The Spandex Insecurity—the Ego has Landed

Now before you get all upset about the sexist picture, at least read a little bit of this to see why I selected it. Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my MP3. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained (McKendree Spring). Men and women. Customers and companies. Most parties will deny they are competing, yet neither will yield. The customer is always right–Turns out it makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. If anything, were you to listen to what CSRs are instructed to do for the callers and compare that with what they are instructed not to do for the callers, it’s clear that their mandate is to minimize the negative impact to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute an insurance claim?

Part 2: Are 7 sigmas 8 too many?

The worst part about being wrong in public is having an audience.  Yesterday marked the eight-and-a-half year point since my heart attack.  I celebrated with a six mile run.  Instead of hiding my car keys under the bumper like I always do, I stuck them in the pouch of my MP3 case.

I was back within the hour and in a hurry to get to my water bottle that I had locked in the car.  No keys.  After considerable thought and machinations of my considerable cerebral skills I decided to retrace my steps; all twelve thousand of them.  Still no keys.  I called my wife and she retraced my route.  No keys.

I had apparently out-thunk myself.  We called AAA to get them to make us a key, and waited—two hours.  After several failed attempts Sparkie finally unlocked the car.  I opened the door, placed the palm of my right hand on the keys, reached across the seat for my water bottle…

The keys, locked inside the car right where I had left them.  No need to worry about missing any subsequent MENSA meetings.  My wife simply gave me the look—men, you know the look.  It is the one that means I will not tear into you now; instead I will save this for when I really need it.

I threw all seven of my sigmas at solving a zero-sigma problem, looking for a complex solution when an easy one would have worked.

Patient Experience Management (PEM) solutions are often approached in the same manner—sigma overkill—reengineering some arcane, one-off process without taking time to understand the real nature of the problem or its outcome.

In yesterday’s blog we drew a comparison between clinical PEM and non-clinical PEM (http://wp.me/pyKA6-Ih).  We also inferred that non-clinical PEM processes are not unlike some of the process employed by hotels.

So, what might be done to improve non-clinical PEM?  What easy wins can be achieved?

When you arrive at a hotel for an event or an overnight stay where do you go?  You go to Reception or to the front desk to check in.  When you leave you go to the same place to check out, or you bypass the process and simply leave.  You can do that because you have been a guest of the hotel.

Now let us look at the same process at a hospital.  Where do you go?  You go to Admissions, and to leave you go to Discharge.  Other than hospitals, can you think of another establishment that uses the terms admissions and discharge?

Prisons.

Admission and Discharge are suggestive of many things, but the feeling that does not spring to mind is the notion that anyone working at the prison cares much about inmate experience management.  Admissions and Discharge do not evoke warm, welcoming feelings.  They do not lead you to feel that your stay is in any way voluntary.  In fact, even ignoring that the medical vernacular for the term discharge is often used with adjectives of color—the yellowish discharge—the term discharge infers that you do not have permission to leave until you are discharged.

Ever notice the big open space right next to admissions?  Know what it is called?

The Waiting Room.  What happens there?  You wait.  It is a special, nicely furnished place designed for you and others to do nothing, prepared for you to waste your time.

Your appointment was scheduled weeks ago.  You are probably apprehensive and a little worried about what may happen to you over the next few hours or days.  You have blocked out your calendar to be there—taken off from work, arranged for a baby sitter, and arranged for someone to prepare meals for the children while you are away.  You probably needed someone else to adjust their calendar to ensure you get to the hospital on time.  The hospital told you when to arrive.  You are there on time but someone somewhere is not ready for you.

Did they forget you were coming, or does the very nature of having a waiting room infer that their time is more valuable than theirs?  The hospital is not only okay with the idea that you will be made to wait, they have preplanned it as part of the patient experience and built a special place for that activity to occur.

This waiting experience reminds me of my flight arriving at the airport only to find out that there is no gate at which to park the plane or no attendant to roll the jet-way to the plane’s door.  How is this possible?  Have they not known for the last several months that every day at such and such time this plane will be arriving?

