Hospital

Why your Website is Killing Patient Satisfaction

Posted by

0

Hospitals probably have more than one hundred points of contact with each patient.  These points of contact (POCs) begin before the patient is admitted and continue after the patient has been discharged.

The first contact may come by a visit to one of the hospital’s clinics, a 3 A.M. call to a primary care physician, or browsing the hospital’s website.

Yesterday I assessed whether the website of a large hospital group was functional or whether it was just a website window-dressed to look like a customer portal. I assess functionality based on whether I was able to accomplish what I set out to accomplish.

I counted dozens of different phone numbers to call. Along with the list of numbers were links for physician and employee portals, links to the board, a link for donors, wellness, specialties, medical professionals, and dozens more, all on the front page. 

There was even a link, albeit not a portal for patients—a rather important link since the number of visits by patients and prospective patients probably greatly exceeds the combined number of visits by all other visitors to the site.  Unfortunately the patient link was imbedded with six other equally weighted links.

I clicked the patient link and was greeted by two-dozen new links, each displayed as being of equal importance.  There were links for patients to use before coming to the hospital and links for them to use once they were home.  Points of contact with your hospital.  Points of satisfaction or dissatisfaction. 

I clicked some more.  Schedule an appointment.  There are actually two links for scheduling an appointment.  The first link gave me a phone number I could call M-F between 8 and 5:30 P.M.  What number do I call at 6 PM I wondered?  I tried the second link; it took me to the same place. Could I schedule an appointment online or through a mobile device?

What did I learn? There are 168 hours in a week.  Their scheduling service operates for 47.5 hours a week, 28% of the week’s hours. If I dialed that number after hours would I get a recording telling me how important my call was?  If my goal was to schedule an appointment using their website, or to schedule an appointment at any time on any device not only did the hospital not meet my expectation, it did not even offer me an alternative. A dead-end.

If it costs the hospital thirty dollars to schedule an appointment by phone and nothing to schedule an appointment online, why not complete the task correctly, the first time, and for zero cost?

I next looked at what I could do when I was home, more POCs, more chances to be satisfied or dissatisfied. 

Manage my medical records. Using the website I was able to print and mail, two very non-electronic processes, a request to have my records printed and mailed to me.  There was no way to submit my request using their website.  If I did not own a printer or did not have access to a printer my expectation was not met, and was I not offered an alternative.  Some people, a whole lot of people, actually like to complete tasks using a tablet or smart phone. Another dead-end.

Let’s try billing. For Medicaid patients there are two numbers to call for help understanding your bill. That means understanding Medicaid bills is a nontrivial exercise.  That tells me that if I asked the same Medicaid billing question of three different people I might expect to get three different answers.  Why not design the sight so that it provides one right answer to whatever question is asked?  Why not include an online chat feature? Why not create a link to a YouTube video, produced by the hospital that explains Medicaid billing?

Medicare.  No link to prequalifying, not even a phone number for questions.

How to pay your bill.  Perhaps the most difficult and least desirous task a patient must do. There is no link explaining the various components of the bill, and nowhere on the site is a copy of a sample bill explaining or highlighting the various sections of the bill.

There is also no link to understand how to file a dispute or a claim with a payer.  Maybe it is not possible to do this for every payer, but using the 80:20 rule there must be ways to help the majority of patients understand what they are up against rather than having them face down the evil empires on their own.

Patients come to the hospital’s website with expectations.  Patient satisfaction is repeatedly won or lost at your hospital’s website and on the phones.  POCs.  Having a tool that proposes to help patients with their bills that not only does not help them but that adds to their frustration will crush patient satisfaction.

Hospitals want patients to pay their bills and to pay them on time.  Patients who do not understand their bill will not pay more completely, nor will they pay faster.

The next time you look at your hospital’s website ask yourself how different it would look had someone asked a patient how it should function.

Image

Dinner’s warm, it’s in the dog–Patient Experience Management

Posted by

0

dog

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen. “Dinner’s warm—it’s in the dog.” She walked out of the kitchen. I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

Patient Experience Management (PEM) is comprised of two things; patient equity management and patient expectation management. Ask your CFO and your Chief Marketing Officer.  Patients are assets in the same way that the laptops in the nurse’s station and the worn vinyl couch in the waiting room are assets.  They are part of the organization’s valuation.  Unlike durable goods, patients for the most part do not depreciate.  Most organizations know more about how to keep the couch from walking away than they do about preventing the patient from disappearing and never returning.

