EHR

Video Game Theory applied to Healthcare IT

Posted by

0

My twelve-year-old son overheard a conversation I was having about EHR, Meaningful Use, and ICD-10, and I watched his eyes glaze over.  So I tried to explain it to him in terms I thought he might understand.  Maybe this explanation is the one I should have used with my client.

John and Sally have a thousand dollars in the bank.  They pool some of their money and have a hundred dollars to spend on video games.  The game they really want, Project From Hell, costs sixty dollars.  About half the people who play Project From Hell never make it to the end, and never get the chance to claim their prize.  It takes two years to play, and one or both of them could be eliminated from the game for failing to play well.

The second game is a take-off on Faust, Sell Your Soul to the Devil.  To play this game, you must first beat Project From Hell.  Sell Your Soul costs thirty dollars.  However, the upside is that if you win, which is not very likely, you can earn two dollars.

The third game, Bet Your Savings, is the most intriguing.  All kids who have a computer must play Bet Your Savings, which costs thirty-five dollars.  The way Bet Your Savings works is that if you do not play, or if you play and lose, ten percent of the money in your bank account disappears.

I asked my son which games John and Sally should buy.  He said if they bought Project From Hell and Sell Your Soul, they would only have ten dollars left, and that the reward from Sell Your Soul, two dollars, was not worth much.  He also noted they do not have enough money to buy all three, and that since Bet Your Savings was mandatory, unless John and Sally wanted to automatically lose ten percent of their savings, they must choose Bet Your Savings.

He decided they should buy Project From Hell and Bet Your Savings.

By now you have figured out the Project from Hell is your EHR, Sell Your Soul is Meaningful Use, and Bet Your Savings is your ICD-10 initiative.

Resources are scarce.  Do you have enough money to do Meaningful Use and ICD-10 correctly?  Many hospitals do not, and yet they are charging full tilt at meeting Meaningful Use to possibly net a few dollars.  Many hospitals have not invested enough to meet ICD-10.

Where should you place your limited resources?  If you are still confused, feel free to ask my son.

 

EHR: Puppy Training Your Vendor

Posted by

0

To ensure we take an accurate look at the provider-vendor relationship, we must be willing to acknowledge that healthcare providers are from Mercury and the EHR vendors are from Pluto.  They exist in different orbits, and their business models are very far apart—they never intersect; not in space, and not on your project.

1. Have your own inside expert. Don’t rely on the vendor to tell you what you should be doing.  Never.  Ever.  Unless of course you think the vendor knows more about how you want to run your hospital than you do.  Remember, you select them—not the other way around.

Bringing a vendor into your hospital is a lot like bringing home a new puppy. Both need to know who runs the show. Don’t roll over.  They may not be looking to be led, but if you don’t lead them they will lead you.

You should have the expert on board at the outset, before you select the EHR vendor.  The expert should be your advocate.

2. Establish a specific executive liaison with your vendor.  This is not your new tennis partner.  This should be the person who has the authority to ensure your quantifiable wishes are being met, and whose responsibility it is to deliver the message to his troops, and marshal the resources necessary to get the job done.

3. Specify your contractual objectives. Ensure that the contract is aligned with the clinical and business objectives of the healthcare organization, not the vendor.  Before you can accomplish this, you have a lot of work to do with your team.  You must define your clinical and business objectives.  Often these two groups also have a Mercury and Pluto relationship.  Once you have these, your next task is to deliver these objectives to the vendor and have the vendor tell you in writing what they will meet, what they might meet, and what they can’t meet.  It would be nice to know these before you sign their contract.

4. Involve more people than just the IT staff. Need a rule of thumb, involve as many users as IT people—Mercury and Pluto.  You will need new processes, not just to squeeze an ROI from the EHR, but because many of your old ones have probably been around since the invention Band-Aid.

Each of these recommendations will actually help you and help your vendor be successful.  It will not be an adversarial relationship as long as you manage it.  If you don’t manage the relationship, you won’t have to worry about meeting Meaningful Use—you’ll be too busy selecting a replacement vendor.

One final thought, don’t let the vendor loose unsupervised on the oriental rugs.

 

What is the future of the EHR/N-HIN landscape?

