Hospital

New thoughts on EHR and ARRA money

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So, there I was, laying out my plans for 2012.  I had started training to become the first person to cross the English Channel on horseback, but I was having difficulty finding a company to sponsor me.  Given my reputation as a water-walker, several firms indicated they would sponsor me to walk it, but I have never been one to do things the easy way.

Scratch the horse idea.

Then it hit me.  I’ve decided to retrace the footsteps of the Norwegian explorer Thor Heyerdahl in his quest to travel from Peru to Pacific Polynesia on a raft made from natural materials.  His book Kon-Tiki narrates his 101 day journey.

But since balsa wood is scarce, I will need some other readily available material I can lash together to build my vessel.  (Have you figured out where this is headed?)

With so many broken EHRs littering the dustbins, I figured why not?  I bought them for pennies on the million and had them shipped to the seaport of Callao.  I hired a few systems integrators to integrate the various platforms; McKesson and EPIC formed the major components of the hull, and several copies of AllScripts served as decking.

Launch is set for April 1 of this year.  My backup plan in case this fails is to use all of the unclaimed ARRA money, convert it into single dollar bills, and lay it on the water in front of me, bill by bill, for 4,000 miles.  I know this is a bit extravagant, but I hate to see all that money go to waste.

Healthcare IT, let’s not lose site of the patient

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It is easy to remove oneself from what is important as we trade metaphorical tomatoes about what is wrong with EHR, what may happen to the healthcare reform, and why the nationwide health information network is DOA.

Debating healthcare IT on the Internet is an esoteric and antiseptic conversation, one with few if any catastrophic implications to anyone other than the person trying to sell a used, $100 million EHR on eBay.

We write about the fact that it is supposed to do something to benefit the patient. Is there a more sterile word than patient? Whether we use patient or patients, we keep it faceless, nameless, and ubiquitous. They do not have to be real for us to accomplish our task; in fact, I think we do our best work as long as we keep them at arm’s length.

[More:]

We calculate ROIs for EHR around people who exist to us only by their patient IDs.

What if these hominoid avatars turned out to be real people? What if indeed?

Recently I learned of a real patient; a friend, 37, mother of three. She has had lots of tests. They call it Myelodysplastic Syndromes. MDS sounds more polite. One would think that because it has its own acronym that might imply good news. It does not.

The thing I like best about Google is knowing that if an answer exists, I can find it. I may have to vary the syntax of the query a few times, but sooner or later I will find what I seek. The converse can be quite disquieting, especially if you happen to enter a phrase like, “survival rates for MDS.” After a few tries I realized that the reason I was not getting any hits to my query had nothing to do with poor syntax. It had everything to do with a lack of survivors.

“Last Christmas” is a rather strange title for a blog. In this instance the title has nothing to do with anything religious. It is simply a line in the sand, a statement with a high degree of probability. Unfortunately, “Last Christmas” does not have the same meaning as the phrase, “this past Christmas.”

My friend has had thirty-eight Christmases. Apparently, MDS is able to alter simple mathematical series. If presented with the numerical series 1, 2, 3. . .37, 38, 39, and if we were asked to supply the next number, we would all offer the wrong answer–40. In her case there may be no next number; the series will likely end with 39. That’s MDS math.

Then there are the three children, each one of them in the same grade as my three children. They will be learning a different version of MDS math. All the numerical series in their lives will reset and begin again with the value of one. First Christmas since mom died. First birthday since mom died. Every life event will be dated based on its relationship to an awful life-ending event.

It will be their B.C. and A.D.

EHR probably has very little value when you break it down to the level of an individual patient. Stalin said something like, “one death is a tragedy, and a thousand deaths is a statistic.” While it is unlikely that he was discussing patient outcomes, the import is the same.

Rule One: There are some awful diseases that will kill people.
Rule Two: Doctors are not allowed to change Rule One.

I guess it goes to show us that as we debate things that we view as being crucial components of whatever lies under the catch-all phrase of healthcare, when it comes down to someone you know who probably is not going to get better, some things do not seem very important.