When was the last time someone in your hospital asked prospective patients about their expectations prior to admitting the patient?  Answer; never.  Chances are that someone in your organization has at some point surveyed or polled discharged patients about their satisfaction.  Those surveys were probably compiled and aggregated, and somehow a rating of high, average, or below average was derived.  What information did that rating yield?  Nothing.

Let’s say you surveyed one thousand patients and that the average patient satisfaction score was ‘below average’.  As compared to what?  Without knowing the patients’ expectations ahead of time it is not possible to calculate how far off below average is from the expectation of average, nor is it possible to know what needs to be done to improve patient satisfaction enough to increase satisfaction.

Viewing patient satisfaction in aggregate tells you very little.  Your expectations, and how your experience compared to those expectations will differ from mine.  The only way to understand how to improve the patient experience across the board is to ask.  Don’t just ask about the treatment they received because in most hospitals the treatment will be stellar.  This is where most hospitals are missing the boat when it comes to improving the patient’s experience.

Let’s say a patient is in the hospital for three days to have a certain procedure done.  The procedure was performed perfectly.  That does not mean the patient will rate their experience as high.  Many other things happen over those seventy-two hours that result in a bad overall experience; the check-in, the food, the noise in the hall, poor service, the bill.

Still not with me?  Suppose you go to Chicago for a three-day convention and you give a one hour speech on day two.  Your speech goes well but your hotel room is noisy, too hot, the cable is broken, they charge you twenty dollars a night for wireless service, and somebody else’s dinner was billed to your room.  If you are like me, when someone asks you about your trip you tell them about the problems with your room, not that your speech went well.  In fact, you probably went to the hotel manager and demanded that the hotel comp your bill.

Expectations not met.  Why?  Basic business processes were a disaster.

Back to the warm dinner in the dog and my phone call. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, the expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

What do you think?

Is your Mission Statement just Parsley?

Posted by

0

What is your organization’s mission, your vision, your goal?  Can you articulate it?  If yes, write it below in the space provided.

Okay.  Why do you have a mission statement?  Is it of any more value than the parsley on your Denny’s Grand Slam breakfast plate, or is it actionable?  What does it tell you to do?  Is it something to which all of your employees can contribute?  Can you measure if your actions helped meet the mission?  Does the business strategy result from the mission statement?

Here’s one you probably haven’t thought of.  Let’s say every one of your employees puts your mission statement into action.  Does that improve your organization, or does it bring it to its knees?  Your mission statement either communicates your mission or it does not.  What does it say to your employees, to your customers?  If it does not create a message that makes you unique, fix it or dump it—or say, “We are just like those other guys down the street.”  Just because it communicates, does not make your mission sustainable.

Here are some real examples of hospital mission/vision statements.  Read them and see if you begin to understand why I think the hospital business model is in trouble.  I have not published the name of the hospital, as that is not what is important to this discussion.

Providing exemplary physical, emotional and spiritual care for each of our patients and their families

Balancing the continued commitment to the care of the poor and those most in need with the provision of highly specialized services to a broader community

Building a work environment where each person is valued, respected and has an opportunity for personal and professional growth

Advancing excellence in health services education

Fostering a culture of discovery in all of our activities and supporting exemplary health sciences research

Strengthening our relationships with universities, colleges, other hospitals, agencies and our community

Provide quality health services and facilities for the community, to promote wellness, to relieve suffering, and to restore health as swiftly, safely, and humanely as it can be done, consistent with the best service we can give at the highest value for all concerned

We are caring people operating an extraordinary community hospital.

Ensure access to superior quality integrated health care for our community and expand access for underserved populations within the community. Create a supportive team environment for patients, employees, and clinical staff.