Posted by

0

One may argue it is possible to build the real Brooklyn Bridge with nothing but toothpicks, and a lake filled with Elmer’s Glue.  Difficult yes; prudent, no.   Urban legend is when the United States first started sending astronauts into space, they quickly discovered that ballpoint pens would not work in zero gravity.  To combat the problem, NASA scientists spent a decade and $12 million to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300C.

The Russians used a pencil.

The ability to do something is not justification for doing it.  Nor is that fact that someone has put it forth as an idea.  The willingness to do something merely because everyone is doing it or because someone instructed it be done probably has nothing to do with a business strategy, or if it does, it shouldn’t.

In the next five to seven years the business of healthcare at the provider level will have the opportunity to change markedly—the unanswered question is, will it have the ability?  To answer that at the provider level—primarily hospitals and clinics—I believe one must distinguish between the business of healthcare (how the business is run) and the healthcare business (how the care is delivered).

In many respects, the business of healthcare and the strategy surrounding it is pinned to a 0.2 business model.  Certainly there are exceptions to any aphorism, but taken as a whole, there is plenty of room for improvement.  As one hospital CEO told me, “What we really lack is adult supervision.”

So, how exactly does the toothpick bridge apply to healthcare?   Here’s my take on the situation.

  1. It may be possible to build and roll out a national network of EMRs through EHRs connected by HIEs to an N-HIN—I don’t think will happen in the next five to seven years, especially if to be effective the network requires a minimal participation of somewhere between 70 to 80 percent of healthcare providers.
  2. Even if I am wrong, why would anyone build a national EHR network out of toothpicks?  Could they possibly have devised a more complex and costly approach?
  3. The government arrived late for the party, has only limited authority, and chose to provide cash incentives instead of direction or leadership.  They passed the responsibility of the success of the national EHR roll out to hundreds of thousands of healthcare providers.
  4. The providers are burdened by having no experience in the sector, hundreds of EHR systems from which to select, no standards, hundreds of HIEs, no viable plan, no one with singular authority, a timeline that cannot be meet, and an unwritten set of Meaningful Use requirements.

The plan sounds like something designed by Rube Goldberg.  Could it be done this way?  I do not think we will ever know.  Not necessarily because it will fail, but because I think the plan will be supplanted by a more realistic one from the private sector.

The government’s plan relies on a top-down approach—albeit with a missing top; from the government, to the providers, to the patients.

The private sector plan will come from firms like Apple, Google, and Microsoft.  It will work because it will be built from the bottom up; from the patients, to the providers, and back.  Personal Health Records (PHRs) will become EMRs.  This approach will allow them to flip their PHR users to EMR users, and will be adopted quickly by millions of customers (patients).  Their approach will have a small handful of decision makers calling the shots instead of hundreds.

This model’s other component will be driven from another direction, by large hospitals and clinics that connect to small hospitals, small practices, and ambulatory physicians via a SAAS model.  Something like this is underway today at the Cleveland Clinic using their offering, DrConnect.

I believe the approach will be refined even further as the distinction between PHRs and EMRs erodes.  Instead of requiring remote care providers to have their own mini-EHR integrated with their practice management system, they will be able to use the EHR of a large hospital.  I anticipate that they will be able to log on to the system to access their patients’ EMRs as though they were actually resident in the large hospital.  This will all but eliminate the role of Health Information Exchanges (HIEs).  It will also extend the reach of those large hospitals, and aid in the retention and recruiting of physicians.

Why is this important?  Because the federal plan, which won’t be viable for several years, is designed to use software solutions which address a current business issue.  By the time their networked solution is fully functional it will be well on its way to obsolescence.  The government is forcing the expenditure of more than a hundred billion dollars on a static offering to address a non-static issue.  Their approach will not be able to keep pace with the changes demanded by market forces.  It reminds me off building a plan to go to the moon based on where the moon was instead of where it will be.

 

EHR Strategy: The Wildebeest Postulate

Posted by

0

The Kalahari; vast, silent, deadly. The end of the rainy season, the mid-day heat surpasses a hundred and twenty. One of the varieties of waterfowl, most notably the flame red flamingo that nested in the great salt pans in Botswana, has begun its annual migration. In the muck of one of the fresh-water pools that had almost completely evaporated, writhes a squirming black mass of underdeveloped tadpoles. A lone Baobab tree pokes skyward from the middle of the barren savanna. In its shade, standing shoulder to shoulder and facing out, a herd of wildebeest surveys the landscape for predators.  Sir David Attenborough and PBS can’t be far away.

