Rants & Musings

EHR: What are your Bona Fides?

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The photo comes from my Robert Redford look alike period.

Do you ever awaken wishing you were all you used to think you were before you figured out you weren’t?  Me either.  I’m someone who has these kind of days when it’s best to keep me away from shiny objects.

During college, I spent several summers volunteering for a group called Young Life at their camps throughout the US.  Silver Cliff was one of their camps in the mountains of Colorado.  Each week we’d take in a few hundred high school kids from throughout the US, and give them the opportunity to do things and challenge themselves in new ways; everything from riding horses to rappelling.

The prior summer I was the head wrangler at one of their camps—I had never ridden a horse prior to being placed in charge of the riding program.  This summer is was the person running the rappelling program.  Needless to say, I had never done that before either.

We received a day’s worth of instruction before we were turned loose on the kids.  One of the first things we had to learn was that the ropes and harness, if properly secured to the carabineers and figure eight, would actually keep you from falling to your death.  The first test was jumping from a platform way up in a tree while on belay.  After a few moments of white-knuckle panic, I stepped over the edge and was belayed safely to the ground.

From there, we scouted a place for the rappel, and found two suitable cliffs, each with about a hundred foot vertical drop.  Watching my first rappel must have reminded others of what it would have been like watching a chimp learn how to use tools for the first time.  After several tentative descents, I was able to make it safely to the bottom in a single jump.

Each day we’d run a few dozen kids through the course, ninety-nine percent of whom had never rappelled, or ever wanted to rappel.  To convince them that it was safe and that they could complete it, I would instruct them in the technique as I hung backwards over the chalk face of the limestone cliff.

Each day we’d have one or two kids who wanted nothing to do with my little course.  Occasionally, while on belay, one of them would freeze half way down the cliff, and I’d have to belay down and rescue them.

Once or twice I’d have an attractive female counselor on belay, her knowing that I was the only thing keeping her from being a Rorschach stain on the rocks below.  Scared, and looking for a boost of confidence, “She’d ask, how long have you been doing this?” I’d look at my watch and ask her how many days ago was Sunday.  I viewed it as an opportunity to have a little fun with her—sort of like turning to your friend in the checkout line in 7-eleven and saying loud enough for others to hear, “I thought we agreed we weren’t going to use our guns.” I also hoped maybe even having to go on a heroic rescue.

How long have you been doing this?  That’s seems like a fair question to ask of anyone in a clinical situation.  It’s more easily answered when you are in someone’s office and are facing multiple framed and matted attestations of their skills.  Seen any good EHR or HIT certificates on the walls of the people entrusted with the execution of the EHR endowment?  Me either.  I have a cardiologist and he has all sorts of paper hanging from his wall.  Helps to convince me he knows his stuff.  Now, if I were to pretend to be a cardiologist—I’ve been thinking of going to night school—I’d expect people would expect to see my bona fides.

Shouldn’t the same logic apply to spending millions of EHR dollars?  Imagine this discussion.

“What do you do?”

“I’m buying something for the hospital I’ve never bought.”

“Why?”

“The feds say we’ve got to have it.”

“Oh.  What’s it do?”

“Nobody really knows.”

“How long have you been doing this?”

“How many days ago was Sunday?”

“What’s it cost?”

“Somewhere between this much,” he stretches out his arms, “And this much,” stretching them further.

“Do the doctors want this?”

“Some do.  A lot don’t.”

“How will you know when you’re done if you got it right?”

“Beats me.”

“Sounds like fun,” she said, trying to fetter a laugh.

Sounds like fun to me too.

A Tongue-in-cheeky Editorial: Recess is Over

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(This piece will be more interesting if you can get someone to hum The Battle Hymn of the Republic while you read it.)

A man left his cat with his brother while he went on vacation for a week. When he came back, he called his brother to see when he could pick the cat up. The brother hesitated, and then said, “I’m so sorry, but while you were away, the cat died.”

The man was very upset and yelled, “You know, you could have broken the news to me better than that. When I called the other day, you could have said the cat was on the roof and wouldn’t come down. Then when I called the next day, you could have said that he had fallen off and the vet was working on patching him up. Then when I called today, you could have said the cat had passed away.”

The brother thought about it and apologized.

“So how’s Mom?” asked the man.

“She’s on the roof and will not come down.”

The economy is on the roof and will not come down.

