Hospital

The Services We Offer

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What we have here is a failure to communicate, and unfortunately the failure is mine.

It has been a week of learning.  According to one of the thought leaders in healthcare, whom I’ve known for more than a year, he does not understand what services my firm offers hospitals, and he thinks others may have the same problem.

He suggested it would be helpful to spell it out, service by service.  So here goes.

Program Management:

We work with hospital CIOs and COOs as their advocate by serving as the program management officer (PMO).  We define functional requirements, select software, and manage IT applications vendors for enterprise applications like EHR, CRM, and ERP.

Operational Efficiency:

We work with the hospital C-suite to identify, define, and implement a unique set of business processes and business rules, eliminating duplicated processes and those which do not add value.  The output is a single set of best practices processes and rules.

Change Management:

Enterprise applications will alter business processes and impact most employees and patients.  Without a rigorous change management effort, the impact of the application on the hospital’s processes and people will be a disaster.  We figure out what must change, how it will change, and how to pull it off.

Patient Relationship Management (PEM):

This is the hospital equivalent of Customer Relationship Management (CRM).  On a PEM project we define the requirements, select an application vendor, define the processes, and manage the project to completion.

Please let me know if you need help with any of these.

Have I erred on the side of stupidity?

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Twice in the span of twelve hours, I received unsolicited and honest feedback from two individuals whose opinion I value, about my attempt to share with you my thoughts about a range of issues concerning the business of healthcare.  One came from my father; since he holds that role he is allowed to offer unsolicited advice any time he wants, and I am entitled to listen to his advice.  The other bit of advice came in response to an email I wrote.  He is one of you, and he wrote the following:

I agree with many of your points and disagree with a few of them, and regardless, it’s a compelling, buzz-worthy angle that gets a lot of re-tweets and what have you, but I think it’s worth considering how these positions are affecting your ability to land consulting gigs in HIT. People want to hire consultants that they think will help them succeed, that think positively and pragmatically, and that are problem solvers (as opposed to problem recognizers): “we can do this together…I’ve had success before and if you let me, I will help you succeed…” that kind of thing. Just my 2 cents. It’s a trade-off, I know. You want to be honest and forthcoming, so I see the dilemma.

This was like being hit by lightening twice in the same day, so I thought I should take time to consider their input.  The feedback led me to ask if there are others who share the same opinion.  Is it possible my ramblings are about as well received, as I would be if I were to walk the streets of Tehran wearing a Star-of-David t-shirt?  What portion of readers drag my postings to their email folder entitled, “Kill him Later”?

Some believe a more effective use of consultants would be to compost them and use the energy generated to power a weed-eater.

Please permit me a few lines to try to explain my thought process for writing in my particular style and tone.  Before I began expressing my opinions on healthcare, I began reading what I considered the best healthcare blogs and editorials.  The first thing I learned is that I had nothing to offer of value on the clinical side of healthcare, so I focused my efforts on discovering what business issues providers dealt with, and which ones might benefit from receiving professional help—a consultant’s twelve-step program for problem solving.

I did a lot of homework; in addition to reading, I interviewed more than a hundred healthcare executives.  What was my takeaway?  One CEO told me the most needed skill on the business side of healthcare was “adult supervision”.  I did not charge in with uncorroborated opinions.  I used LinkedIn discussion groups to pose hundreds of questions about possible problems, studied the responses, and used them as a basis to formulate ideas about what was broken and what needed to be done to fix it.

I should note many of the blogs I read shared two traits; they often stated the same facts available on other blogs, and they rarely seemed to question the efficacy of the impact many of the Healthcare IT initiatives would have on operating healthcare’s business model—ours is not to wonder why, ours is but to do or die.

Not wanting to be superfluous, when I came to the fork in the road, I chose not to take a me-too position.  Instead, I threw metaphorical tomatoes and tried to get people interested in looking at the business model in a more disruptive manner.  Often, I did this by taking extreme positions on issues in the hope I might hit a hot button, and someone would think, “Perhaps we ought to talk to the tomato thrower and see if he can help us”.

My approach may prove to be less than brilliant.  What’s your take?

Tidbits

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I rarely write on Sunday, but with my wife and the kids in Miami for the month while I serve as the EHR Czar, I thought I would share a few thoughts with you.