Let’s look at some of the million dollar words in the mission statements of some highly regarded hospitals.  Ensure, foster, promote, participate, create.  Comprehensive.  Involved, responsive, collaborate, enable, facilitate, passion, best, unparalleled, .  These statements were written by well paid adults.  These statements are awful.  They are awful because they are fluff—unachievable.  They are well intentioned but meaningless euphemisms.

Hospital mission statements are inclusive to the nth degree.  They also seem very similar.  If a perspective patient read your mission statement and read the mission statement of the hospital down the street, could they tell which one is yours?  Probably not.  Who among you has a mission statement which excludes anything?

So, let’s say your board is debating if you should buy the machine in Monty Python’s hospital skit—the machine that goes “Ping.”  Which of the mission’s goals does that support?

How do you make them better?  For starters, make them short. Very.  Twain wrote, “If I had more time, I would have written less.

Southwest Airline’s mission statement—be the low cost carrier.

Dramatic pause.  Something either contributes to the mission or it does not.  Leather seats and free lunches do not.

EHR–“Our Lady of Perpetual Implementations”

Posted by

0

“There is no use trying,” said Alice;
“one can’t believe impossible things.”
“I dare say you haven’t had much practice,” said the Queen.
“When I was your age, I always did it for half an hour a day.
Why, sometimes I’ve believed as many as
six impossible things before breakfast.”

There are a number of people who would have you believe impossible things.  I dare say some already have.  Such as?

“My EHR is certifiable.”

“They told me it will pass meaningful use.”

“We’re not responsible for Interoperability; that happens at the RHIO.”

“It doesn’t matter what comes out of the reform effort, this EHR will handle it.”

“We don’t have to worry about our workflow, this system has its own.”

Sometimes it’s best not to follow the crowd—scores of like-thinking individuals following the EHR direction they’ve been given by vendors and Washington.  Why did you select that package—because somebody at The Hospital of Perpetual Implementations did?

There is merit in asking, is your organization guilty of drinking the Kool Aid?  Please don’t mistake my purpose in writing.  There are many benefits available to those who implement an EHR.  My point is is that there will be many more benefits to those who select the right system, to those who know what business problems they expect to address, to those who eliminate redundant business functions, and those who implement proper change management controls.

EHR’s 5 stages of grief

Posted by

0

Being a blogger is not too dissimilar to being a failure’s biographer.  Unless you simply repeat the ideas of your contemporaries, good blogging requires a certain avidity to oppugn those who revel in the notion that theirs was the only good idea.  To me, their Sang-froid calmness has all the appeal of a cold omelet.  Good writing requires that you make intellectual enemies across a range of subjects, and that you have the tenacity to hold on to those enemies.  So let us step off Chekhov’s veranda and bid farewell to the sisters of Prozorova.

The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.  I heard a story about this on NPR, and it made me think about other scenarios where these stages might apply.

My first powered form of transport was a green Suzuki 250cc motorcycle.  My girlfriend knitted me a green scarf to match the bike.  One afternoon my mother walked into the family room, saw me, and burst into tears.  When I asked her what was wrong, she told me that one her way home she saw a green motorcycle lying on the road surrounded by police cars and an ambulance—she thought I had crashed.  I asked her why, if she thought that was me lying on the road, she did not stop.

My girlfriend’s mother, didn’t like my motorcycle—nor did she like me.  Hence, my first car; a 1969 Corvair.  Three hundred and fifty dollars.  Bench seats, AM radio.  Maroon—ish.  It reminded me a lot of Fred Flintstone’s car in that in several places one could view the street through the floor.  Twenty miles per gallon of gas, fifty miles per quart of oil.

Buyer’s remorse.  We’ve all had it.  There is a lot of buyer’s remorse going around with EHR, a lot of the five stages of grief.  I see it something like this:

  • Denial—the inability to grasp that you spent a hundred million dollars or more on EHR the wrong EHR, one that will never meet your needs
  • Anger—the EHR sales person received a six-figure bonus, and you got a commemorative coffee mug.  The vendor’s VP of Ruin MY life, took you off his speed dial, unfriended you in Facebook, and has blocked your Tweets. You phone calls to the vendor executive go unanswered, and are returned by a junior sales rep who thinks the issue may be that you need to purchase additional training.
  • Bargaining—when you have to answer to your boss, likely the same person who told you which system to purchase, as to why productivity is below what it was when the physicians charted in crayon.
  • Depression—you come in at least fifteen minutes late, and use the side door, taking the stairs so you won’t see anyone.  You just stare at your desk; but it looks like you are working. You do that for probably another hour after lunch, too. You estimate that in a given week you probably only do about fifteen minutes of real, actual, work. (Borrowed from the movie, Office Space.)
  • Acceptance—the EHR does not work, it will never work, you won’t be around to see it if it ever does.  Your hospital won’t see a nickel of the ARRA money.  You realize the lake house you were building will never be yours, but the mortgage will be.