So, here we are.  We have not even been admitted and our non-clinical patient experience is already negative.

Sometimes the best solutions are the first ones overlooked.

Patient Experience Management: For Adults Only

This post is the first in a series that may make you rethink everything you think you know about Patient Experience Management.

Last week I checked in to a hotel for three days; seventy-two hours.  I was at the hotel for an event that required ninety minutes; one-and-half hours.

A few weeks prior to my stay someone told me where I had to be, how long I would be there, and what I would be doing.  My reservation was made, and I sorted out how I would get to the hotel.

The check-in process was flawless.  My room was ready.  My wakeup calls were timely. The room was serviced daily.  Plates with food arrived.  Plates without food departed.  The requirements for my ninety minute event were met and I was escorted to the correct room.

On hour seventy-two I checked out of the hotel and I received a copy of my bill.  The last thing I encountered was having someone asking me how my experience was.

Try thinking the remainder of this discussion through with me.

Of the seventy-two hours I was at the hotel only two percent of it (1.5 hours) had to do with my reason for being at the hotel—the presentation I was giving at the HFMA.

So, you may ask, how did it go?  The speech or the stay at the hotel.  Two different experiences.  Let us say that my speech tanked, or that people couldn’t find the room, or that the projector did not work.  If someone asked me, how “was your speech,” I might conclude by saying, “The speech was awful, but the hotel was great.”

On the other hand, what if the hotel lost my prepaid reservation, was only able to give me one night instead of two, made me sit in the lobby for two hours because my room wasn’t ready, could not get the air conditioning working in my room, and then billed me for two nights instead of one.

If that was the case I would conclude that my experience was awful, and I would go out of my way to let everyone know about it.

To those who want to argue that a hospital is not a hotel I will concede the point.  However, I will argue that for those who actually wish to significantly improve patient experience management that much of the improvement can be made by treating it as a hotel, and by treating your patients as guests.

For the time being, let us agree to have this discussion separate and apart from the Emergency department—we will address the ED in a later post.

The patient experience, which many claim to be managing, may be grouped into two parts—the treatment, and then everything else that happens to you from the time you schedule your visit to the time when you finish paying you bill.

Most patients fully expect their experience of their treatment will be very positive—that is why they came to the hospital.  Patients know that for treatable issues they will leave the hospital better than when they entered.  Therefore, it is a given that they will rate their treatment experience as a positive one.  A positive treatment is considered de rigueur.

However positive, the patient often views their treatment experience as the result of the procedure they underwent.  If they came in for their gall bladder and leave without their left leg, no amount of explaining how well the amputation went will convince them their experience was positive.

Both inpatients and outpatients spend the bulk of their time in the hospital undergoing non-patient experiences and suffering through ineffective and impersonal processes.  All patients spend most of their time simply as visitors, as customers, as guests of your facility.  Unfortunately, few hospitals spend much time improving those processes that are common to all patients.

To improve in the area of patient experience management, break the person’s experience into two categories; clinical and non-clinical.  While there is merit in reengineering the processes around a hip transplant, doing so does nothing for everyone who did not have a hip transplant.

Over the next several posts I will suggest what can be done to improve the non-clinical patient experience in a way that can change how people view your hospital.

Patient Experience Management

Have I mentioned I am an unapologetically type A person, for the most part an off the chart Meyers Briggs INTJ? This morning I awoke feeling no more querulous than usual—that would change rather abruptly. In general, I make it a rule never to learn anything before having my first cup of coffee. Unfortunately, today wasn’t going to be one of those days. In fact, my mood was a direct result of the instrument pictured above.

These days I am using this device to make my coffee as my espresso maker’s LED screen is displaying a message telling me my grinder is blocked—sounds a little like something two tablespoons of Pepto should be able to fix, doesn’t it? Google was no help—three hits, each instructing me to send it back to the dealer for a $350 repair. Sounds more like a response you’d get regarding a car, not a coffee maker.