I went to a reception a few nights ago with some healthcare executives in the Philly area.  It was one of those events whereby the caterer thought the chi-chi crowd would do back-flips over canapés of fava beans stuffed with cheese made from the breast milk of yaks.  One of those events where you can’t complain without being as obvious as someone walking the streets of Tehran wearing a Star of David T-shirt.

Sometimes  you get an ah-ha about life which is so profound it must be shared with friends.  I got one of those today while making a breakfast of smoked salmon, capers, and New York bagels.  I retrieved a clean plate from the dishwasher.  I knew when I finished breakfast I would have to empty the dishwasher–a task that always irks me.  The lights brightened, the sky opened, and I learned something most consultants would try to kiss their elbows to understand.

We have two dishwashers–machines, not people.  Naturally, that cuts down on the number of times we have to empty the dishwasher.  Mind you, my discovery only works for people whose spouse is out T town and for homes who have two dishwashers.  Here’s the deal.  Wash the dishes in one dishwasher.  Sooner or later you get hungry.  You think about going to the cabinet to grab a plate and the it occurs to you that you already have a clean plate in the dishwasher; along with a drinking glass, and utensils.  Why not use them?  And after dining–and this is the revelation–place the newly soiled dishes in the other dishwasher.  Guys, this re-engineering of the traditional kitchen processes eliminates the need to ever empty the dishwasher.  Everything in the dishwasher is caught in an infinite loop, eliminating the need for kitchen cabinets.

This new process brought to mind an episode of ‘Happy Days’ when The Fonz explains to Ritchie how bachelors make a salad to conserve wasting time on extraneous business processes.  The Fonz told Ritchie to hold the head of lettuce above the sink and pour salad dressing on the lettuce, thereby eliminating the need for a plate.

Where were we?  That is unplanned an alliteration.  Given that, how do I make this worth your time?

Permit me to address the C-suite.  Does it seem to you that those people in your firm are paid for working hard, or for delivering results?  I think they are paid for working hard, for looking like they are working hard, for doing the things people in their esteemed position ought to be doing.

They are busy.  Why?  Because those who are not perceived as being busy are fired.

Who at your firm is delivering results?  Who is defining what the results needs to be?

Someone needs to define the ah-ha moments for your organization.  Somebody needs to take charge, to know that it is possible not to unload the dishwasher, to know that there is no value in stuffing the fava beans with the cheese.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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Is the C-suite fiddling while EHR burns?

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There is an adage in the military—different spanks for different ranks.  If speaks to a double standard, the less egregious their punishment for similar offenses, similar misjudgments.

We see that every day in business, and we see it a lot in healthcare, especially in hospitals.  Physicians are held accountable for medical errors.  Hospitals pay millions for malpractice insurance knowing that mistakes will be made and people will be held accountable for their mistakes.

But what about on the business side?  Who is held accountable for business mistakes?  An acquisition that failed to deliver.  An expensive new service offering that bled the company dry.  A decline in the number of patients. The failure of a major IT initiative to deliver results.

Take EHR.  Some of you are saying, “Yes, please take it.”

  • Around sixty percent of the large EHR projects have failed in one respect or another
  • Most will not receive ARRA incentives
  • A large number of hospitals are on their second implementation of EHR
  • Some have productivity losses of thirty percent

Who is going to be fired for the two hundred dollar misstep?  The board?  Never.  The CEO—no.  The COO or CFO?  Unlikely.  The CIO?  That is the safe bet.

Did the CIO authorize the expenditure?  Nope.  Did the CIO get all the dollars needed to be successful, all the user support?  Unlikely.

In most cases the CIO has all of the responsibility and only some of the authority.  There are a handful of people in each organization tasked with the oversight of the large project.  They are the ones who should be asking the right questions, the ones who should be demanding answers.

A failed project, a failed strategy should not come as a surprise.  The only people who will be wearing EHR 2.0 T-shirts are those who authorized EHR 1.0.  How come these individuals are not accountable?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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What benefit is there to meeting Meaningful Use?

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Commercials bug me.  Big surprise.