When Washington with an eyes-wide-shut management style gives you lemons, the only thing left to do is to find the humor in it.  Perhaps Thomas Paine was being prescient when he wrote “These are the times that try men’s souls.”  Maybe he should have used the word ‘tire’ instead of ‘try.’  I am reminded of the scene in Young Frankenstein when the next thing heard after Dr. Frankenstein tells Igor “Could be worse…could be raining” was a resounding clap of thunder.

Whoever is trying to fix Recession 2.0 is doing so without a hall pass—what has been tried has defied or defiled the laws of physics.  What had been a vibrant economy stepped off Checkhov’s veranda and bade farewell to the sisters of Prozorova while the sisters

It is raining while Washington scurries around like frightened mice passing out umbrellas and pretending the sun is shining.  Washington has not learned that they can’t put the rain back into the clouds.  The current economic plan—I know there is not one, but let us pretend—reads like a failure’s biography.

And now, with sang-froid calmness, Congress is on its summer recess—could there be a more apropos term to describe their daily activities—as opposed to all of their other recesses.  While there is some debate about whether recess should be canceled, to not so gives me the impression of Nero fiddling while DC burns.

Perhaps the misérables came closest to getting correct the conversation between the electorate and the elected when they caused Marie Antoinette, sans head, to eat her cake.  Their casus belli was the arrogance of the ruling class. We are not suffering as much from Washington’s arrogance as we are from the results of their collective ignorance and failure to lead.

The politicians’ camera-ready soliloquies have all the appeal of a cold omelet.  While some, like the Marines, run to the sound of the gun that is fired, the people in Washington do not.  Instead of running towards the sound of the gun many want to discuss the sound.  Others question whether there really was a gun and question who owned it and whose fault it was, but none are running on our behalf armed with ideas about how to solve the problem.

Is it not better to have tried to lead and to have failed than to have never have tried.  None are leading.  According to the voices in my head, the conundrum facing us seems to be that those in Washington believe that without being reelected they will be unable to lead because they will not be around to do the leading.  The overarching flaw in their understanding of their mission appears to be that instead of leading now, their efforts are always focused on winning the opportunity to not lead in their next term.

Any one of them could get reelected simply by trying to lead us to a solution.  The solution doesn’t even have to work.  Take the crayons out of the Crayola packet and try something.  The time to argue about who started the mess is over–we all own it, let us fit it.

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(This piece will be more interesting if you can get someone to hum The Battle Hymn of the Republic while you read it.)

A man left his cat with his brother while he went on vacation for a week. When he came back, he called his brother to see when he could pick the cat up. The brother hesitated, and then said, “I’m so sorry, but while you were away, the cat died.”

The man was very upset and yelled, “You know, you could have broken the news to me better than that. When I called the other day, you could have said the cat was on the roof and wouldn’t come down. Then when I called the next day, you could have said that he had fallen off and the vet was working on patching him up. Then when I called today, you could have said the cat had passed away.”

The brother thought about it and apologized.

“So how’s Mom?” asked the man.

“She’s on the roof and will not come down.”

The economy is on the roof and will not come down.

When Washington with an eyes-wide-shut management style gives you lemons, the only thing left to do is to find the humor in it.  Perhaps Thomas Paine was being prescient when he wrote “These are the times that try men’s souls.”  Maybe he should have used the word ‘tire’ instead of ‘try.’  I am reminded of the scene in Young Frankenstein when the next thing heard after Dr. Frankenstein tells Igor “Could be worse…could be raining” was a resounding clap of thunder.

Whoever is trying to fix Recession 2.0 is doing so without a hall pass—what has been tried has defied or defiled the laws of physics.  What had been a vibrant economy stepped off Checkhov’s veranda and bade farewell to the sisters of Prozorova while the sisters

It is raining while Washington scurries around like frightened mice passing out umbrellas and pretending the sun is shining.  Washington has not learned that they can’t put the rain back into the clouds.  The current economic plan—I know there is not one, but let us pretend—reads like a failure’s biography.

And now, with sang-froid calmness, Congress is on its summer recess—could there be a more apropos term to describe their daily activities—as opposed to all of their other recesses.  While there is some debate about whether recess should be canceled, to not so gives me the impression of Nero fiddling while DC burns.

Perhaps the misérables came closest to getting correct the conversation between the electorate and the elected when they caused Marie Antoinette, sans head, to eat her cake.  Their casus belli was the arrogance of the ruling class. We are not suffering as much from Washington’s arrogance as we are from the results of their collective ignorance and failure to lead.