Some things never change. I make my way across the freshly laid macadam to meet the school bus. Fifty feet in front of me is a young silver maple tree, the buds of its green leaves yielding only the slightest hint of spring hidden deep within. The late afternoon sun casts a slender shadow across the sodded common area. One by one they come—soccer moms; big moms, little moms, moms who climb on rocks; fat moms, skinny moms, even moms with chicken pox—sorry, I couldn’t stop myself—as they will every day at this same time, seeking protection in its shade. My neighbors.  It’s only sixty-five today, yet they seek protection from the nonexistent heat, a habit born no doubt from bygone sweltering summer days. A ritual. An inability to change. In a few weeks the leaves will be in their full glory, and the moms will remain in the shadow of what once was, standing shoulder to shoulder facing outward, scanning the horizon for the bus. A herd. Just like wildebeest.

The children debus–I invented the word.  Mine hand me their backpacks, lunch boxes, and musical instruments.  I look like a Sherpa making my way home from K-2.

I shared this analogy with the neighborhood moms—the bruises will fade gradually. I can state with some degree of certainty they were not impressed with being compared to wildebeest. So here we go, buckle up. By now you’re thinking, “There must be a pony in here somewhere.”

Some things never change; it’s not for lack of interest, but for lack of a changer.  For real change to occur someone needs to be the changer, otherwise it’s just a bunch of people standing shoulder to shoulder looking busy. How are you addressing the change that must occur for EHR to be of any value?  EHR is not about the EHR.  It’s not about ARRA money, and it is not about IT.  It is about moving from a 0.2 business model to 2.0.  You need someone who sees the vision of what is is—sorry, too Clintonian—must lead.  Be change.

One of the great traits of wildebeest is that they are great followers.

 

HIT: The Change Keeps Changing

Posted by

0

Hello to those whom I’ve yet to meet.  This is rather long, so you may wish to grab a sandwich.

I write to share a few thoughts.  I reside in the small place where those who refuse to drink the Kool Aid reside. For those who haven’t been there, it’s where those who place principle over fees dare to tread.

Where to begin? How to build your provider executive team? (Those who wish to throw cabbages should move closer to their laptops so as not to be denied a decent launching point.)

I comment on behalf of those in the majority who have either not started or hopefully have not reached the EHR points of no return—those are points at which you realize that without a major infusion of dollars and additional time your project will not succeed. Those who have completed their implementation, I dare say for many no amount of team building will help. Without being intentionally Clintonian—well, maybe a little—I guess it depends on what your definition of completed is.

If I were staffing a healthcare organization, to be of the most value to the hospital, I’d staff to overcome whatever is lying in wait on the horizon, external influences—the implications of reform and Stages 2 and 3 of Meaningful Use, and a national roll out of EHR with no viable plan to get there.  Staffing only to execute today’s perceived demands will get people shot and will fail to meet the needs of hospital. To succeed we need to exercise an understanding of what is about to happen to healthcare and to build a staff to meet those implications.

Several CEOs have shared that they are at a total loss when it comes to understanding the healthcare implications of reform and IT.  They’ve also indicated—don’t yell at me for this—they don’t think their IT executives understand the business issues surrounding EHR and reform.  I somewhat disagree with that perspective.

Here’s a simplified version of the targets I think most of today’s hospital CIOs are trying to hit.

1. Certification
2. Meaningful use
3. Interoperability—perhaps
4. Budget
5. Timing
6. Vendor management
7. Training
8. User acceptance
9. Change management
10. Work flow improvement
11. Managing upwards

There are plenty of facts that could allow one to conclude that these targets have a Gossamer quality to them.  Here’s what I think. You don’t have to accept this, and you can argue this from a technology viewpoint—and you will win the argument. I recently started to raise the following ideas, and they seem to be finding purchase—I like that word, and since this is my piece, I used it.

Before we go there, may I share my reasoning? From a business perspective, many would say the business of healthcare must move from a 0.2 to a 2.0 business model. (This is not the same as the healthcare business—the clinical side.)  The carrot?  The ARRA incentives—an amount that for many providers will prove to be more of a rounding error than a substantive rebate.