How to recover your lost EHR productivity

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Success and failure are often separated by the slimmest of margins. Sometimes you have to be prepared to think on your feet to out think unfavorable circumstances. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the puddles from the hardwood flooring, thinking while mopping about how I might answer to my wife if she happened to return to a kitchen that looked like the Land of Lakes. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year can’t be far off.

A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.

A few of you have asked, let’s say we buy into what you are saying, how do you propose we turn around the results of our EHR implementation? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that your EHR investment was wasted. Additionally you cannot hide the fact that your productivity is dropping faster than Congress’ favorability polling.

The first requirement to turn EHR infamy into fame is to halt the slide towards the EHR abyss.  Publically acknowledge that productivity is in the dumpster.  Think of it as an IT 12-step meeting; “Hi, my name is Paul, and my EHR project is killing us.”  See, that was not so difficult.  After all, everyone already knows about the productivity problem.  The only unanswered question is whether or not you are going to man-up and own the problem and own the solution.  If you don’t, they will find somebody who will.

Your EHR implementation broke new ground.  It may be the first time that automating a task has ever made the task take more time rather than less..

And what is the problem that requires fixing?  It is this.  The EHR being used by your doctors and nurses was never designed, it was coded, and that distinction has everything to do with why productivity has dropped.  Not a single business system designer ever researched how your EHR needed to work.  Nobody trained in cognitive psychology or human-computer interaction or content strategists ever watched the doctor-patient-nurse interaction and translated those observations into design specs for your EHR.  Ipso-facto, the amount of time required to complete each patient visit has increased, and since the number of hours in a day remained constant, the number of patients that can be seen in a day has decreased.

The time has come to define a plan to recover the lost productivity.

So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”

 

EHR’s marmalade-and-toast hypothesis

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Les choses son contre nous—things are against us.  EHR is the marmalade-and-toast hypothesis, that the marmalade-side will land on the carpet when the toast falls from the breakfast plate, played out in bits and bytes.  Resistentialism is the belief that inanimate objects have a natural antipathy towards human beings.  If one were to view the marmalade-toast through the glasses of resistentialism one would conclude that the likelihood of the toast laying marmalade-side down increases with the cost of the carpet. So it is with the EHR.  Your expensive EHR is laying marmalade-side down on a very expensive carpet.

EHR has created an air of technostalgia with users yearning for the bygone days when the technology involved a number two pencil and a pad of paper.  Now that you are using your EHR system, do you ever wonder how different the experience of using it would have been if someone had asked for your input about what the EHR should do?  Would merely asking have solved the EHR myopia that was brought about by those who implemented it, implemented it without involving a single systems designer?

That this problem even exists is demonstrated by the fact that to use the EHR required hours of training.  Users sat there like sock puppets listening to the buzzword-bingo put forth by the trainers.  This should have been the clue that none of what they were about to learn was intuitive or self-evident.  The reason they offer EHR training is to explain “This is how you get the system to do what you need it to do,” because without viewing it that way it will not do anything.

The EHR has turned a lot of normally complacent physicians and nurses into stress puppies.  To understand how far amiss the functioning of the EHR is from what the users had hoped it would be all one has to do is observe it being used.  How many doctors and nurses have apologized to a patient during an exam because of something related to the EHR?  “Sorry this is taking so long…If you will just bear with me while I figure out how to do this…When the nurse returns I will get her to show me how to schedule your next appointment.”

If ever there was a time to have employed defensive pessimism, the implementation of EHR was such a time.  Users went into the project skeptimistic, certain it would go badly.  As niche worriers doctors and nurses imagined all the ways that the EHR would under deliver and would make their jobs more difficult, and they watched their stress portfolios rise.  The forgotten task was that nobody mapped out ways to avert the damage.

That this jump-the-shark problem can and should be corrected by something not much larger than a two-pizza team—a team small enough that it can be fed by two pizzas—seems to have escaped the reason of many.

Many are guilty of treating the productivity drop brought on by EHR as a problem with no solution.  If a problem has no solution it is not a problem, it is a fact.  And if it is a fact it is not to be solved, but coped with over time.  There is way too much coping going on.