The politicians’ camera-ready soliloquies have all the appeal of a cold omelet.  While some, like the Marines, run to the sound of the gun that is fired, the people in Washington do not.  Instead of running towards the sound of the gun many want to discuss the sound.  Others question whether there really was a gun and question who owned it and whose fault it was, but none are running on our behalf armed with ideas about how to solve the problem.

Is it not better to have tried to lead and to have failed than to have never have tried.  None are leading.  According to the voices in my head, the conundrum facing us seems to be that those in Washington believe that without being reelected they will be unable to lead because they will not be around to do the leading.  The overarching flaw in their understanding of their mission appears to be that instead of leading now, their efforts are always focused on winning the opportunity to not lead in their next term.

Any one of them could get reelected simply by trying to lead us to a solution.  The solution doesn’t even have to work.  Take the crayons out of the Crayola packet and try something.  The time to argue about who started the mess is over–we all own it, let us fit it.

A Tongue-in-cheeky Editorial: Recess is Over

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(This piece will be more interesting if you can get someone to hum The Battle Hymn of the Republic while you read it.)

A man left his cat with his brother while he went on vacation for a week. When he came back, he called his brother to see when he could pick the cat up. The brother hesitated, and then said, “I’m so sorry, but while you were away, the cat died.”

The man was very upset and yelled, “You know, you could have broken the news to me better than that. When I called the other day, you could have said the cat was on the roof and wouldn’t come down. Then when I called the next day, you could have said that he had fallen off and the vet was working on patching him up. Then when I called today, you could have said the cat had passed away.”

The brother thought about it and apologized.

“So how’s Mom?” asked the man.

“She’s on the roof and will not come down.”

The economy is on the roof and will not come down.

When Washington with an eyes-wide-shut management style gives you lemons, the only thing left to do is to find the humor in it.  Perhaps Thomas Paine was being prescient when he wrote “These are the times that try men’s souls.”  Maybe he should have used the word ‘tire’ instead of ‘try.’  I am reminded of the scene in Young Frankenstein when the next thing heard after Dr. Frankenstein tells Igor “Could be worse…could be raining” was a resounding clap of thunder.

Whoever is trying to fix Recession 2.0 is doing so without a hall pass—what has been tried has defied or defiled the laws of physics.  What had been a vibrant economy stepped off Checkhov’s veranda and bade farewell to the sisters of Prozorova while the sisters

It is raining while Washington scurries around like frightened mice passing out umbrellas and pretending the sun is shining.  Washington has not learned that they can’t put the rain back into the clouds.  The current economic plan—I know there is not one, but let us pretend—reads like a failure’s biography.

And now, with sang-froid calmness, Congress is on its summer recess—could there be a more apropos term to describe their daily activities—as opposed to all of their other recesses.  While there is some debate about whether recess should be canceled, to not so gives me the impression of Nero fiddling while DC burns.

Perhaps the misérables came closest to getting correct the conversation between the electorate and the elected when they caused Marie Antoinette, sans head, to eat her cake.  Their casus belli was the arrogance of the ruling class. We are not suffering as much from Washington’s arrogance as we are from the results of their collective ignorance and failure to lead.

The politicians’ camera-ready soliloquies have all the appeal of a cold omelet.  While some, like the Marines, run to the sound of the gun that is fired, the people in Washington do not.  Instead of running towards the sound of the gun many want to discuss the sound.  Others question whether there really was a gun and question who owned it and whose fault it was, but none are running on our behalf armed with ideas about how to solve the problem.

Is it not better to have tried to lead and to have failed than to have never have tried.  None are leading.  According to the voices in my head, the conundrum facing us seems to be that those in Washington believe that without being reelected they will be unable to lead because they will not be around to do the leading.  The overarching flaw in their understanding of their mission appears to be that instead of leading now, their efforts are always focused on winning the opportunity to not lead in their next term.

Any one of them could get reelected simply by trying to lead us to a solution.  The solution doesn’t even have to work.  Take the crayons out of the Crayola packet and try something.  The time to argue about who started the mess is over–we all own it, let us fit it.

EHR: the Prefect Problem

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A perfect problem, in its existing state, is unsolvable.  The way most of us handle it is to click our heels together three times and hope it goes away.  We tend to work on imperfect problems, those that can be solved.

One of my college professors—way back when we still had inkwells on our desks—told me that if you cannot solve the problem the way it is stated, it is to your advantage to restate the problem.  I tried this on a final exam; the problem as it was stated was to contrast two philosophers, one of whom, having not read the book, I had no idea who he was. I restated the problem to contrast two philosophers I knew.  He wrote back on my exam saying I had made a nice effort at using the technique but that the philosopher I chose was the wrong one.