Large healthcare providers are being asked to hit complex, undefined, and moving targets, and they are planning on adapting to reform and reforming their own business model while they implement systems which will change how everyone works.  Hospitals are making eight and nine figure purchase decisions based in part on solving business problems they have not articulated. If success is measured as being on-time, in-budget, and fully functional and accepted, for any project in excess of $10,000,000, the chances of failure are far greater than the chances of success.

Their overriding business driver seems to be that the government told them to do this. Providers are making purchasing decisions without defining their requirements. Some will spend more on an EHR system than they would to build a new hospital wing.  Many don’t know what the EHR should cost, yet they have a budget. Many don’t know if they need a blue one or a green one, if it comes in a box, or if they need to water it.

So, where would I staff to help ensure my success—this is sort of like Dr. Seuss’, “If I ran the Circus”—the one with Sneelock in the old vacant lot.  I’d staff with a heavy emphasis on the following subject matter experts:

• PMO
• Planning & Innovation
• Flexibility
• Change Management
• PR & Marketing

Contrary to popular belief, not all of these high-level people need to have great understanding of healthcare or IT. You probably already have enough medical and IT expertise to last a lifetime.

Here’s why I think this is important. Here’s what I believe will happen. Three to five years for now the government would like us to believe there will be a network of articulated EHRs with different standards, comprised of hundreds of vendor products, connected to hundred of RHIOs, and mapped to a N-HIN.  Under the proposed model, standardization will not occur if only for the fact that there is no monetary value to those vendors whose standards are not standard.

Interoperability, cost, and the lack of standardization will force a different solution—one which is portable.  I think the solution will have to be something along the lines of a single, national, open, browser-based EHR.  It will be driven by consumers.  Consumers will purchase the next generation of super-smart portable devices that offer a combination of iPad/iPhone functionality.

The Personal Health (PRH) will have evolved to become the EMR.  How is this possible?  What do smart devices do?  They do one thing, billions of times each day, and they do it perfectly—they send and receive ones and zeros.  That is what today’s EMR are—ones and zeroes.  Those next-gen devices will be EMR-capable.  Why?  Because there are more than a hundred million customers who will keep buying these devices.

The so-called N-HIN will be the new Super Internet—not some cobbled together network of RHIOs.

Firms like Apple, Google, and Microsoft will drive this change.  We already buy everything they offer, in fact, we line up at midnight to do so.  By then, those firms will care less about selling the devices than they will about transporting the ones and zeroes that comprise the data.  Their current PHRs are their way of introducing themselves to consumers as players in healthcare.

The point I am trying to drive home is that from being able to adapt to change and reform, lean towards staffing the unknown.  Staff with leaders, innovators, and people who can turn on a dime. Build your organization like turning on a dime is your number one requirement. Don’t waste time and money worrying about Certification or Meaningful Use. If anyone asks you why, you can blame me.

If you want a real reason, I have two. First, they won’t mean a thing five years from now. Second, if I am the person writing an incentive check, I want to know one and only one thing—will your system connect with the other system for which I am also writing a check?  That is the government’s home run.

 

EHR: The 40-chicken crocodile

Posted by

1

Got a couple hundred million burning a hole in your pocket?  Why not buy an EHR?  Indeed.

Riddle me this Batman, “What is a 40 chicken crocodile?”

It is the number of chickens you have to feed it each day to keep it from eating you. What is the crocodile at your hospital?  Is it your EHR?

Let me recount to you a true story about the details of one of the EHR “success” stories.  A major hospital who selected their EHR from among one of what I like to call the oligopoly EHR Flavor of the Month Club.  You know the suspects.

Permit me to throw a wrench to those clairvoyants who think they know where this is going before I’ve even written it.  Admittedly, I have a tendency to throw metaphorical tomatoes in one direction—that of the vendors.  That’s because, they are often easy targets.  Slow down Pepito.

This hospital, and from what I was told, the vendor, did it right.  I am not sure I would have differed from the approach of either.  The hospital spent a few years in its vendor selection process, and they were very thorough.  They spent two years building their process maps, ensuring the vendor implemented the EHR to meet their needs, not the other way around.  Operations led the nine-figure project.

They implemented many of the support functions and a few of the specialty functions.  Here come the chickens.  After implementation, cash flow dropped by 80 percent for several months due to significant issues they encountered cleaning up the revenue side.  Doctors were instructed to cut their hours by fifty percent to allow them to learn to use the system.  Hours are still down by twenty percent, well more than a year later.  Users use about one-third of the functionality, even after a rigorous training program.