I brought this pot home, a gift from my client in Madrid. It works using the same principles as a pressure cooker. Water is placed in the bottom; an espresso grind goes above the water.  Steam is forced through the grind, past a metal sieve, and into the container where as it cools it is reconstituted as a liquid—coffee. Anyway, as my coffee is cooking, I notice the metal sieve sitting on the counter. It seemed like too much work to turn it off, rinse the pot, regrind the coffee, and wait the additional five minutes. I was too tired for a do-over.

Too bad for me. Now, I’m not sure if what happened next would be found under the topic of fluid mechanics, converting steam into thermal energy, or general explosives, but it would have made for an entertaining physics experiment. In what appeared to play out in slow motion—like the Challenger explosion—actually occurred in a fraction of a second. It seems the metal sieve does more than strain the grinds from the steam. It also prevents a thermonuclear reaction. Apparently when the pressure passes the fail-safe point, the reaction proceeds to the next logical step. That step, which I observed, involves coffee and grinds exiting the pot so rapidly that before I could blink they covered the kitchen walls, counters, and floors as far away as ten feet. (It was actually pretty impressive to watch.) I was informed that once I finish writing about my travails I will be attending to the mess.

The scene reminded me of one of the forensic shows on cable. I halfway expected the medical examiner Dr. Henry Lee to walk through my door to examine the splatter pattern.

The choice I faced was to do it over, or deal with the consequences. I was in a hurry, consequences be damned—it turns out that it wasn’t the consequences that would be damned. My guess is that I’m looking at at least thirty minutes of cleanup work.

It pays to invest the time to do something right the first time—I refer to that as the DIRT-FIT principle; sort of like dealing with patients. Let’s say a certain patient call takes nine minutes to handle correctly. As many of you have observed, there are two ways to go about this. You can do it over a period of several four minute calls because your people don’t want to get dinged for exceeding their handle time allotment, or you can allow the people to talk until the patient’s need is solved.

As patients, we know you prefer the first approach. Patients prefer the second approach.

The Patient as Customer

The headline for a recently published McKinsey survey stated “Ninety percent of hospital CEOs ranked Patient Experience Management (PEM) as their first or second priority over the next three years.

Buried deep within the article was a throw away statement that little will be done regarding PEM because nobody knows who owns the patient.

Any journalism student worth their salt would tell you the real headline for the survey should read something like “Ninety percent of hospital CEOs and COOs do not know who owns the patient at their hospital.”

From a business perspective, in the conversation about patients and PEM one thing is always overlooked.  These people, the patients, also have a business avatar.  They are also customers.  PEM from a business perspective focuses on all the non-clinical aspects of the patients as a customer.

There are dozens of non-clinical processes that affect each customer (patient)—admissions, discharge, billing, scheduling, disputes, claims…

Many of these processes are ineffective and inefficient.  Many are redundant and duplicative.  Many add more cost than value.

If you want to improve the patient experience, look first at these.  You will be surprised by how much better your organization will be perceived.

When Patients Rule: Crowdsourcing & S-CRM

The one application of crowdsourcing that is most overlooked is one which hardly fits the definition. This type is not premeditated. It is the type where the “machine” is a means to an end, and it does not originate at the organization. In fact, the organization is the target of this type of crowdsourcing—Social-CRM.

Most definitions of crowdsourcing include the notion of a call going out to a group of individuals who are then gathered via the call to solve a complex problem, acting like a shared problem solving methodology, much like the theory of Law of Large Numbers.

The crowd is likely to have an upper limit in terms of the number of members. By default, traditional crowdsourcing is fashioned to work from the top down; it is outbound, a push model.

Social-CRM (S-CRM) tends to work from the bottom up. There are no boundaries to the number of members; in fact, there can be thousands of members. Also atypical is the fact with S-CRM no single event or call to action drives the formation of the crowd. The crowd can have as many events as it has members.

The unifying force around S-CRM is each member’s perspective of a given firm or organization. Members are often knitted together by having felt wronged or put-off by an action, product, or service provided or not provided by said organization. Most organizations do not listen to, nor do they have a means by which they can communicate with the S-CRM crowdsource. This in turn causes the membership to grow, and to become even more steadfast in the individual missions of their members.