You have probably seen the commercial for the Sleep Number Bed.  A bare mattress, a glass of wine on the mattress, a bowling ball is dropped on the mattress.  The glass of wine does not spill.  That makes some people rush out and buy the mattress.  Why?  For the security in knowing that just in case they leave a glass of wine on their mattress and then happen to drop a bowling ball on it, the wine will not spill.

That dog don’t hunt unless you happen to be opening a bowling alley/Motel 6.  The company is trying to entice you on the merits of doing something by asking you to make the leap of faith by equating the bowling ball falling on the bed to having your spouse get in or out of the bed without disturbing your sleep.

A feint.  A maneuver designed to distract or mislead you from the real purpose.  Meaningful Use.  Certification.  A feint.  Designed to distract or mislead you from the reason you need an EHR.  The terms of Meaningful Use, that is, what is meaningful to your organization should be set by your organization, not some national standard applicable to every hospital in the country.  Hospitals are not ubiquitous—the Meaningful Use standards are.  How can a single set of standards be in line with what you require?

What’s the feint?  Certification, cash incentives, Regional Extension Centers.  A full court press trying to get hospitals to do what the feds want it to do in order to meet their goal of a nationwide interconnected healthcare system.

What proof, other than a check, has anyone offered that you benefit from meeting Meaningful Use?

Should you try to meet Meaningful Use?  I think not.  There is no ROI, and the full set of standards have yet to be published.  What should you do?  Have a glass of wine, or better yet—go bowling.  Don’t forget to buy one of those snazzy bowling shirts.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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Are hospitals making the the same mistake as BP?

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“The time has come,” the Walrus said, “To talk of many things: Of shoes and ships and sealing-wax, of cabbages and kings—…

A lot of the strategic issues in healthcare are not easily explained.  One issue can be explained to a fifth-grader.  So, get your crayons out and follow along.

Fifty-some days and counting.  Say it with me—BP.  In many respects healthcare’s approach to social media is analogous to BP’s—the major difference is that neither the payors, pharma, nor the providers has yet to wipe out an entire geography—but the week is not over yet.

BP is offering an MBA in how not to use social media.  Nobody is queuing up on Amazon to buy the book, “BP’s ten pointers on crisis management.”

The funny thing about disasters is being able to schedule them in Outlook.  There are no pop-ups fifteen minutes before the big bang reminding you to get ready—“pipeline blows up in 15 minutes.”

We both know, sooner or later you will have one.  While yours may not crater the shrimping industry, it may be enough to do some serious damage to your business.  Most hospitals have a risk management group.  BP has one.  The mission statement of risk management is to assess and mitigate risks.

BP’s group probably had a plan in place to address a number of risks—risks like OPEC, an expansive war in the middle east, a tanker collision.  Apparently, they overlooked the risk of having a blowout a mile under the ocean.  Who’da thunk it?

If you Google “oil spill” there are fifty million hits.  Add “BP” to the search and the results narrow to a mere forty million.  That toothpaste is never going back in the tube.  People who can’t find the Gulf of Mexico on a map know that BP ruined it.  Thirty years from now people will still know the name of the firm that poisoned the Gulf, destroyed businesses, ruined vacations, made people sick, and cratered home sales along hundreds of miles of shoreline.

No matter what type of disaster BP could have faced, they demonstrated they were not prepared.  Even if it is proven that the disaster was not BP’s fault, it is too late to change their ownership of it.  Nobody is ever going to delete those forty million Google pieces linking BP to failure.  If BP hired a thousand workers whose only job was to try to counter each piece of negative media it would take them decades.

What is the one word to describe BP’s social media strategy?  LATE.

There is no useful social media strategy worth anything that begins after a disaster, none worth anything that begins after a misstep, after a faux pas.  Dictionary.com defines a faux pas as a social error—a boo-boo.

Unlike Meaningful Use, a good social media strategy can have an almost infinite ROI.  A good social media strategy, in addition to adding revenues and capturing patients, can help assuage the bleeding.  A good social media strategy played out in advance creates allies.

Let us look at this from the perspective of large healthcare providers.  What types of unfavorable events could negatively affect a hospital?

  • A medical disaster
  • Fraud
  • Medical errors
  • Reform
  • Scandal
  • Medical malpractice
  • Natural disasters
  • A data breech

While all negative events are not the same, many aspects of a good social media strategy apply regardless of the type of problem.