The EHR productivity drop can be undone.  It will not be undone by redoing the training.  It will be undone by assessing the human factors and user experiences of those using the EHR, by researching how they users want to use it, and by reconfiguring the user interface.

This is not cheap, but it is much less expensive than the cost of loss productivity.

 

EHR: What questions remain unanswered?

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“We need to talk about your TSP reports.”  Office Space—Possibly the best movie ever made. Ever worked for a boss like Lumbergh? Here’s a smart bit of dialog for your Wednesday.

Peter Gibbons: I work in a small cubicle. I uh, I don’t like my job, and, uh, I don’t think I’m gonna go anymore.

Joanna: You’re just not gonna go?

Peter Gibbons: Yeah.

Joanna: Won’t you get fired?

Peter Gibbons: I don’t know, but I really don’t like it, and, uh, I’m not gonna go.

Joanna: So you’re gonna quit?

Peter Gibbons: Nuh-uh. Not really. Uh… I’m just gonna stop going.

Joanna: When did you decide all that?

Peter Gibbons: About an hour ago.

Joanna: Oh, really? About an hour ago… so you’re gonna get another job?

Peter Gibbons: I don’t think I’d like another job.

Joanna: Well, what are you going to do about money and bills and…

Peter Gibbons: You know, I’ve never really liked paying bills. I don’t think I’m gonna do that, either.

One more tidbit:

Peter Gibbons: Well, I generally come in at least fifteen minutes late, ah, I use the side door – that way

Lumbergh can’t see me, heh heh – and, uh, after that I just sorta space out for about an hour.

Bob Porter: Da-uh? Space out?

Peter Gibbons: Yeah, I just stare at my desk; but it looks like I’m working. I do that for probably another hour after lunch, too. I’d say in a given week I probably only do about fifteen minutes of real, actual, work.

I like to think of Peter as my alter-ego.

When I’m playing me in a parallel universe, I’m reading about a surfer dude cum freelance physicist, Garrett Lisi. Even the title of his theory, “An exceptionally simple theory of everything,” seems oxymoronic. He surfs Hawaii and does physics things—physicates—in Tahoe. (I just invented that word; it’s the verb form of doing physics, physicates.)

Ignoring that I can’t surf, and know very little physics, I like to think that Garrett and I have a lot in common. I already know Peter Gibbons and I do. So, where does this take us?

It may be apparent that I look at EHR from a different perspective than many of others involved in this debate; I’m the guy who doesn’t mind yelling ‘fire’ in a crowded theater. The guy who will never be invited to speak at the HIT convention unless they need a heretic to burn for the evening entertainment. I can live with that.

Like Garrett, I too see an exceptionally simple theory in everything, especially when it comes to improving business. It’s not rocket surgery, but then, it was never meant to be. You’ve seen the people running it, they are definitely not rocket surgeons—before someone writes, I know it should be scientists.

Sometimes I like to look at the problem from a different dementia—Word didn’t have a problem with that usage. I look at the productivity loss brought about by EHR and ask myself three questions:

1. Why do people really believe that retraining the end users will help–training them did nothing good for productivity?

2. Why are many hospitals thinking that scrapping their EHR and putting in a new one will improve productivity?

3. Why are their no major initiatives to recapture the lost productivity?

What do you think?

EHR’s Kitchen Table Amateurs (KTAs)

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So I’m making dinner the other night and I’m reminded of a story I heard a while back on NPR. The narrator and his wife were telling stories about their 50 year marriage, some of the funny memories they shared which helped keep them together. One of the stories the husband related was about his wife’s meatloaf. Their recipe for meatloaf was one they had learned from his wife’s mother. Over the years they had been served meatloaf at the home of his in-laws on several occasions, and on most of those occasions his wife would help her mom prepare the meatloaf. She’d mix the ingredients in a large wooden bowl; 1 pound each of ground beef and ground pork, breadcrumbs, two eggs, some milk, salt, pepper, oregano, and a small can of tomato paste. She’d knead the mixture together, shape into a loaf, and place the loaf into the one-and-a-half pound pan, discarding the leftover mixture. She would then pour a mixture of tomato paste and water, along with diced carrots and onions on top of the two loaf, and then garnish it with strips of bacon.