In traditional crowdsourcing, once the problem solving ends, the crowd no longer has a reason to exist, and it disbands. With S-CRM crowdsourcing, since the problem never seems to go away, neither does the crowd.

Every firm has one or more S-CRM groups biting at its ankles, hurting its image, hurting the brand, causing customers to flee, and disrupting the business model. Even so, most organizations ignore the S-CRM crowd just like someone ignores their crazy Uncle Pete who disrupts every family gathering.

Patient Experience Management (PEM): Left Brainers, Right Brainers, and No Brainers

Sometimes I feel a little like the ambassador from the planet Common Sense, and unfortunately very few of us speak the same language. Let’s see if we can segment the Patient Experience Management (PEM) population into left brainers, and right brainers. I am wrestling with an issue that I believe is a no-brainer.

One point, upon which both sides seem to agree, is that without the patients, PEM would be superfluous. The breakdown is that for a hospital to flourish in the long term, hospitals should re-engineer their business processes to facilitate the dissolution or substantive reduction of traditional customer service.  This extends beyond the cordial relationship of a nurse or a doctor and their patients in hospital beds.

In many, if not most instances, the very existence of traditional customer service provides a vehicle which acts as an enabler for failure. It gives hospitals permission to be mediocre in dealing with their interactions with their patients and physicians. In effect, traditional customer service is a tacit admission to the employees and the patients, “We don’t always get it right. We don’t always do our best.

Before deciding not to read further, ask yourself a few questions. The purpose of the questions is to try and articulate a quantifiable business goal for customer service, PEM.

1. Does customer service have planned revenue targets
2. Does it have its own P&L?
3. Does it have a measurable ROI?
4. What is the loaded cost for each patient and doctor interaction?
5. Could the costs of those interactions be eliminated by fixing something in operations?

If the answers to 1-3 are no, the answer to 4 is unknown, and the answer to 5 is yes, your hospital inadvertently made the decision to ignore revenues and to incur expenses that provide no value to your organization. I believe this premise can be proved easily.

The careers of many people are directly tied to the need to have customer service and call centers. Big is good. Bigger is better. Software, hardware, telecommunications, networks—more is better. Calls are the lifeblood of every call center. Without those calls, the call center dies. Calls are good, more calls are better.

When was the last time you were in a meeting when someone said something like, “In the last three years our patient call volume has continued to increase,” or, “Calls have gone up by forty percent.” That part may sound familiar. The phrase nobody has heard is, “We can’t continue to add that many calls.” Tenure and capital. That part of the business is managed with the expectation that the number of calls will continue to grow. And guess what? It does. How prophetic is that? Or is it pathetic? You decide.

Given that, how does the typical healthcare provider manage their customer service investment? Play with the numbers. In many organizations, if customer service management can show that patient satisfaction is holding steady, no matter how bad it is, and they can use the numbers to show that some indicator has moved in a favorable direction, other areas of the business are led to believe that customer service is performing well.

Memo to those executives who are authorizing customer service expenditures—I want to make sure there is no mistaking how I view the issue. If that is what you are hearing from your customer service managers, they either don’t understand their responsibility, or they understand it and they don’t want you to understand it.

To be generous, if patient satisfaction with regard to customer service is below ninety-five percent, your customer service is in serious need of a re-think. Just because patient satisfaction is not tanking faster does not mean customer service is functional.

Most executives know how to get numbers to paint whatever picture they need to paint. Beware the sleight of hand. Any time the customer service manager comes to you and says he is improving operations by reducing the average amount of time someone spends on the phone talking to a patient (average handle time), don’t believe anything else he tells you. Allow me to translate. When the customer service budget is tight (too many interactions and too few people with which to interact) the way to make it fit the budget is to make your people end the call quicker. Shorter calls mean more calls per hour. Note—speed buys you nothing, except for more repeat calls, less resolution, less patient satisfaction. It’s a measure of speed—IT IS NOT A MEASURE OF ACCOMPLISHMNET.