What is the difference between the two problem types?  The first step is the ability to understand what makes the perfect problem uniquely unfixable.  Perhaps a few examples would help.

  • The CEO imposed a deadline for the implementation of EHR.
  • CMS Meaningful Use rules do not fit with our operational strategy.
  • If we do not implement EHR by this date, we do not get the money.
  • We must meet Meaningful Use
  • We do not have enough resources from the EHR users to understand their processes.
  • We cannot continue to support these low-margin services
  • We do not have enough time to define our requirements
  • We cannot afford to spend the time required to assess our processes before we bring in the EHR vendor.

What can be done?  The easy answer is to plan for failure and do your best to minimize it.

What is another way to describe the above examples?  They are constraints.  They can all be rewritten using the word “can’t”.  Rewritten, we might say, “We had a chance to succeed, but because of X, Y, and Z we can’t.”  If that assessment is correct, you will fail, or at least under-deliver at a level that will be remembered for years to come.  That’s a legacy none of us wants.

There are a few solutions to this scenario.  You can eliminate the seemingly intractable constraints; the organization can determine to re-implement EHR and hope for different results; or they can simply find someone else to solve the perfect problem.

Experience teaches good leaders really want reasoned advice.  They want the members of the C-suite to tell them what must be done to be successful.  Good leaders do not accept “can’t”—not on the receiving end, not on the delivering end.

Some will argue, “This is the way our organization works.”  Even if that is true one must consider what is needed to make an exception to the constraint.  Would you accept this logic from a subordinate?  Of course not.  You’d demand a viable solution.  If you are being constrained in your efforts to solve a perfect problem, perhaps it is time to restate the constraints.

Maybe the solution to the perfect problem is to restate it in a manner that makes it imperfect—solvable.

 

Some Tips on Blogging

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Several of you have written asking me to share some of my ideas and tips about blogging, so here goes.

Observation leads me to believe many bloggers do not know a good sentence from a turnip.  If I find myself rewriting someone else’s sentence instead of reading their blog, I quit reading.

Another observation I have made is many people who consider themselves writers do not know how to tell a story.  Now, I am not talking about Mark Twain kinda’ storystelling, just the basics.

Writing is difficult—those who would have written “writing is hard”—just proved my point.  The task is difficult; the object is hard—eighth grade English class.

If you want to write well, be prepared to work.  One of my favorite sayings is “if I had more time I would have written less.”

My overriding rule to myself is not to be redundant.  If all I am doing is writing about the same topic as others, or offering the same perspective, I am just wasting air.  I go out of my way to be contrarian, and I do so for the same reason.

Just because Word or dictionary.com warns you that the word you just typed is not a word is irrelevant.  If it helps tell the story, use it.  Also, only people with small minds believe there is only one way to spell each word.

I write conversationally, and I do so purposefully.  I find it helpful to use tools—analogies and allegories to tell a story, to set a stage, or to draw in the reader.  I use other such devices, but I do not know the names of devices any more than I know participles.

There are those who would guide your writing by telling you to make an outline before you type your first word.  Bollocks.  I don’t make an outline before I speak to someone, so why would I do so when I write to someone?

Now that I think about it, the last sentence sums up how I write.  I write to one person; you, not to an audience.  I guess I write this way believing that I will never get the words right enough to please a thousand strangers, but I can probably get them close enough to please one person.

I use the same approach for public speaking—I never use notes, figuring that if I don’t already know the material well enough to speak extemporaneously—I just spelled that correctly; surprised the heck out of me—I ought to let someone else speak.  Some people think that is really brave however, others just think I am being lazy.

Getting ideas can be a bit of a bugger.  I find the writing comes easier than the ideas.  If you have kids, write about what you observe and then try to tie their antics into the story you are telling.

I keep a Word file titled ‘blog ideas.’ I email myself ideas and new words, and jot down things on scraps of paper.  Keep a jar of adverbs on your night-stand ‘cause you never know when you may need them.  I know the New York Times is written at the level of a ninth grader, but I give my readers credit for being more curious that the average ninth graders.

If you find yourself wanting to slam someone in your blog, slam yourself and figure out how to tie that in to the point you are making.  If you slam others, you will lose others.