He went on to say that meatloaf night at home was one of his favorite dinners. His wife always prepared the dish exactly as she had learned from her mother. One day he asked her why she threw away the extra instead of cooking it all. She replied that she was simply following her mother’s recipe.  The husband said, “The reason your mom throws away part of the meatloaf is because she doesn’t own a two-pound baking pan. We have a two pound pan. You’ve been throwing it away all of these years and I’ve never known why until now.”

Therein lays the dilemma. We get so used to doing things one way that we forget to question whether there may a better way to do the same thing. Several of you have inquired as to how to incorporate some of the EHR strategy ideas in your organization, how to get out of the trap of continuing to do something the same way it’s been done, simply because that’s the way things are done. It’s difficult to be the iconoclast, someone who attacks the cherished beliefs of the organization. It is especially difficult without a methodology and an approach. Without a decent methodology, and some experience to shake things up, we’re no better off than a kitchen table amateur (KTA). A KTA, no matter how well-intentioned, won’t be able to affect change. The end results would be no better than sacrificing three goats and a chicken.

So, think about how to define the problem, how to find a champion, and how to put together a plan to enable you to move the focus to developing a proper strategy, one that will be flexible enough to adapt to the changing requirements. But keep the goats and the chicken handy just in case this doesn’t work.

EHR: How trained users killed productivity

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In order to complete today’s lesson you will need one prop, your EHR vendor contract. I will pause for a moment—please let us know when you are ready to proceed.  Ready?

Now, turn to the section with all of the commas and zeroes, that is right, it is probably labeled pricing.  Skim down until you see the line item for training.  Got it?  It is a rather substantial number is it not?  And that number is simply the number your vendor is charging you to train your people.  Your actual training costs are probably double or triple that amount.

Why?  Because there is an opportunity cost for each hour of time one of your employees spends in training to use the EHR.  It is an hour they are not spending doing what they were hired to do.  Now I know some of you are thinking ‘Only Roemer will try to make a big deal out of EHR training.  Goodness knows, he has come down hard on everything else associated with EHR,” and you are probably correct.

Gartner suggests that for an average ERP project firms should budget seventeen percent of the total project cost to training end-users.  Seventeen percent.  I can hear the CFOs gnashing their respective teeth.  Knowing that EHR is at least as disruptive to the organization, and will have more users than ERP, let us agree that a good rule of thumb for training costs for EHR is fifteen percent of the total cost of the EHR project.  When you factor in the opportunity cost of 2X the number starts to get pretty big.

We all can name hospitals whose EHR project cost north of one hundred million dollars.  Who are we trying to kid; we can name hospitals whose cost was way north of that figure.  Looking back at your vendor contract I am willing to bet that nobody budgeted training at or around fifteen percent of the total cost of the project.

Is that a bad thing?  No.  Why?  EHR projects are not failing as a result of hospitals not spending enough on end-user training.  I know that statement flies in the face of conventional IT wisdom, but here is my thinking behind that statement.

Training is designed to get the end-users to use the EHR the way the EHR is intended to be used.  And that is not a good thing.  Whoa big fella.  Don’t believe me?  Just look at your EHR productivity numbers.  Didn’t productivity nose-dive once you required your trained end-users to use the EHR?  Still don’t believe me, ask your physicians and nurses.

Why not train everybody again, wouldn’t that help?  What did Einstein say about the definition of insanity?  Insanity is doing something over and expecting different results.  If the hospital already spent fifteen million dollars to train the end-users on the EHR, and the result was a twenty percent drop in productivity, might it not be time to say enough already?

EHR adage 101: When you are in a hole stop digging.

The EHR project summary for many hospitals reads a little like this:

  • EHR cost               $100,000,000
  • Training cost          $15,000,000
  • Opportunity cost $15,000,000
  • Productivity loss 20%
  • Cost of productivity loss—priceless

Face it; you spent millions of dollars to be worse off than you already were.