The hospital held off doing most of the clinical implementations for two years.

I asked for some recommendations.  What would you have done differently?  Here’s what I learned.  If you have a research organization you need to spend extra special attention to their workflows.  Managing post-go-live was a big issue to begin to offset productivity losses. Without a continuous process improvement program the EHR would not have been accepted. Do not pick a go-live date at the outset of the project as it causes the organization to be paralyzed simply to hit the date.  Testing was compromised to meet the go-live date. The post go-live issues are still being fought.  Do not let the design or build teams skimp on either reporting or testing, they are still playing catch-up.

So, after doing a pretty bang up job, at least from where I sit, there are still a lot of chickens being fed to the crocodile.  Wonder how many chickens it would have taken had the users not been as involved as they were.  How many had the users not spent two years pre-build defining processes?  A lot.  Now comes the rest of the clinical effort.  See you at the poultry counter.

 

EHR: When you are in a hole, stop digging

Posted by

2

 March 21, 2011 07:05

I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school.  The camp was for high school students of varying backgrounds and their counselors.  On more than one occasion, the person on the other end of my rope would freeze and I would have to talk them down safely.

Late one day, a thunderstorm broke quickly over the mountain, causing the counselor on my rope to panic.  No amount of talking was going to get her to move either up or down, so it was up to me to rescue her.  My total amount of rappelling experience was probably only a few more hours than hers.  Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her on the face of the cliff.

The sky blackened, and the wind howled, raining bits of rock on us.  I remember that only after I locked her harness to mine did she begin to relax.  She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.

That episode reminds me of a story about a man who fell in a hole.  The man continues to struggle but can’t find a way out.  A CFO walks by.  When the man pleads for help, the CFO writes a check and drops it in the hole.  A while later an EHR vendor walks by—I know this isn’t the real story, but since I am the one writing I’ll tell it the way I want.  Where were we?  The vendor.  The man in the hole pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.

I walk by and see the man in the hole.  “What are you doing down there?”  I asked.

“I fell in this hole and don’t know how to get out.”

I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole.  “Why did you do that?”  He asked.  “Now we’re both stuck.”

“I’ve been down here before” I said, “And I know the way out.”

I know that’s a little sappy and self-serving.  However, before you decide it’s more comfortable to stay in the hole and hope nobody notices, why not see if there’s someone who knows the way out?

Drafting someone to sort out your EHR problems doesn’t do anything other than add another name to the org chart.  Work plans and org charts are very similar in one key respect—they both have a lot of blank space between the all of the boxes.  And, that is where a lot of the problems arise—in the blank spaces, spaces that have to do with planning, process improvement, and change management.

Everyone is implementing an EHR, but not everyone is doing it correctly.  There is a very special set of IT skills needed to meet the challenges of a failed or failing project.  People with those skills are disaster recovery specialists.  They are the people who jump in the hole with you because they have been in the hole before and they know the way out.

Has Meaningful Use Optimisim Run Amuck?

Posted by

0

I make it a point to read every article Gienna Shaw writes for HealthLeadersMedia.com.  She consistently captures large amounts of information and packages it into a concise understanding of the material.  In the February issue of HealthLeaders http://www.healthleadersmedia.com/industry_survey/ she wrote a piece summarizing the results from their survey of organizations on their projected timeline for achieving Meaningful Use; Making Meaningful Progress.  I thought it might be helpful to offer readers a bit of a different perspective, something that may cause you to pause and wonder whether I am living on another planet, or whether it is the majority of those surveyed who migrated to Venus.

Were it only that the responses of those surveys were based in reality—the world would be a better place, the Cubs would win the World Series, and my son’s room would no longer resemble an obstacle course.

According to the survey findings, sixty-eight percent of those surveyed expect to achieve Meaningful Use by 2012, and that total climbs to seventy-seven percent by 2013—assuming the Mayan prediction of the world ending the year before prove false.  Things always look rosier when you have the luxury of ignoring other factors prior to answering the question of whether you will achieve Meaningful Use; like whether the EHR implementation will be successful and whether there is enough time to meet the dates they selected.

