropped by 80 percent for several months due to significant issues they encountered cleaning up the revenue side.  Doctors were instructed to cut their hours by fifty percent to allow them to learn to use the system.  Hours are still down by twenty percent, well more than a year later.  Users use about one-third of the functionality, even after a rigorous training program.

The hospital held off doing most of the clinical implementations for two years.

I asked for some recommendations.  What would you have done differently?  Here’s what I learned.  If you have a research organization you need to spend extra special attention to their workflows.  Managing post-go-live was a big issue to begin to offset productivity losses. Without a continuous process improvement program the EHR would not have been accepted. Do not pick a go-live date at the outset of the project as it causes the organization to be paralyzed simply to hit the date.  Testing was compromised to meet the go-live date. The post go-live issues are still being fought.  Do not let the design or build teams skimp on either reporting or testing, they are still playing catch-up.

So, after doing a pretty bang up job, at least from where I sit, there are still a lot of chickens being fed to the crocodile.  Wonder how many chickens it would have taken had the users not been as involved as they were.  How many had the users not spent two years pre-build defining processes?  A lot.  Now comes the rest of the clinical effort.  See you at the poultry counter.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

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3 thoughts on “EHR-the 40 chicken crocodile

  1. User involvement is critical, but … Their involvement is to define requirements, not solutions. Requirements include what has to be done and how it will be done at the user interface. The IT guys define options and costs and the users make the decisions about what will be done and how at the user interface.

    The problem with most user designs that I have seen has not been that they don’t work. The problem is they are incomplete. In daily life, the “what if’s” occur so seldom that we can make up answers as we go. That doesn’t work with computer systems because if something unusual comes up, there are not a lot of real time options. The IT guys have to keep asking the “what if’s.”

    It is really important to get roles defined, understood and then enforced. The folks who have been all the way through a system development a couple of times need to setting the rules and enforcing them. And they need to be willing to explain why a rule is important. This is not a matter or respecting your elders, it is a matter of getting the job done.


  2. Pingback: ICMCC News Page » EHR-the 40 chicken crocodile

  3. Thanks Hal. Here’s how I look at it in a nutshell.

    Users do. IT replicates what users do. Users answer “what”. IT answers “how”. When one group does not have the answer, we have workarounds.

    IT can’t replicate what they don’t know.


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