The five stages of EHR grief.  Where are you in the grieving process?

True, there are a handful of EHR successes.  Not nearly as many as the vendors would have you believe.  More than half of hospital EHR implementations are considered to have failed.

If you are just starting the process, or are knee-deep in vendor apathy you have two options.  You can bring in the A-team, people who know how to run big ugly projects, or you prepare to grieve.

If it was me, I’d be checking Facebook to see if I was still on my vendor’s list of friends.

ICD-10’s Hidden Cost

Posted by

1

The characters on the train into Philadelphia, while never dull, were more interesting than usual this morning.  The woman across the aisle from me wore her hair in a style that could be described best as resembling a termite mound.  The ride felt so much like bumper cars that I was tempted to ask the driver if he had to pass some sort of training program to get his license, or if all he had to do was to collect a certain number of bottle caps.  It gives me the feeling that there should be a lifeguard at the gene pool.

The med student seated next to me on the train reads his book, but then, everyone one the train reads. I asked him what he was reading.  Turns out it was a book about converting from ICD-9 to ICD-10.  Medical coding.  Those little numbers, charge codes, on your doctor’s invoice that enable the doctor to charge you for the specific services provided.  There didn’t seem to be much of a plot, and he did not seem to be very engrossed in the material.

The conversion from ICD-9 to ICD-10 may be the biggest gotcha on healthcare’s horizon, especially with regard to hospitals.

Money will be spent and money will be lost—lots of it.

Health and Human Services (HHS) estimates that the cost of converting can be broken down into three categories, and it estimate the relative cost of those categories:

  • Training                              22%
  • Lost productivity               35%
  • System changes                43%

Two of these, training and system changes, are controlled variables.  They relate to things the service provider will be doing.  The other, lost productivity is the result of how well the service provider managed the other two.

HHS estimates productivity charges will range from 6-10% due to the fact that it will take people between 500 and 1,000 hours to become proficient in the new codes.  Others have estimated that for hospitals with more than 500 beds the total cost of the conversion (actual cost plus opportunity cost) will be more than ten million dollars.

So, in layman’s terms, what does that mean with regard to the business of managing the hospital?  How does one develop a project plan for lost productivity?  What are the tasks?

Let’s look at what is involved.

System Changes:

Everything will be changing; business rules, business processes, forms, reports, and systems.  Ask yourself which systems that you use involve coding?  Now ask yourself if you like using those systems.  Are they easy to use?  Are they easily understood?  If the only thing changed in those systems is the codes, they will still be just as tedious to use and those systems will be less usable.

A large hospital will spend five million or more dollars to change systems and the end result will be that those systems, at least for the first 500 to 1,000 hours will be less usable.  I believe those hours are underestimated.  Most systems are tied to other systems into what has become a bit of a kluge.  Changing integrated systems is a lot like playing the children’s game Pick Up Sticks—touching one stick often winds up making things happen to the other sticks.  Changing one system will cause things to happen to the other systems.  Ineffectiveness breeds more ineffectiveness.

Lost Productivity:

According to estimates, thirty-five cents out of every dollar spent on the conversion will be allocated to lost productivity.  This is like buying a gallon of milk and having to pour a third of it in the sink before you placed the carton in the refrigerator.

What are the why’s and where’s of the productivity loss, and what can be done about it?  Interpreting the HHS estimates, they are essentially stating that while the conversion will be done, it will not be done well.  In fact, those in the know published that hundreds of millions of dollars will be lost converting to ICD-10.

