EHR

EHR-Shift Happens

Posted by

0

When my youngest daughter, who is also my oldest daughter was two, we had her straight-jacketed in her car seat as we headed off to run a few errands.  Cute as a button and immobile—just like the book says.  My wife had nicely fixed what was left of her hair—to our surprise, her four-year-old brother had given her a haircut the day before—with a pink beret.  As she had nothing else to do in the back seat, she toyed with the beret, eventually removing it.

After a few miles, checking on her via the rear-view mirror I noticed the beret was nowhere to be seen.  Ninety-nine times out of a hundred, that would mean she had dropped it out of reach, or tossed it to one of her invisible friends in a one-way game of catch.  I asked her where the beret was—sorry for ending in a preposition, but I have a call with a client in a few minutes and do not have the time to ensure I am writing this with the proper King’s English.

Her reply was to simply point to her mouth and giggle.  I repeated the question and she repeated her response.  Being the Super Dad; my son’s term for me, I eased to the side of the road.  We checked the floor of the car, check her car seat, and under her blankets—no beret.  We replayed the question for the third time and received the same response.  We checked her mouth—no beret.  We were hesitant to believe the charade-like communications of a two-year-old.  Nobody in their right mind would swallow a beret.  Then we started to think about the situation.  Bright, shiny, colorful things probably all look like candy to a two-year-old.

We called my sister-in-law, a pediatric nurse practitioner, and an executive at Children’s Hospital of Philadelphia.  She made it clear that we needed to head to the hospital, do not pass Go; do not collect two hundred dollars.

We drove to the ER.  They did their magic, and we were soon looking at her image of her tummy—that’s the most clinical term I know to describe the situation.  There was the beret—we could not tell if it was pink, but we were hopeful that this had to be the same one about which I am writing.

As it turns out, the problem did not lay with her ability to communicate, it lay with our inability to believe that someone without an MBA—feel free to substitute MD or PhD—could define the situation accurately.

I do not have time for a segue, so let us jump into this.  It is easy to ignore what others are saying when a bunch of acronyms a printed on a business card after the presentation of your name.  Been there, done that, too well educated for whatever opinion you may care to offer on the topic.

My docs, and goodness knows I have several of them, I trust with my life—and I have.  These same docs, I would not trust to manage the P&L of a lemonade stand.  This has nothing to do with their IQ, it has to do with their training.  They would not trust me to insert a chest-tube, even though I have watched several episodes of Life in the ER.

At some point, we need to take a hard look at who is best to do what for whom.  Acronyms, in and of themselves, do not qualify one to make business decisions, especially in a virulent environment like healthcare.  Reform, EHR, ONC, Meaningful Use, Certification.  Shift happens, and is happening.

Sometimes there is value in listening to the two-year-old.

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

CIOs, Others React To Meaningful Use Final Rule

Posted by

0

CIOs, Others React To Meaningful Use Final Rule. InformationWeek Healthcare–my comments http://ow.ly/2bS4D

EHR–where do you place the emphasis?

Posted by

0

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.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Why buy an EHR system?

Posted by

1

Do you ever wonder why people buy drills?  Because they need a drill?  No.

They buy drills because they don’t sell holes.

Why buy an EHR system? Because you need an EHR?

I hope you have a better reason than that.  If you’re interested, I sell holes.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Where workflow goes to die

Posted by

0

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.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

EHR’s Gordian Knot

Posted by

0

There were four of us, each wearing dark suits and sunglasses, uniformly walking down the street, pausing at a cross-walk labeled “consultants only”—I think it’s a trick because a lot of drivers seem to speed up when they see us. We looked like a bad outtake from the movie Reservoir Dogs. We look like that a lot.

Why do you consult, some ask? It beats sitting home listening to Michael Bolton or practicing my moves for, So You Think You Can Dance, I tell them.

Listening to the BBC World News on NPR whilst driving, there’s one thing I always come away with—they’re always so…so British. No matter the subject—war or recession—I feel like I should be having a proper pot of tea and little cucumber sandwiches with the crusts removed; no small feat while navigating the road.