There are two major components of a good healthcare social media strategy:

  1. It should be pro-active.  Your social media strategy should be building goodwill each day.  Google the name of your hospital and see how many hits you get.  Next, see how many thousands of those hits are attributable to people outside your organization—too many to count.  You are already late.  People are already posting videos and writing about you.
  2. It should be reactive.  Make sure your “What are we going to do now?” account has a positive balance.  At the very least make sure you can push a button and unleash a plague of social media “I feel your pain” initiatives.

I’d wager a hospital could develop an outstanding social media strategy for less than one-tenth of what it pays in legal fees.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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How the C-suite sees the CIO

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This link is to my latest post for healthsystemCIO.com.  http://healthsystemcio.com/2010/06/10/how-the-c-suite-sees-the-cio/

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

A Perfect Metaphor

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Few things are perfect, and when you find something that is, it is worth examining.  One thing that is perfect is baseball, at least some aspects of it.

Think with me for a minute. 1845.  How much has changed since then?  Just about everything.  Do you know what has not changed—the distance between the bases—90 feet?  This distance may seem insignificant or inconsequential.

In the last 165 years the distance between the bases remained unchanged.  Equipment changed, improved.  The players got bigger, faster, and stronger.  It never dropped to eighty-nine feet; it never jumped to ninety-one feet.

To those who follow baseball, have you noticed how close many of the plays are at first base, or the closeness of the steals of second base?  Can you imagine what would happen to the game of baseball if the distance was shortened to eighty-nine feet?  Almost everyone stealing second base would be safe.  If the distance was ninety-one feet they would all be out.

Somehow, 165 years ago those people got it right, got it absolutely right.  Something as simple as a measurement along a dirt path has stood the test of time.  There are not even any discussions about trying to improve it.

Remember the Titanic?  If one measured all the time spent in its design, and all of the time it sailed before it sank, if you were a betting person you would have bet on the boat.  Reasonable people would have bet on the boat.  You would have been a fool to have bet it would have sunk.

You know what; the Titanic’s sinking was not a fluke. The laws of physics and ship design did not suddenly cease to work.  Do not blame the iceberg.  The Titanic was designed to sink—otherwise it would not have sunk.

What is often misjudged in business is the ill-informed notion that just because something has not collapsed it is not broken.  Hospitals are starting to collapse.  The business model of most of them almost ensures that left unchanged, many, many more will collapse.  They have been designed to collapse.  Just because they have yet to collapse does not mean they won’t, all it means is that they have not—yet.

Few things are perfect.  What discussions there are about the business model are not about improving the model, they are about cutting costs.  What do you have when there are no more costs to cut?  You have a less costly dysfunctional model.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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Strategy Millstones, should that read Milestones?

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If you like adventure, here’s a site to check, http://www.jfk50mile.org/.  This is an annual event whose origin came about during the cold war.  Fortunately for both of us, the entry date has already passed.  The thought behind the JFK fifty-mile hike/run was that because of the possibility of a nuclear attack, each American should be in good enough shape to cover fifty miles in a day.

I participated in the event twice—I wrote participated because to state that I ran the entire way would be misleading— and I can state with certainty that almost no Americans are close to being able to complete this.  The event is run in the fall starting in Boonsboro, Maryland.  It takes place along the Appalachian Trail and the C&O Canal and various other cold, rain soaked, and ice and leaf covered treacherous terrains.

We ran it in our late teens or early twenties, the time in your life when you are indestructible and too dumb to know any better.  One of my most vivid memories of the event was that on the dozen or so miles along the mountain trail, leaves covered the ground.  By default that meant they also covered the rocks along the trail, thus hiding them.  That we were running at elevation—isn’t everyone since you can’t not run at at least some elevation, (that may be the worst sentence every written) but you know what I mean—meant the prior night’s rain resulted in the leaf covered rocks being sheathed in black ice.  That provided a nice diversion, making us look like cows on roller skates—roller blades had yet to catch on outside of California.

There were several places along the trail where the trail seemed to fork—I’m not going to say and I took it—and it wasn’t clearly marked.  Runners could easily take the wrong fork (or should that be Tine?).  I think it would have been helpful had the race organizers installed signs like, “If you are here, you are lost.”  Hold on to that thought, as we may need it later.