Will your hospital be contributing to that loss?  Without question; unless you figure out the causal factors of that loss, and put a plan in place to prevent it.  HHS calculates hospitals will lose thirty-five cents on the dollar even after having spent twenty-two cents of every dollar to train people.

Plan on fifty-seven cents of every dollar spent on the conversion to ICD-10 being wasted.  Get that milk carton out of the refrigerator and pour some more into the sink.

Training:

The training program envisioned by HHS that hospitals will undertake will result in a planned productivity loss of thirty-five percent.  What will your productivity loss be if your training program is less effective than whatever HHS was envisioning?  Clearly they are not holding out high hope for the success of ICD-10 training given that it is estimated that becoming proficient in the new coding could take one thousand hours.  (It only takes about 50 hours of training to obtain a private pilot’s license.)

Training, the variable over which a hospital has the most control is the area where the hospital has the least experience.  After all, the hospital has never had a business system designer design an ICD-10 training program.

Training will be about learning to use correctly new screens and forms and new business processes and business rules.  It must include those in finance and IT, coders, and healthcare professionals.  To be effective, it should be role-based; customized.

Left up to the usual way of doing it, hospitals will provide classroom study, 24-40 hours. They will probably develop a train-the-trainers program, and the trainees will be presented with a nice-looking ICD-10 training certificate.  Good luck.

Training may be needed for more than half of a hospital’s employees.  For training to be effective and to minimize the loss of productivity it must be designed.  It must include:

  • What will the altered systems user interface (UI) look like
  • Should people be trained on that UI, or will changing the UI result in much less training
  • What will the altered forms look like
  • Should people be trained on those forms, or could designing new forms result in much less training
  • Can the training be designed to be delivered online
  • Can the training be designed to be delivered on portable devices
  • Can the training be designed by roles
  • Can the training be designed by person to assess what areas need more training

The answers to these questions are Yes.  Whether it will be is up to you.  Designing a training program will significantly decrease the cost of training and significantly decrease the productivity loss.

What EHR users really want

Posted by

0

I just read an article in the Harvard Business Review about the notion of what Henry Ford would have said if he were asked what people wanted.  The oft-quoted response was “Faster horses.”

At one point Ford had two-thirds of the market.  A few years later Ford’s share had dropped to fifteen percent.  Those in the know suggest this drop accrued to the fact that the customers did not want faster horses; they wanted better cars.

This is somewhat in line with how the healthcare providers have responded to EHR systems.  The hospitals with whom I have spoken have made a wide range of choices with regard to what they are doing with their EHR.

  • They use it because they have no other choice
  • They continue to do paper charting and use the EHR after the fact
  • They use it as a document management system and continue to dictate
  • They use the monitor as a flashlight to help them see while they write their notes
  • They sign a petition stating they are not going to use the EHR that is being forced upon them
  • They change EHRs believing that anything else has to be better than the system they are using

These are all variations of the faster horse theory of EHR.

What EHR’s users want is a better EHR, one that helps them do their job rather than one that hinders them.

Is Your EHR More Like iPhone Or iTunes?

Posted by

0

Below is my latest post on healthsystemcio.com.  Let me know what you think.

Times are perilous, and they ain’t a-changin.  As Europe focuses its attention on whether the Euro will become a collector’s item, and the Middle East eagerly awaits the chance to lower the amount it pays for air conditioning because of the surplus of electricity that will be available from all of Iran’s nuclear reactors, America is all a-twitter about what Angelina Jolie was wearing at the Oscars.

No wonder the impact of the billions being spent on healthcare IT has taken a back seat.

Ask yourself, how good is your EHR? Does it do what you want it to do? Does it do it in the way you need it to do it? If it was your decision, would you have spent a hundred or two-hundred million dollars for it?

Okay, get the smirk off your face.

I have been writing recently a lot about the difference between user acceptance (UA) and the usability of large business systems like EHR systems. A business system is a lot more than an IT application. It also includes process and people — users.

Achieving high user acceptance is easy. Implement one system and make everyone use it. Check the box. User acceptance only involves the IT application: the EHR. UA does not measure the value of the business system to the users; it simply measures the percentage of users.