Today’s conversation included a little homily about the Gordian knot with which the company Timberland is wrestling, questioning whether as a company Timberland should do well, or do good. (Alexander the Great attempted to untie such a knot, and discovered it had no end (sort of like a Möbius strip, a one-sided piece of paper–pictured above. (For the truly obtuse, among which I count myself, the piece of paper can be given a half twist in two directions; clockwise and counter-clockwise, thereby giving it handedness, making it chiral—when the narrative gets goofy enough, sooner or later the Word dictionary surrenders as it did with chiral.))) I’m done speaking in parentheses.

Should they do well or good? Knowing what little command some people have of the English language, those listeners must have wondered, why ask a redundant question. Why indeed? That’s why I love the English, no matter the circumstances they, they refuse to stoop to speaking American.

Back to Gordo and his knot. That was the point of the knot. One could not have both—sorry for the homonym. Alexander knew that since the knot had no end, the only way to untie it was to cut it. The Gordian knot is often used as a metaphor for an intractable problem, and the solution is called the “Alexandrian solution”.

To the question; Well or good. Good or evil. Are the two choices mutually exclusive? For an EHR? They need not be. The question raised by the BBC was revenue-focused (doing well) versus community or green-focused (doing good). My question to the reader is what happens if we view EHR with this issue as an implication, a la p→q.Let’s review a truth table:

if P equals if Q equals p→q is
define requirements increase revenues TRUE
play vendor darts increase revenues FALSE
ignore change management increase revenues FALSE
no connectivuty increase revenues FALSE
new EHR software increase revenues FALSE
change processes increase revenues TRUE
eliminate waste increase revenues TRUE
decrease redundancy increase revenues TRUE
Strong PMO increase revenues TRUE

From a healthcare provider’s perspective the answers can be surprising; EHR can be well and good, or not well and not good.  The Alexandrian solution for EHR is a Alexandrian PMO.

Have your people call my people–we’ll do lunch.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The EHR Certification Myth

Posted by

0

EHR certification inspectors will be dropping in on hospitals like UN inspectors looking for WMDs, only they’ll be slightly less congenial–like Kojak without the warmth.

Why is this a part of the overall plan?  Is this planned failure?  Do they have reason to believe that a certain percentage of EHRs will fail the inspection?

Of course they do.

Let’s describe two failure types; certification and Full test.  The certification test, by definition, is necessary.  The Full test is both necessary and sufficient.  It is possible to pass certification without passing the Full test.  Therefore, the Full test is a stricter test.  Build out to pass the Full test, and by default, one should pass the Certification test.

What is the full test?  Same as always.  Fully functional, on time, within budget, and user accepted.  Functional, for purposes of this discussion includes updated workflows, change management, and interoperability, and a slew of other deliverables.

Here’s what can be concluded just based on the facts.

Fact:  One-third to two-thirds of EHRs are listed as having failed—this statistic will get smaller over time.

Opinion:  The reason the failure rate will get smaller is that the failure rate will be artificially diluted by a large number of successful small-sized implementations.  Large implementations, those have far-reaching footprints for their outpatient doctors, Rhios, and other interfaces requiring interoperability will continue to fail if their PMO is driving for certification.  (Feel free to add meaningful use to the narrative, it doesn’t change the result.)

Fact:  Most large, complex, expensive IT projects fail—they just do.  This statistic has remained constant for years, and it is higher than the percentage of EHR projects that have failed.  Even a fairly high percentage of those projects which set out to pass the Full test.

Opinion:  Failure rate for large EHR projects—let’s say those above $10,000,000 (if you don’t like that number, pick your own)—as measured by the Full test, will fail at or above the rate for non-EHR IT projects.)

Bleak?  You bet.  Insurmountable?  Doesn’t have to be.

What can you do to improve your chances of success?  Find, hire, invent a killer PMO executive out of whole cloth who knows the EHR Fail Safe Points.  EHR Fail Safe Points?  The points, which if crossed unsuccessfully, place serious doubt about the project’s ability to pass the Full test.  The points which will cause success factors to be redefined, and cause one or more big requirements—time, budget, functionality—to be sacrificed.

This person need not and perhaps should not be the CMIO, the CIO, or an MD.  They need not have a slew of EHR implementation merit badges.  The people who led the Skunk Works had had zero experience managing the types of planes and rockets they built.  They were leaders, they were idea people, they were people who knew how to choose among many alternatives and would not be trapped between two.