I’d be willing to bet that somewhere between twenty-five and fifty percent of calls from your patients and physicians can be addressed better via a combination of social media and the Internet.

Patient Experience Management as healthcare’s Watergate

Below is the text of my article in Hospital Impact.

Patient Experience Management as healthcare’s Watergate

March 9th, 2011

by Paul Roemer

For the second straight year, HealthLeadersreports that Patient Experience Management (PEM) is one of the top three priorities for healthcare executives. A McKinsey study of 1,000 executives showed that for 90 percent of executives it ranked first or second.

Those results put my mind at ease on the issue about as much as Iran’s Amadinejad claiming its nuclear efforts are only targeted at improving the yield of their turnip harvest.

Recall the tagline of the McKinsey study–none of the executives knew who actually owned the patient experience, so little was planned for addressing this priority. However, several hospitals were expected to offer more heart-healthy alternatives in the basement cafeteria–I love strong leaders. Be on the lookout for the Amadinejad Turnip-Melt.

[More:]

Anyway, I digress.

Healthcare’s Watergate. Follow the money. Yet, there is no money to follow in two key areas, at least not an amount that suggests hospitals view either area with the same degree of import with which they speak to them. What are they?

  • Patient Experience Management (outflow)
  • Our old friend, Meaningful Use (inflow)

Missing is the planned expenditure that would come even close to making Patient Experience Management a priority. Don’t believe me? Print out a copy of your organization’s strategy, its budget, or its general ledger, and sort all of the planned expenditures from greatest to least. Stop reading when you reach the line item for Patient Experience Management.

Meanwhile, I am going for a run. If you find it before I return, wait for me, but you will not have found it by then.

You did not find the dollar amount budgeted for PEM did you?

Just to stay consistent, there is not much of a Meaningful Use windfall flowing out of CMS and into your neighborhood healthcare services provider either.

In general, money for what seem to be very high operational priorities is dribbling along so slowly so as to suggest these initiatives had prostate problems in the offing.

In addition to the fact there was no booth at HIMSS to showcase the most singularly spoken of topic, Meaningful Use, there was also no booth on Patient Experience Management. There was not a single PEM vendor. Why? Because the vendors know PEM, for now, is a unicorn-like ACOs–and nobody has ever seen a unicorn, so why bother trying to sell unicorn horn polish?

By the way, I need to borrow five chairs for a group photo I am taking of everyone eligible to receive Meaningful Use rebates.

Paul Roemer, MBA, is a healthcare strategist and Managing Partner of HealthcareITStrategy.com. Paul has more than thirty years of management consulting experience, starting with the Big 4 where he held national leadership positions, and the last fourteen years with his own international consulting firm. He has a passion for how we will live and function in the rapidly changing world of healthcare, and how information technology must provide for and help manage the change. He wrestles with how to turn the lack of information of what the business of healthcare will become, the lack of understanding of the issues, and the general lack of knowledge of the future into decisions we can make today to shape tomorrow. Paul has earned a presence on the national healthcare stage through his futuristic thought leadership, and is a recognized speaker and writer on a number of strategic healthcare issues.

Taking Care of Patients (TCOP)–the business side

That’s me in the back row–just kidding. There are approximately 640 muscles in the human body. Yesterday I pulled 639 of them. In anticipation of the onset of winter I’ve been ramping up my workouts, and at the moment am scarcely able to lift a pencil. I came across an article that describes the full body workout used by the University of North Carolina basketball players. It involves a ten-pound medicine ball, and 400 repetitions spread across a handful of exercises. I’m three days into it and giving a lot of thought about investigating what kind of workout the UNC math team may be using. At my son’s basketball practice last night, the parents took on the boys—they are ten. That 640th muscle, the holdout, now hurts as bad as the rest of them.