Usability is a testament to whether or not the system, in this case the EHR, adds value to the organization, to its users. Does it make them better, more effective, more efficient? The secret sauce towards achieving good usability is the addition of design.

Here is an example of a company with two business systems depicting the difference between UA and usability. The company is Apple, the two business systems are the iPhone and iTunes.

iPhone system:

  • Phone, camera, game player, GPS, email, SMS, MP3 player
  • One button
  • No training required
  • Great usability

iTunes system:

  • Web shopping program for purchasing services to use on Apple products
  • Full keyboard
  • High learning curve
  • Poor usability, poor user experience
  • High UA — users have no other choice

Brothers from different mothers. Their usability is so different that it is difficult to believe both business systems came from the same company.

  • One business system lets you do everything using one button; the other barely lets you do anything using 61 keys.
  • One is intuitive, one is anything but

I am willing to bet your EHR reminds your users more of iTunes than it does the iPhone. You can choose to accept it as is, or you can make it better. The great thing about business systems, unlike products, is you can choose to apply design to a poor business system and gain tremendous value for little investment. Or not.

Redux–What people at HIMSS were afraid to say

Posted by

3

One image of HIMSS that will not escape my mind is the movie Capricorn One—one of OJ’s non-slasher films.  For those who have not seen it, the movie centers on the first manned trip to Mars.  A NASA Mars mission won’t work, and its funding is endangered, so feds decide to fake it just this once. But then they have to keep the secret…

The astronauts are pulled off the ship just before launch by shadowy government types and whisked off to a film studio in the desert.  The space vehicle has a major defect which NASA just daren’t admit. At the studio, over a course of months, the astronauts are forced to act out the journey and the landing to trick the world into believing they have made the trip.

Upon the return trip to Earth, the empty spacecraft unexpectedly burns up due to a faulty heat shield during reentry. The captive astronauts realize that officials can never release them as it would expose the government’s elaborate hoax.

I think much of what I saw at the show was healthcare’s version of Capricorn One.  Nothing deliberately misleading, or meant as a cover-up or a hoax.  Rather more like highlighting a single grain of sand and trying to get others to believe the grain of sand in an entire beach.

The sets for interoperability and HIEs served as the Martian landscape, minus any red dust.  There was a wall behind the stage from where the presentation interoperability was shown.  I was tempted to sneak behind it to see if I could find the Wizard, the one pulling all the nobs and using the smoke and mirrors to such great effect.  It was an attempt to make believers, to make people believe the national healthcare network is coming together, to make us believe it is working today and that it is coming soon to a theater near you.

After all, it must be real; we saw it.  People wearing hats and shirts emblazoned with interoperability were telling us this was so, and they would not lie to you.

The big-wigs, and former big-wigs—kudos to Dr. B. for all his hard work—were at the show for everyone to see, and to add a smidgen of credibility to the message.  They would not say this was going to happen if it were not—Toto, say this ain’t true.

The public relations were perfect, a little too perfect if you asked me.  Everyone was on message.  If you live in Oz and go to bed tonight believing all is right with the world, stop reading now.  If what you wanted from HIMSS was a warm and fuzzy feeling that everything is under control and that someone really has a plan to make everything work you probably loved it.

Here is the truth as this reporter saw it.  This is not for the squeamish, and some of it may be offensive to children under thirteen or C-suiters over forty.  In the general sessions nobody dared speak to the fact that:

  • Most large EHR implementations are failing.
  • Meaningful Use isn’t, and most hospitals will fail to meet it.
  • Hospital productivity is falling faster than are the Cubs chances of winning a pennant.
  • Most hospitals changed their business model to chase the check
  • Most providers will not see a nickel of the ARRA money—the check is not in the mail and it may never be.

The future as they see it is not here, and may never be, at least until someone comes up with a viable plan.  Indeed, CMS and the ONC have altered the future, but it ain’t what it used to be.  People speak to the need to disrupt healthcare.  Disrupt it is exactly what they have done.  The question is what will it cost to undo the disruption once reason reenters the equation?  What then is the future for many hospitals?

