Do you ever wonder why people buy drills? Because they need a drill? No.
They buy drills because they don’t sell holes.
Why buy an EHR system? Because you need an EHR?
I hope you have a better reason than that. If you’re interested, I sell holes.
Month: February 2011
Nietzsche on HIT Strategy
The problem with being a consultant is not everyone wants their responses packaged in the same manner I tend to deliver them. I communicate best visually, pictorially.
Asked what I want for dinner, I respond with a 3-D bar graph. Forty-five percent of me wants pasta, thirty percent wants roast beef—a year over year increase of seven percent, but not a statistically significant sample size—and one hundred and twelve percent of me wants whatever she is willing to cook—which means I do not have to cook.
There are two kinds of consultants and, I am the other kind. ‘Nuff said. On a side note, as I keep telling the police, I am not the person responsible for holding giraffe fights in the linen section of Neiman Marcus. Nor am I the guy with the collection of taxidermist-stuffed German World War II soldiers in my basement.
When one reviews the value of a healthcare IT strategy—if your organization does not have one click (http://www.disney.com) and you will be taken to a site to make more valuable use of your time—in order for it to be worth more than graffiti on an overpass (plebian) the plan must have a plan. It also helps if the strategy at least pretends to be strategic.
The stigmata of most strategic plans is they are neither strategic nor plans.
If there is one thing a strategy should be able to address it is to be able to answer why, to be able to answer what benefit the execution of said strategy will deliver.
More than fifty percent of hospitals will not have a written IT strategic plan.
More than half that do have strategic plans will not pass the value test.
Let us suppose for a moment a hospital has what they believe to be a real HIT strategic plan. Does that document contain answers to the following questions?
- Implement XYZ EHR. Why? Why XYZ? What benefits will the hospital receive? Few if any will formalize benefits ahead of time because they can be held accountable when those benefits are not delivered. Is it safer to simply check the box for having “completed” the implementation?
- Meet Meaningful Use. Ditto.
- Accountable Care Organization. Ditto.
- ICD-10. Ditto.
- Family Experience Management. Ditto.
Maybe Nietzsche knew more about IT strategy than he has been credited. “All things are subject to interpretation. Whichever interpretation prevails at a given time is a function of power, not truth.”
My proposed addition to healthcare reform
Now that at least parts of healthcare reform are back on the table, or perhaps under the bus, as I await my appointment as EHR Czar, I got to thinking about what other aspects of healthcare might be reformed.
It occurred to me that our system can fix almost anything we throw at it. We are capable of fixing things that affect one person in a hundred thousand. So, what can the US healthcare system not fix—other than EHR? Things that afflict one hundred thousand out of one thousand.
Those are what I would like Congress to fund; the simple everyday minutias that make me feel gobsmacked each time I walk out of the front door and into the apocalypse of those in need of healing. I stopped for a coffee this morning, and completed the transaction with a mute. I do not know whether she was legally mute or just being her ill-mannered self, but she managed to complete the entire transaction without uttering a single sound, not even a grunt, a hand gesture, or a wayward glance in my direction.
I have reached my point of no return when it comes to those around me choosing to act rudely or unsociably. Manners are free. It costs nothing to exhibit good manners. Unfortunately, it apparently costs nothing to exercise bad manners.
Maybe bad manners are an illness. People cut off, flip off, and rip off others without giving it a second thought. There are days when I feel as though the Seven Deadly Sins are alive and well and having a resurgence. Pride, greed, envy, lust, sloth, anger, and gluttony. I am surprised nobody has added anything to the list, but it is not from lack of effort.
I had thought about pushing for healthcare legislation to place more funding towards curing hair loss—not due to any personal insecurities surrounding that issue. But the more I thought about it the more I felt how much better we would be as neighbors if someone invented a civility pill—take two in the morning twenty minutes before eating.
I have made it my mission to go out of my way to talk to people, especially those who do not wish to speak, those who glance the other way as you pass them on the street. I must admit, sometimes I do it just because I know it will make them uncomfortable. It costs nothing to say hello.
And so, as I await my appointment as EHR Czar, or to be the Grand Poobah of one of those Middle Eastern countries lacking poobahs, I am practicing civility.
EHR Failure Factors–step away from the computer
There are days when it doesn’t pay to be a serial malingerer, and when it does, the work is only part time, but I hear the benefits may be improving as I think I heard somebody mention healthcare is being reformed.
I don’t know if you are aware of it, but there are actually people who have taken an Alfred E. Newman, “What, me worry” attitude towards EHR. For the youngsters in the crowd, Alfred was the poster child for Mad Magazine, not Mad Med.
Just to be contrarian for a moment–as though that’s out of character for me–most providers have no need to fear–does this happen to you? You are writing aloud, trying to make a point, and the one thing that pops into your mind after, ‘there’s no need to fear’ is “Underdog is here.”
Anyway, since many providers haven’t begun the process, or even begun to understand the process, there is still time for them to lessen the risk of failure from an EHR perspective. Many don’t want to talk about it, the risk of failure.
Here’s another data set worth a look (The Chaos Report). They went a little PC on us calling them ‘Impaired” factors. EHR impairment. Step away from the computer if you are impaired, and take away your friend’s logon if they are. These are failure factors.
| Project Impaired Factors | % of the Responses | |
| 1. | Incomplete Requirements | 13.1% |
| 2. | Lack of User Involvement | 12.4% |
| 3. | Lack of Resources | 10.6% |
| 4. | Unrealistic Expectations | 9.9% |
| 5. | Lack of Executive Support | 9.3% |
| 6. | Changing Requirements & Specifications | 8.7% |
| 7. | Lack of Planning | 8.1% |
| 8. | Didn’t Need It Any Longer | 7.5% |
| 9. | Lack of IT Management | 6.2% |
| 10. | Technology Illiteracy | 4.3% |
| 11. | Other | 9.9% |
My take on this is with overall “failures” so high, several respondents could have replied to “all of the above.” Also of note is that these failure reasons differ from the ones listed previously.
Who knows, maybe if we multiply them by minus one we can call them success factors.
EHR-Do not use as a flotation device
EHR potentially will offer a number of benefits. It won’t offer much at all if you don’t install it correctly.
However, EHR is not a panacea. Without having a detaile understading of the business problems you are trying to solve, it may not be of much more value than a Xerox machine.
Can you make color copies with your EHR?
Pale Rhino Consulting 