So, this morning I’m running on the treadmill, because it’s cold and the slate colored clouds look heavy with rain. While I’m running, I am watching the Military History Channel, more specifically a show on the Civil War’s Battle of Bull Run—I learned that that’s what the Yankees called it, they named the battles after the nearest river, the Rebs called it the Battle of Manassas, named after the nearest town. The historian doing the narration spoke to the wholesale slaughter that occurred on both sides. He equated the slaughter to the fact that military technology had outpaced military strategy. The armies lined up close together, elbow to elbow, and marched towards cannon fire that slaughtered them. Had they spread themselves out, the technology would have been much less effective.

Don’t blink or you’ll miss the segue. You had to know this was coming. Does your hospital have one of those designer call centers? You know the ones—wide open spaces, sky lights, sterile. Fabric swatches. The fabric of the chair matches that of the cubicle, which in turn are coordinated with the carpeting. Raised floors. Zillions of dollars of technology purring away underfoot. We have technology that can answer the call, talk to the caller, route the caller, and record the caller for that all important black hole called “purposes of quality.”

The only thing we haven’t been able to do is to find technology to solve the patient’s problems. Taking Care of Patients (TCOP), also known as Patient Experience Management (PEM).  We’ve used it to automate almost everything. If we remove all the overlaying technology, we still face the same business processes that were underfoot ten years ago. Call center technology has outpaced call center strategy. Call center technology hasn’t made call centers more effective, it’s made them more efficient. Call center strategies are geared towards efficiencies. Only when we design call center strategies around being more effective will the strategy begin to maximize the capabilities of the technologies.

 

Patient Experience Management: How to begin

Here is my new post on http://www.healthsystemcio.com

Patient Experience Management (PEM) is not about Patients, but it is often designed just that way.  The problem lies with the plurality, the pesky little “s” that takes the design and implementation away from an individual patient, and places the focus on patients.

Other industries grapple with the same problem, only with them the issue comes about when designing and implementing systems and processes around customers instead of a customer.

Do you recall the talking points of the recent McKinsey survey about patient experience management?  The study made drew two conclusions.  First, ninety percent of hospital executives responded that improving PEM was their first or second priority within the next three to five years.  Second, those same individuals stated they did not expect much to happen regarding PEM because they did not know who in their organization ‘owned’ the PEM business problem.

Ignoring that issue, if only for the reason that almost everyone else seems to be taking the same approach, what if a hospital wanted to move forward and deal with PEM in a meaningful way—not meaningful as in the term Meaningful Use—but in a way whereby having a PEM system actually yielded something for the hospital?

Few industries have done a stellar job with Customer Experience Management (CEM).  What can be learned from their failures?  Plenty.  The failure of CEM systems originates at the get-go. The organization does a poor job of defining its business problem, deciding it needs a system to manage its customers, as though all customers are the same.  With that as its target, it goes out and finds and implements such a system.

Here is the problem from the perspective of PEM, and in some regards for EHR.  Whatever system you choose for PEM, CEM, or for that matter EHR has been designed to address thousands of individuals as a single entity called “our patients” or “our customers.”  The system is build upon managing the experiences of a core set of patient attributes.  Chances are good that whatever PEM system you select—they really are pretty much the same—will address roughly seventy percent of the functional requirements of this entity called “our patients.”

Applications vendors build solutions and hope to find a problem which matches the system they built.  If all your individual patients fit neatly into their vision of this “our patients” entity your worries are over.  If however, patients are different, which they are, they will have many needs which lie outside of the boundary of their application.  It is these set of needs—functional requirements—upon which the success or failure of your PEM will be based.  These same needs are the ones that are unmet today.  These are the ones, the outliers, which raise the ire of your patients and the ones lowering your organizations PEM scores; assuming you track this.

One way to solve this problem, in fact, to my knowledge to only way is to start by defining rigorously the functional requirements of one patient, a super-patient, which encompasses every requirement.  With this done, you have a PEM model, based on a single patient.  Now instead of having PEM requirements which lie outside of the boundaries or core competencies of what a vendor wants to sell you, you have a turbo charged set of requirements.  The diverse PEM requirements of your individual patients are contained within the capabilities of the defined super-patient.

If you approach PEM this way you have defined for yourself a solvable problem.  You now have a problem looking for a solution instead of a vendor with a solution looking for a problem.