Some number of hours after we began we reached the C&O Canal, twenty-six miles of flat terrain along the foot path.  It’s difficult to know how well I was doing in the fifty-mile race, in part because I had never run this distance and because there we no obvious mile markers, at least so I thought.  Then we noticed that about every five and a half to six minutes we would pass a numbered white marbled marker that was embedded along the towpath.  Mile stones.  At the pace we were running, we anticipated we would finish high in the rankings.  As fast as we were running, we were constantly being passed, something that made no sense.  That meant that a number of people were running five minute miles, which we knew they couldn’t do after running through the mountains, or…Or what?

The only thing we knew with any certainty at the end of the day was that the markers with which we used to determine our pace and measure how far we’d run were not mile markers.  We never figured out why they were there or how far apart they were, but we greatly underestimated their distance and hence our progress.

It doesn’t really matter whether you call them mile stones or milestones.  What matters is whether they serve a valid purpose.  If they don’t, milestones become millstones.  Milestones are only useful if they are valid, and if they are met.  Otherwise, they are should’ a, could’ a, would’ as—failure markers, cairns of missed goals and deliverables.

How are your milestones?  Are they valid?  What makes them valid?  Are they yours, or the vendors?  All things to think about as you move forward.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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How to calculate Meaningful Use’s ROI

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Just to make sure we are all turned to the same page in our Cliff Notes on Meaningful Use, today’s conversation is, “There is no “R” in ROI.”

Are you familiar with the Abilene paradox?  It is a paradox in which a group of people collectively decide on a course of action that is counter to the preferences of any of the individuals in the group.  It involves a common breakdown of group communication in which each member mistakenly believes that their own preferences are counter to the group’s and, therefore, does not raise objections.

I think it occurs more often than we think.  Try to recall the last meeting you attended in which you really disagreed with something that was said.  Chances are you knew some of the others in the meeting well enough to know they also disagreed.  The reason you know they also disagreed is because you had discussed the topic.  However, none of you raised your disagreement during the meeting.  Why?  Because you did not want to rock the boat.

It is similar to a pseudoconsensus.  Pluralistic ignorance.  These create a bystander effect—people are more likely to speak out about an issue when they are alone with someone than when others are present.

After further consideration I think we must consider the very real possibility that there is no ROI for Meaningful Use.  I write this in all sincerity.  Healthcare executives march in lock-step or group think to achieve the myth of finding an ROI for Meaningful Use.  The ROI is healthcare’s quest for the Holy Grail, albeit without the Monty Python sound track.  They cannot proceed without one, so they set the target, figure out what data will demonstrate that they have hit it, and disregard the reams of data that does not support the ROI.

What if the government came out with a standard stating all hospitals ought to buy, install, and use a fifty million dollar transplant device that also flosses the patient’s teeth?  This initiative is “optional”, but the government will pay the hospital a two hundred thousand dollar rebate.  There are several types of transplant flossers—the ones that deliver that fresh mint taste cost extra.

If we were having a business discussion about the ROI for the transplant device, healthcare executives would be foaming at the mouth about how impossible it would be to calculate an ROI, and rightly so.  They would argue all hospitals are different, they have different cost structures, the devices are all different.

The standards for Meaningful Use are arbitrary.  The standards were developed by people who do not need to meet an ROI.  There was no mandate in the development of those standards to create standards which when met would yield an ROI.  Any attempt to force an ROI will naturally differ in a number of ways:

  • by provider—size, structure, offering, geography
  • by their interpretation of Meaningful Use
  • by which EHR they implemented
  • when they began the implementation
  • how well they implemented the EHR

Somebody somewhere may hit a positive ROI on Meaningful Use, just like somebody playing darts may hit a bull’s eye.  Any positive ROI will be accomplished more out of chance, and from having fit the data to a predetermined ROI rather than measuring the ROI against its true impact.

Implementing an EHR can be very good for a hospital.  However, it should be a business decision for the hospital based on the same set of business rules the hospital would use to justify any other large expenditure.  If the hospital achieves an ROI it will not be because of having followed an arbitrary set of standards.  Any ROI for an EHR will come from having done it correctly.  Hitting the figure any other way means two things; it was a coincidence, or you are in for trouble down the road.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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