Today I spoke with the CFO of a hospital that owned one of those hundred million dollar EHRs.  His question to me was whether or not he should hire the EHR vendor or a large, expensive system integrator to help him recapture the productivity loss.  I told him no.  Why?  All the EHR vendor will do is to retrain your people, and you have already proven that training your people to use the EHR brought about the productivity loss.  After all, it wasn’t untrained users who did it.  Why not hire a systems integrator for tens of millions to reimplement the system?  Because I bet you put the system in correctly in the first place.

If training is not the reason productivity is low and a poor implementation is not the reason, what is?  Productivity is low because the hundred million dollar EHR never included a single dollar of resource to design it around how your physicians and nurses function.  Your expensive EHR was built to answer the question of what needs to be done; it was not designed to deal with the issue of how something is to be done.  At best, the only input the hospital had, if it had even this much, was a list of functional requirements that was handed over to a bunch of coders.  I am willing to bet in most cases even this did not happen because all of the EHR code was already written.  The EHR is not productive because it was never designed for your organization.

It is never too late to incorporate design into a business system, but remember, neither IT nor the EHR vendors are designers, and you have already seen their results.

Healthcare Social Media: How to put it to work for you

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A cold wind is blowing in from the north, blowing so hard that at times that the rain seems to be falling sideways, echoing off the windowpanes like handfuls of pea gravel. The leaves from the walnut trees, that had prematurely yellowed, dance a minuet as they slowly make their way to the ground in the woods. It feels like the first day of fall, a day for jeans, a long sleeve shirt, and a pair of long woolen socks. The temperature has nosedived. On a normal day, the first indication of sunrise would have begun to push the darkness from the sky. But today is not a normal day. The clouds are hanging low and gray against the dark sky.

The garage door creaked and moaned as it rose along the aluminum track. Halogen headlights pierced the darkness. Its driver, an unkempt and rather rotund woman in her 40s eased the car down her driveway and proceeded through the still slumbering neighborhood. She was a friendless woman, who along with her husband and daughter kept to herself. The neighborhood children were afraid of her, too frightened to retrieve a ball if it fell into her yard and certainly too scared to Trick-or-Treat at her home.

“Were those your dogs barking? I was asleep,” she screeched at me as she exited the car wearing her oversized pajamas. The site alone was enough to frighten children and a few grown men. “I’m going to find out whose dogs were barking,” she chided. “And when I do, someone will be hearing from me. I took my last neighbors to court because their dog barked. I don’t like children. I don’t like dogs. I don’t like yard work, and I don’t want to be invited to any community activities.” I feel pretty confident she won’t have to worry about being swamped by invitations.

It was actually almost ten in the morning the day she registered her complaint—dawn to some people I guess. Three days later, the letter arrived in the mail. The return address indicated it was from a homeowners association. The letter stated that if we couldn’t control the barking of our dogs that we would be reported to the community board of directors. For second, we didn’t know how to react—then we started to laugh. The reason for the laughter was simple; my wife is on the Board of Directors. It’s like the East German Stasi are alive and well and living in Pennsylvania. I can picture this woman hiding behind her drapes, her little steno pad in hand, recording each and every bark that disrupts her bliss.

She’s a tattletale, a 40-something whose problem solving skills never grew beyond that of a third grader. She lives right next door, 100 feet away. We’ve only seen her three times in the 28 months we’ve lived here. Six months ago she sent us a fax, complaining about something or other. A fax, mind you. To her next door neighbor. This is too easy. It’s social networking run amok. She has become my poster child for bad manners, a benchmark against which all subsequent social networking commentaries will be measured.

There are many good social networking opportunities, especially for large healthcare providers.  Such as?  Do you record the number of patient calls you get each year by call type?  The fully loaded cost of each call is probably somewhere around twenty dollars.  It costs a lot of money each time you answer the phone; do you spend it effectively?

What percentage of those calls are resolved the first time?  What percentage of those calls could be answered  more effectively without the phone? How do you answer a call without a phone?  By having the caller get what they need from some form of social media site.