What else should one be considering when assessing the validity of this unbridled optimism?  Thanks for asking.  Here is my list:

  • EHR Failure Rate:  published data suggests EHR failures range between 30-70%.  If we use a conservative figure of 40% we can see that optimistic forecasts of 77% achieving Meaningful Use by 2013 is wrong by a factor of two.  If forty percent of implementations fail, and seventy-seven percent meet Meaningful Use, somebody needs to check the math.
  • Of those systems that have already failed, many of whom are very notable hospitals, they had the luxury of time.  They had as much time as they needed to fail.  Today we have less time to fail, which to me means failure percentages will increase.  For those who have yet to fail, if your goal is meeting Meaningful Use by 2013, watch out.  If you dash for the cash, plan for an EHR do-over.  Remember, there is a binary trap associated with meeting Meaningful Use—it is all or nothing.  There are no dollars awarded for having tried really hard.
  • When was the last time you tried to hire a very experienced EPIC or McKesson resource?  Recent figures suggest a Healthcare IT resource shortfall of fifty percent.  This shortfall will greatly reduce the number of organizations which have any chance of meeting Meaningful Use by the dates they themselves specified.
  • How’s that HIPAA 5010/ICD-10 project coming along?  A high percentage of organizations have not even started the HIPAA 5010 tasks that should have been completed in 2010.  More money will be lost through not meeting ICD-10 than will have been awarded in the EHR rebate lottery.
  • Once your EHR is implemented, what percentage of your IT resources will you need to allocate simply to meet Meaningful Use’s stage one requirements?  One outstanding hospital found that number to be eighty percent over three years.
  • At least with EHR there are people who have current EHR experience.  There is no pool of ICD-10 been-there done-that resources.  So, where do you allocate your scarce resources, EHR or ICD-10?  Either answer you give yields a bad outcome.

So, what is the best approach for the C-Suite?  Meeting Meaningful Use is not mandatory.  Time need not be your enemy.  Why not implement EHR correctly?  Why not adjust your plans so that instead of trying to squeeze every possible dollar out of Meaningful Use you simply try to make EHR work by 2015?  This way you avoid the penalty and give yourself a decent shot of success.

No ARRA money will be awarded for being optimistic.  However, once you tell the CFO to plan for a twenty million dollar ARRA windfall in 2011 or 2012 you better deliver it because you know darn well that he or she has already made plans to spend that money.

I think if we were to check the results of this survey two years from now we would find that less than forty percent of hospitals will have achieved Meaningful Use by the end 2013.

EHR: Is time your greatest enemy?

Posted by

0

The following is my response to an article in Health Data Management regarding an article which argued that time is the enemy of a good EHR implementation. (http://www.healthdatamanagement.com/blogs/Quammen_big_bang_EHR-42096-1.html#read)

I agree fully with the premise of a big bang rather than a phased in approach, but for the following reasons I respectfully disagree if the reason for going all out is because there is not enough time.

Many providers have already demonstrated that time is certainly the enemy.  They have had enough time to spend four hundred million dollars and get EHR wrong, and are in the process of doing the same thing with another vendor.  There is a notable shortage of CIOs wearing EHR 2.0 T-shirts—fail once and you are done.  The attitude seems to be that there is plenty of time to do it wrong and not enough time to do it correctly.

Poor EHR implementations are creating a brand new market for HIT consultants—disaster recovery. The New England Journal of Medicine noted that more than sixty percent of EHR implementations fail.  An even higher percentage will fail to meet Meaningful Use, which is why everyone is in such a rush to implement—the Dash for the Cash.

Providers are sacrificing their own business strategy to get a check for trying to meet a set of standards that have no meaning and no benefit other than to have them fit into a more nationalized healthcare model—something they would never have done on their own.

The first question a provider should ask is “do we want to meet Meaningful Use”.  If the answer is yes, the next question they should ask is “by when?”  Given the rash of failures, providers should figure out what they need to do to avoid being the next hundred million dollar failure.  Paying to do EHR twice or to recover from a failed implementation will far exceed any funds they will have received from the EHR Rebate program.

The problem many will find is that there is no “R” in the Meaningful Use ROI calculation.  The productivity of some of the best providers in the country is still down twenty percent two years after implementation.

If providers want an ROI, they would be much better served by taking their time and doing what they need to do to make EHR do what they need it to do, and to focus their attentions on ICD-10.  The amount of money they will lose from failing to meet ICD-10 will far exceed the EHR rebate.

Patient Experience Management as healthcare’s Watergate

Posted by

1

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.