There are those who would have you believe that your writing must pass the artificial tests prescribed by the politically correct mentalists, and that your writing must wrestle with really big questions–like whether Joyce ever used a semicolon after 1919.  I have never had a politically correct moment and do not intend to start any time soon.  You can get away with this by using humor, but using humor is even more difficult than knowing what a participle is—sorry for the preposition.

If any of this is helpful, feel free to steal it.  If not, thank you for reading.

Jihad Joe: EHR Vendors, What’s not to like?

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When competing hypotheses are equal in other respects, the principle recommends selection of the hypothesis that introduces the fewest assumptions and postulates the fewest entities while still sufficiently answering the question. It is in this sense that Occam’s razor is usually understood.  There is no corollary that works with EHR vendors.

What if we look at HIT vendor selection logically?  Have you ever noticed at the grocery store how often you find yourself in the longest checkout line, or when you’re on the highway how often you find yourself in the slowest lane?  Why is that?  Because those are the lines and lanes with the most people, which is why they move the slowest.

If you are asked in which line is Mr. Jones, you would not be able to know for certain, but you would know that the most probable option is the one with the most people in it.  You are not being delusional when you think you are in the slowest lane, you probably are, you and all the people in front of you.  The explanation uses simple logic.  It’s called the anthropic principle– observations of our physical universe must be compatible with the life observed in it.

It can be argued that the business driver which shapes the software selection process of some is the aesthetics of efficiency, a Jihad Joe approach to expediency.  Buy the same system the hospital down the street bought, the one recommended by your golfing buddy, or the one that had the largest booth at the convention.  Or, one can apply the anthropic principle, rely on the reliability of large numbers and simply follow the market leader.

Might work, might not.  My money is on might not.  There’s still plenty of time to do it right.  If that fails, there will always be time to do it wrong later.  Of course, you can always play vendor darts.  If you do, you should sharpen them so they’ll stick better.

Which EHR should you buy? Read & Learn

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Last week I attended the If It Walks, You Can Hunt It convention.  Hunters—no gatherers allowed—convened from across the globe.  People whose firms make things for hunters to use to kill things were scattered across five hundred thousand square feet of convention floor, offering everything from how to properly kit yourself in trendy camo prior to eviscerating the last Dodo bird using only a rudimentary can opener, to hunting deadly hamsters with Stinger missiles.

I was interested in learning about hunting deer, not because I like to hunt deer, but because I like to eat it, and until they start selling deer at my local convenience store, my options are limited.  Apparently there are numerous weapons one can use to hunt deer.  There is the eco-friendly method whereby the eco-mentalist warrior lies naked under a pile of compost and recycled Priuses—not sure if the plural should be Prii, and tries to lay waste to the poor beast by making it listen to an entire Celine Dion CD.  However, this degree of cruelty is banned in fifty-one states.

Of course, there are the more traditional methods using bullets and arrows, although not in combination as this would be redundant.

I did notice a large crowd of mono-eyebrowed men listening to a pitch in one corner of the hall.  I made my way in that direction and listened to a very enthusiastic salesman talking about how to hunt deer with a fly swatter.  “You will find,” he continued “more people will choose to hunt deer with a fly swatter than with any other device.  It is less cumbersome, it is inexpensive, and you do not have to feed it.”

I thought about his agreement as I watched hundreds of men line up to buy fly swatters.  “Has anyone ever killed a deer with a fly swatter?”  I asked.

“Of course not,” the salesman replied in hushed undertones.  “Just because more people buy it does not mean it does what they want it to do.

Segue.  EHR Vendors.  “We have more EHR customers than anyone else.”

“How is your productivity?”  Asked the cynic.

Do not listen to the man selling fly swatters.  It really does not matter which of the top five EHR products you buy.  What matters is how well you install it.

Bzzzzzz….This fly has been bugging me all day.

Shift Happens: A little IT knowledge can kill you

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It almost killed me.  Curious?  I lived in Colorado for a dozen years, and spent almost every other weekend in the mountains, fly-fishing, skiing, climbing, and painting—any excuse would do.  Colorado has 54 peaks above fourteen thousand feet.  In my twelve years I climbed most of them.  Some solo; some with friends.

I owned almost everything North Face made, including a down sleeping bag with thermal protection which would have made me sweat on the moon and a one-burner propane stove which cranked out enough BTUs to smelt aluminum.  Two of my friends and I felt we needed a bigger challenge than what Colorado’s peaks offered.

The dot in the photo is me.