The person need not be extremely conversant in the technical or functional intricacies of EMR.  Those skills are needed—in spades—and you need to budget for them.  The person you are looking for must be able to look you in the eye and convince you that they can do this; that they can lead, that these projects are their raison d’etre.  They will ride heard over the requirements, the selection process, the vendors, the users, and the various teams that comprise the PMO.

What do you think?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Why is EHR not the right answer?

Posted by

3

The reason I chose to share this story is my belief that it is de rigueur among practitioners.  I have been spending some of my time working on behalf of a small clinic.  Four doctors, two offices, small lab, x-rays, some surgeries.

Great people, great mission.  Every physician spends several weeks each year doing unpaid missionary work in Africa and South America.  Their focus is caring, not dollars.  It is not my job to change their focus.  They do not turn away anyone who cannot pay.  Staff at the front desk help patients pay for their meds.  The four physicians routinely offer services and perform procedures for which they know they will not be paid.  I feel a real sense of pride helping them, and have slashed my rates to make sure they get the help they need without taking money unnecessarily from their coffers.  Their patients love them, and they add about a hundred new patients a month.

The business side of their practice could have been designed by Rube Goldberg.  As I interview the doctors, the nurses, the lab, and the front desk about the practice, I try to do so with a straight face, try not to betray the part of me that wants to say, “You’re kidding, right?”

They meet with about fourteen-hundred pharmaceutical reps each year.  I tried to pin down why they do it, but could not come up with an answer to support a business reason.  Since the pharma reps can no longer offer trinkets equivalent to those needed to purchase Manhattan, they give away lunch.  Enough lunches to ensure that everyone in the practice should weigh eight-hundred pounds.

They use the F-word a lot—faxes.  Two fax machines running often enough that without proper cooling they would melt through the floor.  The average fax is handled eight times before it is placed in the patient’s chart.

There is no email, no web site.  There is no triage—docs and nurses do not screen patient phone calls to determine who needs to be seen.  Seventy-five patients a day, two and a half people are full time on billing.  Three people man—actually, it should be “woman”, the front desk.  (Is that an intransitive verb, or simply poor writing on my part?)  The staff wants more staff.

I have been hired to help them with the selection and implementation of their EHR.  I can solve the EHR problem in five minutes, but I won’t.  Having an EHR will solve none of their problems, at least not until they turn what they do into a business.

Realigning their business processes will do more for their mission than any EHR.  Processes are inefficient and ineffective.  I cannot figure out how they collect money or pay bills.

I am willing to bet they are not alone in having these issues.  I’d bet that these problems can be extrapolated to hospitals.  Is Practice Management more important to physicians than EHR?  My guess is that the right answer is yes.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Why EHR would not have worked in the 1960’s

Posted by

0

EHR, where’s my hammer?

Posted by

0

Those of you who’ve visited previously may have caught on to the fact that my wife likes to keep me away from bright shiny objects such as tools.  Let me tell you about my first house, a two-story stucco building in Denver, built in 1902.  My favorite part of the home was the brick wall.  That is had a brick wall was not apparent when I purchased it.

I came home from work to find that my dog had eaten through the lath and plaster in the living room and there was the brick.  I had to decide what to do.  I knew nothing about lathing—I know that’s not really a word—or plastering.  What to do.  My only tool was a hammer, so I began to hammer.  For those who haven’t done this, hundred year old plaster being pounded with a hammer makes a lot of dust.  This process proved to be very slow.

What did I do?  I bought a bigger hammer—such a guy approach to a problem, isn’t it?  It took three hammers to get down to just bare brick.  What would you have done?  When your only tool is a hammer every problem looks like a nail.

As you go through the EHR planning process in your war room—you do have a war room, don’t you?  (Try Sam’s Club, after all, they sell EHRs.)  Get out the really big piece of paper, the one with your EHR design—you do have a really big piece of paper, don’t you?  (Back to Sam’s.)

Next to the box on the paper labeled “Shiny New EHR” should be lots of empty space so you can draw in all of the other systems with which your EHR will have to interface.  One of the readers of this blog wrote recently that his EHR had more than 400 interfaces.

EHR, if done correctly, will do much for patients, doctors, and administrators.  It’s not a panacea.  It won’t reach its potential unless you also integrate it with those systems that unlock its potential.  Improving your efficiency and effectiveness takes more than merely an EHR system.

When your only tool is a hammer, you’d better hope every problem is a nail.  What other tools are you using?  Please share your ideas about what works well.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer