Somehow, my social media article healthsystemcio.com made the top story of Chime Healthcare CIO SmartBrief. http://ow.ly/2snrU
Not bad for a metaphorical tomato thrower.
Thanks for playing along.
change management
Failed EHRs: Maybe it’s the jeans
There I was listening to NPR while driving home from the airport. Their lead story was about Levis’ announcement of a new line of custom-fit jeans for women. They developed the line after studying the shapes of more than 60,000 women—I guess that is good work if you can get it. Levis somehow determined that 80 percent of all the women on the planet fall into three distinct categories, Curve IDs. (Does that mean the other twenty percent fall into roughly 3,752,841 body types?)
Why did Levis go through all this effort? Apparently 87 percent of women say they can’t find a pair of jeans that fits them. Fifty-four percent stated they try on at least ten pairs of jeans before deciding on a pair. I concluded from a few of the things I read on Google that for those whom believe the jeans don’t fit—must be a lot of bad jeans out there.
There are a lot of failed EHR implementations out there. How do I know that to be true? I studied the shapes of more than 60,000 failed EHR implementations and, guess what? They fall into three failure categories—EHR Failure IDs—lack of due planning, lack of process change, and lack of user involvement. I guess it’s difficult to get an EHR to fit…Kind of like finding a good pair of jeans.
Here’s my take on the matter. Chances are that whatever EHR does not seem to fit in Provider A is fitting just fine at Provider B. How could that be? Same system. Same code. The functionality of the system has not changed in the time since it was selected. Maybe the reason the EHR does not fit is not the fault of the EHR.
That said, there are those of you who think I may tie this discussion back to the discussion of the jeans, and write something like, “Maybe the reason the jeans do not fit is not the fault of the jeans.” I may be dumb, but I am not that dumb.
Kind Regards,
Paul
Paul M. Roemer
Managing Partner, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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My thoughts on “One EMR Vendor’s View of Meaningful Use”
What if Meaningful Use turns out to be no more relevant to EHR than agriculture is to bull fighting? Even worse, what if meeting Meaningful Use (MU) damages a provider’s business?
There is a world of difference between EHR and Meaningful Use. It is a square and rectangle proposition. All instances of MU require an EHR. However, all EHRs do not require MU.
When I evaluate changing a business strategy, I like to do so under the following test:
- Is it necessary?
- Is it sufficient?
For the strategy to be beneficial to an organization it must be both necessary and sufficient.
Let us begin with whether MU is necessary. Necessary for what—to make the provider’s caring for its patients better; to make their business better. MU does neither. Implementing an EHR, though it is optional, is important. So is meeting MU. The last time I checked, there were no long queues in Madison to grab an EHR, and no people camping outside of the CMS offices to be first in line for the ARRA money. MU does not pass the test of necessity.
Does MU pass the test of sufficiency? Is it adequate? Again, for what? The way to answer this question is to ask, “How would your organization implement EHR if MU did not exist”? your answer to this question defines what is necessary.
Much of MU has to do with how EHR is implemented and adopted. For all the attention vendors are paying to MU, it is a bit nonsensical. Most of the onus on MU is tied to the provider. The most the vendor can offer is that they will not do anything to encumber a provider’s chances of meeting MU. Many of these vendors are the ones who will require you to implement an upgraded version of their product in order to meet certification.
In closing, will the MU money run out? On the contrary, I think they will not be able to give it away.
How to Revive a Failed EHR Implementation
My latest post on www.healthsystemCIO.com. Here’s an idea I think merits consideration.
http://healthsystemcio.com/2010/07/30/how-to-revive-a-failed-ehr-implementation/
What do you think?
Finally, an EMR worthy of a T-shirt
Those who are regular readers know I’ve commented on more than one occasion that you never see anyone at the HIMSS convention walking around wearing a T-shirt imprinted with the slogan, “I love my EPIC”, or one stating, “McKesson forever”–unless they were talking about the implementation plan.
Today, my perspective changed–I’m going to start selling T-shirts printed with the phrase, “SRS-Soft Rocks my Docs.”
You may ask, ‘Who is SRSSoft’? Fair question. I could not have given an adequate response to that question prior to today.
I spent some time with them, ran their demo–I played doctor but they stopped me before I was able to insert a chest tube. I ran the demo. Why is that important? It went like this.
“So, if you were a doctor, what would you do?”
With enthusiastic anticipation, I searched for my scalpel–that wasn’t what he meant. “I’d see who my next patient is.”
“Do it.” (Mind you, all of what I am doing happens on one screen faster than a sneeze.) I clicked the schedule and up popped all the patient’s information.
“Next?”
“I’d probably want to review their chart.”
“Do it.” (Don’t try this at home unless you are a devotee of Scrubs or other medical training.
Same screen, up pops the chart.
“Next?”
I click on the notes from their last visit, compare their labs by pulling up a comparison chart–new versus old; scan the X-RAY, and review their list of medications. I did this all on one page and figured out in less time than it took you to read this. We did the demo using two screens. That way, if I am describing what I am seeing to the patient on their X-RAY, instead of holding the film up at the ceiling and hoping my patient understand what I am talking about, I point to it with my mouse and let the patient see it one their screen.
Tomorrow I was going to issue an EHR RFP for a small clinic. Not any more. No point in having them pay me to hunt down a solution when I’ve already found one. Did I mention you can also get it with a world-class practice management system?
So what makes me think this EMR can handle a practice size of up to a few hundred doctors? Let me try to summarize its benefits with the following. If we separate healthcare into two arenas–the business of healthcare (the business side) and the healthcare business (the clinical side)–this EMR is so well designed, it makes the mundane business tasks almost invisible to the doctor. Instead of spending twenty percent of each day moving charts, filling out forms, sending faxes, dictating and transcribing notes, the clinical team can either spend more time with their patients or see more patients.
Now, let me tell you about their secret sauce, part of what makes it so special. You are going to think I’ve lost my mind when you read this.
One of the first questions most doctors are going to ask a vendor is whether or not the system is certified. (Do not repeat this to anyone–that is why I am writing in parentheses–this system is not certified. They have no plans to get it certified.) Why? Because certification is as relevant to the value of an EMR as agriculture is to bull fighting. Certification will not improve care, will not enhance the doctor patient relationship, it will not improve the patient experience, it will not increase productivity. Certification does one thing. It enables you to get a check provided that your EMR implementation does not fail, provided that you pass the Meaningful Use audit, and provided you are willing to upgrade your existing system to your vendor’s new and improved certifiable version. That certifiably makes little to no business sense.
Anyway, if you want a system that makes the stuff you hate doing go away, take a look at this.
I’ve also written about way hospital EHRs fail. A big reason for their failure is the drop in productivity they experience, and a lack of acceptance from the doctors. Sort of makes me wonder if they could use this tool as a front-end for those big pricey EHRs.
Me, I printing T-shirts. PayPal accepted.
The Services We Offer
What we have here is a failure to communicate, and unfortunately the failure is mine.
It has been a week of learning. According to one of the thought leaders in healthcare, whom I’ve known for more than a year, he does not understand what services my firm offers hospitals, and he thinks others may have the same problem.
He suggested it would be helpful to spell it out, service by service. So here goes.
Program Management:
We work with hospital CIOs and COOs as their advocate by serving as the program management officer (PMO). We define functional requirements, select software, and manage IT applications vendors for enterprise applications like EHR, CRM, and ERP.
Operational Efficiency:
We work with the hospital C-suite to identify, define, and implement a unique set of business processes and business rules, eliminating duplicated processes and those which do not add value. The output is a single set of best practices processes and rules.
Change Management:
Enterprise applications will alter business processes and impact most employees and patients. Without a rigorous change management effort, the impact of the application on the hospital’s processes and people will be a disaster. We figure out what must change, how it will change, and how to pull it off.
Patient Relationship Management (PEM):
This is the hospital equivalent of Customer Relationship Management (CRM). On a PEM project we define the requirements, select an application vendor, define the processes, and manage the project to completion.
Please let me know if you need help with any of these.
EHR 2 a-days
It’s hot and muggy; a hazy pall seems to levitate before me. We call it Pennsylvania in summer. Chest pain yesterday, nitro in gym bag. Intervals today. I hate running intervals as much now as I did in high school, but they’re better for the heart than just running distance. Twenty-four 110’s. Did I mention it was hot?
I am on the high school track. The football team is/are—where are all the English majors when you need them—going through their drills. Running and thinking. That’s a good combination for me. After two laps I’m glistening, after three I’m soaked through. That’s when it hits me.
Practice. Offensive and defensive drills. Blocking and tackling. Run the option. Block the punt. Come back tomorrow and do it again. Do it until you get it right. Do it until you can get it right in the game. Pretty neat idea all this practicing.
Know where this is headed? See, that wasn’t too difficult—remember, the desk is hard, the task is difficult. (My one takeaway from eighth grade English.) Who doesn’t get to practice, doesn’t even have a coach? Bingo, the EHR Project Management Executive. It would be better if they did. Imagine this conversation:
“Sorry Charlie, hit the showers.”
“Why Coach?”
“Your change management isn’t working for you today. You’re leaving processes untouched.”
“It was the docs’ fault. They just toy with me. Treat me like a wonk and tell IT jokes behind my back.”
“Your game plan is coming apart.”
“But I didn’t get to practice, we didn’t even get to warm up. I’ll do better next time.”
“Which next time is that Charlie? With whose money? These are The Bigs, Charlie. Only grownups play here. I’m afraid I’m going to have to send you back down to Single A.”
“Private practice.?”
“Sorry Charlie”—sounds like the tuna commercial.
You’ve got one shot at this, no warmups, no practices; there are no do-overs, and you are gambling millions. DIRT-FIT Do It Right The FIrst Time
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
EHR–where do you place the emphasis?
You said I stole the money. Sometimes it all depends on what you emphasize. For example, say the sentence aloud to a friend, and each time place the emphasis on a new word. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. The meaning changes as you change your emphasis. You said I stole the money? You can even change it so that it reads like a question.
The same is true with providers and the level of success a firm has working with EHR. Where is your emphasis? If you believe there is a correlation between emphasis and spending, I bet we can prove your firm’s is much more closely aligned to technology than it is to process. What does technology address? Let’s list how deploying technology makes your firm better, or does it? Millions followed by millions more. Redesign the patient portal. Add EHR. Mine the data—heck, strip mine it. Show me the ROI. Isn’t that a lot of money to spend without a corresponding business justification?
The technology that is tossed at the problem reminds me of the scene from the “Wizard of Oz” when the Wizard instructs Dorothy and the others, “Pay no attention to the man behind the curtain.” When Toto pulls the curtain aside, we see a nibblet—I love that word—of a man standing in front of a technological marvel. What’s he doing? He’s trying to make an impression with smoke and mirrors, and he’s hoping nobody notices that the Great Oz is a phony, that his technology brings nothing to help them complete their mission.
From whose budget do these technology dollars usually come? IT. From the office of the CIO. What did you get for those millions? Just asking.
Part of the problem with doing something worth doing on the EHR front is that it requires something you can’t touch, there’s no brochure for it, and you can’t plug it in. It’s process. It requires soft skills and the courage to change your firm’s emphasis. They won’t like doing it, but they will love the results.
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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Where workflow goes to die
There are two types of business processes; easily repeatable processes (ERP), and Barely repeatable processes. Most of the real work that needs to be done in EHR workflow improvement happens in the blank white space between the boxes on the org chart. That’s where you’ll find a lot of the BRPs–Barely Repeatable Processes.
It is easy to automate the ERPs, and nearly impossible to automate the BRPs. If you can’t reform either set of processes with your EHR all you have implemented is a very expensive chart scanner.
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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Contact me: paulroemer paulroemer paulroemer
July is “take your EHR strategy to lunch month”
Several have written suggesting I toss my hat into the ring to serve as the EHR Strategy wonk or czar. I was in the process of thinking it through when I was awakened from my fuegue state by a loud noise–my ego crashing to the floor.
Some have suggested that a camel is a horse designed by a committee. Their point in saying that has something to do with how committees function less well than individuals–the problem with “group thinking.” Personally, I think the camel design seems rather functional.
Some have asked, what is it about the EHR universe that has you dehorting the EHR process as though you are some sort of savant–nobody really asked that, but I wanted a segue and that’s all I came up with.
It’s the committees. I feel a little like Quasimodo repining about the bells. Raise your hand if you are on an EHR committee. See? Now, if you think that not only has the committee not accomplished much, but believe that it may never accomplish much, lower your hand. Now look around. Not many hands still up.
Please take a look at this for a moment. Don’t try to understand it–it will only make your teeth hurt.
2011 requirements
- For hospitals, 10% of all orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) directly entered by an authorizing physician must be made through a computerized physician order entry process. Individual physicians still must use CPOE for all orders, even if electronic interfaces with receiving entities are not available. The initial draft did not specify the required percentage for hospitals and did not address the electronic interface issue.
- Physicians must be able to check insurance eligibility electronically from public and private payers, when possible, and submit claims electronically. This was not in the initial draft.
- Patients must receive timely electronic access to their health information, including lab results, medication and problem lists, and allergies. The initial draft did not include the word “timely.”
- Physicians must implement one clinical decision rule relevant to specialty or high clinical priority. This was not in the initial draft.
- Physicians must record patient smoking status and advance directives. This was not in the initial draft.
- Physicians must report ambulatory quality measures to CMS. This was not in the initial draft.
- Physicians must maintain an up-to-date list of current and active diagnoses based on ICD-9 or SNOMED. The initial draft did not specify use of the two classification sets.
2013 requirements
- Specialists must report to relevant external disease or device registries that are approved by CMS. This was not in the initial draft.
- Hospitals must conduct closed-loop medication management, including computer-assisted administration. This was not in the initial draft.
- All patients must have access to a personal health record populated in real time with health data. This was moved up from 2015 in the initial draft.
Additional provisions
- Patients’ access to EHRs may be provided via a number of secure electronic methods, such as personal health records, patient portals, CDs or USB drives.
- CMS will determine how submitting electronic data to immunization registries applies to Medicare and Medicaid meaningful-use requirements.
- CMS may withhold federal stimulus payments from any entity that has a confirmed privacy or security violation of the Health Insurance Portability and Accountability Act, but it may reinstate payments once the breach has been resolved.
Source: Health IT Policy Committee
See? Take a few minutes and work this into your EHR task time-line for processes, work flows, change management, training. Need more time? I’d need more time than I have, and when I finished I guarantee I couldn’t explain it to anyone. This is what happens when people get into a room, have a charter, and try to do something helpful. I am sure they are all nice people. But be honest, does this make your day, or does it make you want to punish your neighbor’s cat–you may have to buy them a cat if they don’t already have one.
What to do? Here’s my take on it. Plan. Evaluate the plan. Test the plan. Know before you start that the plan can handle anything any committee tosses your way. Let people who know how to run large projects into the room. Seek their counsel, depend on them for their leadership. If the plan is solid, the result has a better chnace of surviving the next committee meeting
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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Contact me: paulroemer paulroemer paulroemer
Pale Rhino Consulting 