Success and failure are often separated by the slimmest of margins. Sometimes you have to be prepared to think on your feet to out think unfavorable circumstances. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.
Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.
I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the puddles from the hardwood flooring, thinking while mopping about how I might answer to my wife if she happened to return to a kitchen that looked like the Land of Lakes. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.
Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year can’t be far off.
A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.
A few of you have asked, let’s say we buy into what you are saying, how do you propose we turn around the results of our EHR implementation? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that your EHR investment was wasted. Additionally you cannot hide the fact that your productivity is dropping faster than Congress’ favorability polling.
The first requirement to turn EHR infamy into fame is to halt the slide towards the EHR abyss. Publically acknowledge that productivity is in the dumpster. Think of it as an IT 12-step meeting; “Hi, my name is Paul, and my EHR project is killing us.” See, that was not so difficult. After all, everyone already knows about the productivity problem. The only unanswered question is whether or not you are going to man-up and own the problem and own the solution. If you don’t, they will find somebody who will.
Your EHR implementation broke new ground. It may be the first time that automating a task has ever made the task take more time rather than less..
And what is the problem that requires fixing? It is this. The EHR being used by your doctors and nurses was never designed, it was coded, and that distinction has everything to do with why productivity has dropped. Not a single business system designer ever researched how your EHR needed to work. Nobody trained in cognitive psychology or human-computer interaction or content strategists ever watched the doctor-patient-nurse interaction and translated those observations into design specs for your EHR. Ipso-facto, the amount of time required to complete each patient visit has increased, and since the number of hours in a day remained constant, the number of patients that can be seen in a day has decreased.
The time has come to define a plan to recover the lost productivity.
So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”
People blindly believed the hype. There is so much irrationality in every business and every IT related project. This is especially true with Americans and in industries where the collective business-technology acumen s low. As healthcare and healthIT mature this will imporve.