We decided on a pair of volcanoes in Mexico, Pico de Orizaba and Popocatépetl—both over 18,000’.  We trained hard because we knew that people who didn’t train died.  We trained with ropes, ice axes, carabineers, and crampons.  One day in early May we arrived at the base of Pico de Orizaba.  The man who drove us to the mountain made us sign the log book, that way they’d know who they were burying.  After a six hour ride from a town with less people than you’d find inside a rural K-Mart, we were deposited at a windowless cinder-block hut—four walls, tin roof, dirt floor.  Base camp.

Before the sun rose we were hiking up ankle-deep volcanic ash; gritty, coarse, black sand.  The sand soon turned in to thigh-deep snow.  We took turns breaking trail, stopping only long enough to refill our water bottles by hand-pumping glacier melt from the runoff in the bottom of cobalt blue ice caverns carved from solid glacier.

Ice Cave we used to collect drinking water

Throughout the trek we passed crude wooden crosses stuck into the ash and snow, serving as grim reminders of those who’d gone before us.

We knew the signs of pulmonary edema, but were reluctant to acknowledge them when we first saw it.  It was about one the following morning when we decided to make camp.  My roommate was having trouble concentrating, and his speech was slightly slurred.  When we asked him if he was ill, he responded much like one would expect an alcoholic would respond when asked if he was okay to drive.  “I’m fine.”

We were at 16,000’, the wind chill had the temperature slightly warmer than a Siberian winter, and the snow made for a whiteout.  The slope seemed to be at about forty-five degrees.  The sheet of ice upon which we stood was slicker than a car salesman selling Corvairs out of his basement.  I removed my tent pole from my pack and placed it on the ice—we were going to camp for the night.  We watched in intellectual confusion as the tent pole gained speed quickly and hurtled down the side of the volcano, quickly lost in the darkness.

Realizing my friend wasn’t doing well, and that I was now feeling somewhat punkish, we made the difficult decision to turn back.  The only survival for edema is to lose enough altitude until you reach one where there is enough air pressure to force the oxygen into the blood.  Eighteen hours of climbing.  Pitch black.  We headed down, me carrying my pack and his, he with our friend.

We arrived at the block hut around four that morning.  By then I was no longer making any sense.  My roommate had recovered, but I had become somewhat delirious—at least that’s what they told me later.  Not knowing right from left or wrong, I was determined to keep walking.  The two of them took turns laying on me to prevent me from sneaking out during the night.

A little knowledge almost killed us.  The scary thing is that we knew what we were doing.  We had trained at altitude, had a plan, worked the plan.  The plan shifted.  Sometimes shift happens.

It happens more with IT.  Much more.  Do you know what the chances are of any IT project ‘working’ that costs more than$7-10 million?  (Working is defined as having a positive ROI, a project that was delivered on time, withing the budget, and delivered the expected results.) (IT includes workflows, change management, training, etc.)  Two in ten.  Twenty percent.  That’s below the Mendosa Line—non baseball fans may have to look up that one.  Remember the last industry conference you attended?  Was it about EHR?  Pretty scary knowing most of them were planning for a failure.

Put your best efforts, your brightest people on planning the EHR.  Make them plan it, then make them plan it again, and then make them defend it, every piece of it.  If they don’t convince you they can do it in their sleep, you had better redo it.  Do they know what they’re planning to do?  Do they know why they’re planning to do it that way?  If they haven’t done it before, this may not be the best time for them to practice.  EHR is not a good project for stretching someone’s capabilities.

Planning is difficult to defend twice during the life of a large program.  First, at the beginning of the program when the C-Suite is in a hurry to see people doing things and signing contracts.  The second time planning is difficult to defend is the moment the C-I-Told-You-Sos are calling for your head for having such an inadequate plan.

How would I approach planning an EHR program for a hospital?  If we started in September, my goal would be to;

  • Have a dedicated and qualified PMO in place in four weeks
  • Begin defining workflows and requirements by October (I’m curious.  For those who have done or are doing this piece, how many FTE’s participated?  I ask because i think chances are good that your number is far fewer than I think would be needed.)
  • Issue a requirements document by mid-January.
  • Be able to recommend a vendor by the end of March.

That seems like a lot of time.  There are plenty who will tell you they can do ‘it’ quicker.  Good for them.  The best factor in your favor right now is time.

Reread this in a year and see where you are…

…See, I told you so.  Anyone want to go hiking?

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

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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.

PEM can be a number of things; Patient experience management, Patient equity management, and Patient expectation management. In this instance, we are discussing the latter. 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, their expectationbar 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.