Imagine that in less than a few months you redesign part of your web site and you develop several YouTube presentations to explain your bills better than any single person could explain it on the phone.  You could provide a similar service for patients who need help contacting their insurance company, and need help filing a claim.  The ROI on social media is significant, and it’s nicer than sending a fax.

Well, that’s it for the moment. I’m off to the store. I think I’m going to buy a third dog.

Patient Experience Management–what is it?

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If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:
E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients
If this were true–this is an illustration, not an axiom–the percentage of complaints in the call centers of an healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. As a number of calls increase the percentage of complaints is likely to increase, and as the number of patients increases there will probably be an even greater increase in the percentage of complaints incurred. I think we can agree that a reasonable goal for a healthcare provider is to decrease the percentage of complaints and perhaps to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers like to assess the issue of Patient Experience Management  (PEM) is by looking at how much money providers throw at the problem. I think some people think that if one provider has 2 call centers, and another provider has 3 call centers, that the provider with 3 must be more interested in taking care of the their patients, and might even be better at PEM.  I don’t support that belief. I think it can be demonstrated that the provider with the most call centers, and most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures increase year after year, and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

PEM is such an easy way to see large improvements accrue to the provider, especially using social media.

AP reports national EHR rollout will fail-now what?

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I just fell out of the stupid tree and hit every branch on the way down. But lest I get ahead of myself, let us begin at the beginning. It started with homework–not mine–theirs. Among the three children of which I had oversight; coloring, spelling, reading, and exponents. How do parents without a math degree help their children with sixth-grade math?

“My mind is a raging torrent, flooded with rivulets of thought cascading into a waterfall of creative alternatives.” Hedley Lamar (Blazing Saddles). Unfortunately, mine, as I was soon to learn was merely flooded. Homework, answering the phone, running baths, drying hair, stories, prayers. The quality of my efforts seemed to be inversely proportional to the number of efforts undertaken. Eight-thirty–all three children tucked into bed.

Eight-thirty-one. The eleven-year-old enters the room complaining about his skinned knee. Without a moment’s hesitation, Super Dad springs into action, returning moments later with a band aid and a tube of salve. Thirty seconds later I was beaming–problem solved. At which point he asked me why I put Orajel on his cut. My wife gave me one of her patented “I told you so” smiles, and from the corner of my eye, I happened to see my last viable neuron scamper across the floor.

One must tread carefully as one toys with the upper limits of the Peter Principle. There seems to be another postulate overlooked in the Principia Mathematica, which states that the number of spectators will grow exponentially as one approaches their limit of ineptitude.

Another frequently missed postulate is that committees are capable of accelerating the time required to reach their individual ineptitude limit. They circumvent the planning process to get quickly to doing, forgetting to ask if what they are doing will work. They then compound the problem by ignoring questions of feasibility, questions for which the committee is even less interested in answering. If we were discussing particle theory we would be describing a cataclysmic chain reaction, the breakdown of all matter. Here we are merely describing the breakdown of a national EHR roll out.

What is your point?  Fair question.  How will we get EHR to work?  I know “Duh” is not considered a term of art in any profession, however, it is exactly the word needed.  It appears they  are deciding that this—“this” being the current plan that will enable point-to-point connection of an individual record—will not work, and 2014 may be in jeopardy—not the actual year, interoperability.  Thanks for riding along with us, now return your seat back and tray table to their upright and most uncomfortable position.

Even as those who are they throw away their membership in the flat earth society, those same they’s continue to press forward in Lemming-lock-step as though nothing is wrong.

It is a failed plan.  It can’t be tweaked.  We can’t simply revisit RHIOs and HIEs.  We have reached the do-over moment, not necessarily at the provider level, although marching along without standards will cause a great deal of rework for healthcare providers.  Having reached that moment, let us do something.  Focusing on certification, ARRA, and meaningful use will prove to be nothing more than a smoke screen.

The functionality of most installed EHRs ends at the front door.  We have been discussing that point for a few months. When you reach the fork in the road, take it.  Each dollar spent from this moment forth going down the wrong EHR tine will cost two dollars to overcome.  To those providers who are implementing EHR I recommend in the strongest possible terms that you stop and reconsider your approach.