Informatics, Is There Really an Impact?

I posted the following to a post on the HIMSS Blog titled, Informatics, Is There Really an Impact?. What do you think?

I think there is an impact, but for all but a few the impact of informatics is not positive. It is however, exactly the one for which they planned—albeit not deliberately. I think the evidence supports the reasons for the abject pickle in which providers find themselves comes from the fact that most failures can be traced back to the very beginning of a provider’s efforts to implement EHR.

To compound matters, as these same providers look to implement Accountable Care Organizations (ACOs) to their existing business models, they will find themselves pickling their entire informatics effort.

A hospital CEO recently confided to me that his peers could not be less qualified when it comes to the skills needed to select an EHR system. He stated EHR decisions are being made based on what others have done, on conversations had at a trade show, or on a pitch from a vendor.

Now, before we start slamming the vendors and their products—as I can be fond of doing—I do not think most EHR failures have as much to do with the vendors as they have to do with the providers. Very little documented rigor exists when it comes to selecting an EHR vendor. In fact, I would wager many large providers issued a more detailed request for proposal (RFP) to select their cafeteria vendor than they did for the EHR.

I am a firm believer that if you cannot find something on Google, the reason you cannot find it is that it does not exist. Googling EHR RFP does not offer anything useful. Is that perhaps because there are not many providers who have developed a meaty EHR RFP?

There are a number of providers who are on version 2.0 for the EHR. They are doing so under the mistaken belief that the problems they encountered with version 1.0 had to do with the software. Looking at the large provider EHR landscape, there are providers who are switching from vendor A to vendor B. Now, if that was the only thing going on, one might find cause to blame vendor A. Unfortunately, other providers, some in the same town are switching from vendor B to vendor A which sort of leads one to suspect that perhaps the software is not the problem.

An argument can be made that if a provider selects its EHR from among the leading 5-7 vendors, they should have about an equal chance of having a successful implementation. At some providers, vendor A is working reasonably well. At other providers, vendor B is working reasonably well.

Of course, as the evidence supports, providers have about an equal chance of having an unsuccessful EHR implementation. Some providers are trying to make the argument that after implementing EHR—and spending an excess of one hundred million dollars—having a productivity loss of around twenty percent does not mean their EHR implementation failed.

I think one can state categorically that if your productivity drops twenty percent, your implementation failed. I think that if your EHR plan at the outset predicted a twenty percent productivity drop, your EHR project would never have been approved.

So, why the mess? If a provider ran a disaster recovery project on what went wrong, the most likely answers would come down to many of the items you listed in your post; a lack of requirements, poor planning, and a morbid lack of time and resources directed to process alignment and change management. Why is this the case? I think it is because the target providers are trying to hit has more to do with meeting Meaningful Use than with implementing an EHR that will meet their needs.

Two years from now when providers reassess informatics in light of the failure of ACOs, it will likely come down to these same issues. There is plenty of time to get these issues right. But then again, there is always plenty of time to do it twice.


2 thoughts on “Informatics, Is There Really an Impact?

  1. Paul, as usual, you are spot on.. I concur the providers in many cases do not know what to pick. And many of the vendors don’t know what needs to be in an EMR to give benefits. Achieving Meaningful Use certainly does very little for increased staff efficiency, improved throughput, decreased errors or increase compliance with internal and most external rules and regulations.

    A major fault is we have people who have never set foot in a clinic configuring software that requires providers to change the way they run their operations. In most industry areas, a lot of time and money are spent development a competitive advantage and to give all of that up because ‘the software needs you to do it THIS way’ is very silly.

    My approach over the years has been ‘why have an application at all, if one size fits none and if building a custom app is about the same as trying to develop the next generation of a Ferrari in your garage’?

    What on earth can be wrong with mapping your practices, improving them, then using software to compile and put these inline such that the software guides the processing of instances?

    The providers see their processes, their forms, their user interface can be ONE screen (fixed time tasks on one side, floating time tasks on the other) and, if they have mastered Outlook, they are 90 % there in terms of training.


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