Who lost the ‘R’ in EHR’s ROI?

This is my latest post in healthsystemcio.com.


As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Let’s agree for the moment that workflows can be parsed into two groups—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs). (I read about this concept online via Sigurd Rinde.)

An example of an ERP industry is manufacturing. Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work—artistes.

Then there are the ERPs.  Remember The Flintstones and I Love Lucy?  Fred Flintstone was looking at a job advert for someone to put cotton in pill bottles; and Lucy got a job boxing bon bons.  ERPs are the easy business process to map, model, and structure. They are the perfect processes for large enterprise software vendors to automate.

EHRs contain both types of business processes, BRPs and ERPs.

How can you tell what type of business processes you are trying to incorporate in your EHR? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss ERP and BRP in the same sentence with EHR?  The reason is simple. The taxonomy of most, if not all EHR systems, is that EHRs are designed to support ERPs. Unfortunately, most of the business processes that the EHR has to model are one-off processes, BRPs.  Healthcare providers are faced with the quintessential square peg in a round hole conundrum; trying to fit BRPs into an ERP system.

Since much of the ROI in the EHR comes from being able to redesign the workflows, it stands to reason that the ‘R’ in ROI will be sacrificed, and the ‘I’ will be much higher than planned.

On the other hand, if one looks at a hospital’s non-clinical business processes almost all of those are ERPs.  Many of them are some combination of being outdated, duplicated, and rework.  If you are looking to recover your ROI and to decrease cost, these ERPs offer a good opportunity to do both.

What do you think?


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