Just to make sure we are all turned to the same page in our Cliff Notes on Meaningful Use, today’s conversation is, “There is no “R” in ROI.”
Are you familiar with the Abilene paradox? It is a paradox in which a group of people collectively decide on a course of action that is counter to the preferences of any of the individuals in the group. It involves a common breakdown of group communication in which each member mistakenly believes that their own preferences are counter to the group’s and, therefore, does not raise objections.
I think it occurs more often than we think. Try to recall the last meeting you attended in which you really disagreed with something that was said. Chances are you knew some of the others in the meeting well enough to know they also disagreed. The reason you know they also disagreed is because you had discussed the topic. However, none of you raised your disagreement during the meeting. Why? Because you did not want to rock the boat.
It is similar to a pseudoconsensus. Pluralistic ignorance. These create a bystander effect—people are more likely to speak out about an issue when they are alone with someone than when others are present.
After further consideration I think we must consider the very real possibility that there is no ROI for Meaningful Use. I write this in all sincerity. Healthcare executives march in lock-step or group think to achieve the myth of finding an ROI for Meaningful Use. The ROI is healthcare’s quest for the Holy Grail, albeit without the Monty Python sound track. They cannot proceed without one, so they set the target, figure out what data will demonstrate that they have hit it, and disregard the reams of data that does not support the ROI.
What if the government came out with a standard stating all hospitals ought to buy, install, and use a fifty million dollar transplant device that also flosses the patient’s teeth? This initiative is “optional”, but the government will pay the hospital a two hundred thousand dollar rebate. There are several types of transplant flossers—the ones that deliver that fresh mint taste cost extra.
If we were having a business discussion about the ROI for the transplant device, healthcare executives would be foaming at the mouth about how impossible it would be to calculate an ROI, and rightly so. They would argue all hospitals are different, they have different cost structures, the devices are all different.
The standards for Meaningful Use are arbitrary. The standards were developed by people who do not need to meet an ROI. There was no mandate in the development of those standards to create standards which when met would yield an ROI. Any attempt to force an ROI will naturally differ in a number of ways:
- by provider—size, structure, offering, geography
- by their interpretation of Meaningful Use
- by which EHR they implemented
- when they began the implementation
- how well they implemented the EHR
Somebody somewhere may hit a positive ROI on Meaningful Use, just like somebody playing darts may hit a bull’s eye. Any positive ROI will be accomplished more out of chance, and from having fit the data to a predetermined ROI rather than measuring the ROI against its true impact.
Implementing an EHR can be very good for a hospital. However, it should be a business decision for the hospital based on the same set of business rules the hospital would use to justify any other large expenditure. If the hospital achieves an ROI it will not be because of having followed an arbitrary set of standards. Any ROI for an EHR will come from having done it correctly. Hitting the figure any other way means two things; it was a coincidence, or you are in for trouble down the road.
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942