  • Hospitals on the whole will lose more much more money due to failing to be ready for ICD-10 than they will ever have seen through the ARRA lottery.
  • It make take years to recover the productivity loses from EHR and the recoup those revenues.
  • Hospitals spending money to design their systems to tie them into the mythical HIE/N-HIN beast will spend millions redesigning them to adapt to the real interconnect solution.
  • The real interconnect solution will be built bottom-up, from patients and their primary care physicians.
  • Standardized EMRs will reside in the cloud and patients will use the next generation of smart devices.  And like it or not, the winners will be Apple, Google, and Microsoft, not the ONC and CMS.  Why?  Because that is who real people go to to buy technology and applications.  A doctor still does not know which EHR to buy or how to make it work.  Give that same doctor a chance to buy a solution on a device like an iPad and the line of customers will circle the block.

And when doctors are not seeing patients they can use the device to listen to Celine Dion.  This goes to show you there are flaws with every idea, even some of mine.

(I published this post one year ago, just after the Orlando HIMSS.  It appears to still be valid today. Comments?)

The True Measure Of Success For HIT Systems

Posted by

0

My newest post in healthsystemcio.com.  Feedback appreciated.

The title of the book on the lap of the person sitting next to me was “Cost Justifying Usability”. My cynicism jumped immediately to Def-Con 4.

Cost Justifying Usability. Did the author get his inspiration for the title at the Shopping-For-New-Ideas store? Now, before you laugh too hard, recall that many inane ideas make gobs of money, such as thePet Rock and Chia Pet. For every book, there must be an audience. I can only believe that the intended audience for this epic must be senior business executives.

Imagine yourself being one of those executives. Someone finds you lying on the floor in the fetal position and suggests you read the book. How should you respond?

  • I assumed usability was the antecedent  for buying that system
  • We just spent $300 million dollars on an enterprise system. Does making it usable cost extra?
  • They told us the drop-dead date is March 21. Drop-dead is the perfect phrase; we only measured cost and speed — nobody thought to measure usability?

What is the title of the antithetical book—Cost Justifying Unusability or, Cost Justifying Failure?

The statement most in HIT are afraid to utter is that most HIT spend has no ROI. There is no ROI because the usability measure of most of the largest HIT systems (enterprise and EHR) is negative — productivity is showing a net loss instead of a net gain.

Usability is not the same as user acceptance. User acceptance for these unusable systems will approach 100 percent. Why? Because users have no other option. And then there is Meaningful Use — an odd phrase because it has nothing to do with users. An EHR can pass Meaningful Use and have low user acceptance and the usability factor of hammering a nail with a banana.

If the healthcare industry needs to be convinced that a cost justification for usability is required before anyone takes the issue seriously, perhaps a moniker change is in order — HIT to OBIT.

Call me silly, but I think the time has come to do away with how we measure the success of all business systems projects. Was the system usable — did it increase ROI, did it make the organization more effective, and did it enable innovation? Only two approaches to measure need be used.

  1. On time, on budget, high user acceptance, unusable:             failure
  2. Not on time, not within budget, usable:                                        success

No matter what else happens, if the best your business system project does is to give you back performance similar to what you had without the system, a reasoned executive would say the investment in the system was wasted. It then stands to reason that if the new system delivered worse performance than what you had previously, it too is a wasted investment.

When I talk with some seasoned executives in HIT about the success or failure of their EHR system, I pause for a second waiting for someone to say, “Pay no attention to the small man behind the curtain.” Their standard of measure? See above, Approach 1. Some would have you believe it is heretical to say that spending a hundred million dollars on a system whose usability is poor was a waste of money. Most of those who defend the spend are those who did the spending.

Ask the users if they think the money was well spent. These three quotes came from a physician whose hospital spent $400 million on a name-brand EHR.

  1. “Their (the hospital’s) most expensive resource spends a lot of time doing data entry.”
  2. “The data is very good if you are a patient or an insurance company that wants to sue us.”
  3. “My productivity is still down thirty percent.”

Imagine yourself as a hospital executive and answer the following question. Which of these two pieces of information is more valuable: knowing your EHR passed Meaningful Use or, learning from your users that the EHR is unusable? In HIT, there are two rules:

  1. The usability measure of most EHRs is unacceptable.
  2. Paying more for your EHR than the next guy or gal does not change Rule 1.