EHR’s Two Types of Failure at your Hospital

"Kinetic productivity"

I have been rereading John Eldredge’s book Wild at Heart.  It seems his purpose for the book is to help men cope with their feelings of not measuring up to their father’s expectations.  It delivers its punch at much the same level as the last scene in the film Field of Dreams when the father and son have a chance for one last catch.

(I am pausing parenthetically for a moment for the men to wipe their collective eyes.)

Here comes the segue, so hold on to your EHRs.  Let us spend some time dealing with lost opportunity and failure.  What if we define two types of failures; kinetic failure and potential failure?

Kinetic Failure: the failure to achieve the possible

Potential Failure: the failure to achieve the probable

Viewed from the perspective of productivity, let us define X to represent the service provider’s pre-EHR productivity; the distance from P to A represents the productivity loss brought about by the EHR, and the distance from A to K represents the opportunity loss.


One can argue with some degree of reason that the purchase of an EHR was made with the reasonable assumption that in addition to improving quality and patient safety the EHR would improve productivity to some degree.  In fact, assuming the provider did any sort of cost benefit analysis or return on investment calculation, any ROI, if it exists lives somewhere along the path between A and K.

If productivity is not improved, the service provider incurs an opportunity loss, a kinetic failure. At that point the best a service provider can hope to achieve is to not suffer a productivity loss.

One can also argue that the purchase of an EHR was made with the reasonable assumption that the implementation of EHR would not reduce productivity.

In many service providers EHR has resulted in a double hit to productivity; not only did they not achieve the productivity gains that were possible, they lost productivity.  A lot of people raise complaints when they speak about how much productivity costs.  One thing that is for certain, productivity costs a lot less than lost productivity.

This lost productivity, the kinetic failure, is the elephant in the service provider’s waiting room.  It has been poking its trunk through the door, and the only thing it wants once it gets its trunk through the door is to get all the way in the room.

Well, it is in the room, all the way in.

Part of the confusion facing providers is due to the fact that no matter how bad the productivity loss, a provider can still qualify as a meaningful user. That fact has led many providers to believe that since they can still qualify as such, that perhaps the productivity loss cannot be all bad news.

Let us look at a real example from a client of mine, a hundred and forty physician practice.  This practice had hit a barrier in terms of its ability to add patients, doctors, and staff.  It was running consistently an hour to an hour and a half behind with its patients.

The practice spent millions to implement an EHR.  Several months post implementation the practice was still running an hour behind.  Automating bad practices resulted in only one thing; the bad practices were completed faster.

To have any hope of avoiding kinetic failure and potential failure a healthcare practice must address how it runs its business.  Some business processes are duplicative, some are outdated, and some are wasteful.

Every one of those eats away at possible and probable productivity.  EHR was not designed to be a productivity windfall, but it clearly shines a spotlight on lost productivity.

Fortunately, even if your EHR has led to a productivity loss, all is not lost. Kinetic productivity can be regained, and potential productivity can be captured.  The path to productivity slices right through how the EHR is being used.  User Experience, UX, and usability, can and should be examined, redesigned and deployed.  This is not for the squeamish as it will cut through constraints like ‘We can’t do that’ and ‘We have always done it this way.’

Can’t and always must become productivity’s road kill.

7 thoughts on “EHR’s Two Types of Failure at your Hospital

  1. Paul, insightful article. What I’d like to add is that much of what is wrong with EHRs is that they are not designed with new/redesigned workflows in mind. Until we stop mimicking old workflows and trying to do “business as usual,” we’re wasting precious time and money on implementing electronic medical record systems. Each practice needs to redesign their workflows to ensure process improvements in every “task” that makes sense. Then customize the EHR to enhance those new workflows.


  2. This is a great case. That’s why I have always disagreed with non-physician consultants who insist on mapping existing workflows to the new EHR. That’s recipe for faster chaos. In my experience, the physicians most likely to succeed are the ones that were well organized before implementing EHR.


    • Karim,
      Would you agree, however, that is good to map current state first so you know your current workflows then map future state for the changes? We do this and overlay the maps to be sure we don’t forget any “tasks”. Just to be clear: I would never suggest using current workflows with the EMR. They should be used for reference. Jonena


  3. I enjoyed this thread and agree that before any EMR or other systems project that attempts to automate a process can be initiated, the “to-be” processes need to be mapped and “finalized” (read agreed to by those that will actually have to execute the process). Always best to document the “as-is” process as well to identify the areas of change….suspect I am not stating anything that we don’t already know but curious to understand if there are documented best practices for the specific processes that create the productivity bottlenecks. Hard to believe that each practice would set out to solve the problem on their own without first checking to see if others have already cracked the code. Thanks for allowing me to provide my POV.


  4. The story here is mirrored in many other areas. Years ago I remember John Bessant telling us that automation without busi9nes sprocess redesign just meant automating your existing problems, and you use almost identical words here. Basically, efrficiency is more than doing existing things faster, and innovation is more than adding technology to existing operations.


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