Rants & Musings

The impact of ACO on financial systems

Posted by

0

This is my latest post on healthsystemCIO.com

http://healthsystemcio.com/2011/02/08/the-rough-road-to-interoperable-financials/

Why people buy an EHR

Posted by

0

Do you ever wonder why people buy drills?  Because they need a drill?  No.

They buy drills because they don’t sell holes.

Why buy an EHR system? Because you need an EHR?

I hope you have a better reason than that.  If you’re interested, I sell holes.

Nietzsche on HIT Strategy

Posted by

0

The problem with being a consultant is not everyone wants their responses packaged in the same manner I tend to deliver them.  I communicate best visually, pictorially.

Asked what I want for dinner, I respond with a 3-D bar graph.  Forty-five percent of me wants pasta, thirty percent wants roast beef—a year over year increase of seven percent, but not a statistically significant sample size—and one hundred and twelve percent of me wants whatever she is willing to cook—which means I do not have to cook.

There are two kinds of consultants and, I am the other kind.  ‘Nuff said.  On a side note, as I keep telling the police, I am not the person responsible for holding giraffe fights in the linen section of Neiman Marcus.  Nor am I the guy with the collection of taxidermist-stuffed German World War II soldiers in my basement.

When one reviews the value of a healthcare IT strategy—if your organization does not have one click (http://www.disney.com) and you will be taken to a site to make more valuable use of your time—in order for it to be worth more than graffiti on an overpass (plebian) the plan must have a plan.  It also helps if the strategy at least pretends to be strategic.

The stigmata of most strategic plans is they are neither strategic nor plans.

If there is one thing a strategy should be able to address it is to be able to answer why, to be able to answer what benefit the execution of said strategy will deliver.

More than fifty percent of hospitals will not have a written IT strategic plan.

More than half that do have strategic plans will not pass the value test.

Let us suppose for a moment a hospital has what they believe to be a real HIT strategic plan.  Does that document contain answers to the following questions?

  • Implement XYZ EHR.  Why?  Why XYZ?  What benefits will the hospital receive?  Few if any will formalize benefits ahead of time because they can be held accountable when those benefits are not delivered.  Is it safer to simply check the box for having “completed” the implementation?
  • Meet Meaningful Use.  Ditto.
  • Accountable Care Organization.  Ditto.
  • ICD-10.  Ditto.
  • Family Experience Management.  Ditto.

Maybe Nietzsche knew more about IT strategy than he has been credited.  “All things are subject to interpretation.  Whichever interpretation prevails at a given time is a function of power, not truth.”

 

My proposed addition to healthcare reform

Posted by

0

Now that at least parts of healthcare reform are back on the table, or perhaps under the bus, as I await my appointment as EHR Czar, I got to thinking about what other aspects of healthcare might be reformed.

It occurred to me that our system can fix almost anything we throw at it.  We are capable of fixing things that affect one person in a hundred thousand.  So, what can the US healthcare system not fix—other than EHR?  Things that afflict one hundred thousand out of one thousand.

Those are what I would like Congress to fund; the simple everyday minutias that make me feel gobsmacked each time I walk out of the front door and into the apocalypse of those in need of healing.  I stopped for a coffee this morning, and completed the transaction with a mute.  I do not know whether she was legally mute or just being her ill-mannered self, but she managed to complete the entire transaction without uttering a single sound, not even a grunt, a hand gesture, or a wayward glance in my direction.

I have reached my point of no return when it comes to those around me choosing to act rudely or unsociably.  Manners are free.  It costs nothing to exhibit good manners.  Unfortunately, it apparently costs nothing to exercise bad manners.

Maybe bad manners are an illness.  People cut off, flip off, and rip off others without giving it a second thought.  There are days when I feel as though the Seven Deadly Sins are alive and well and having a resurgence.  Pride, greed, envy, lust, sloth, anger, and gluttony.  I am surprised nobody has added anything to the list, but it is not from lack of effort.

I had thought about pushing for healthcare legislation to place more funding towards curing hair loss—not due to any personal insecurities surrounding that issue.  But the more I thought about it the more I felt how much better we would be as neighbors if someone invented a civility pill—take two in the morning twenty minutes before eating.

I have made it my mission to go out of my way to talk to people, especially those who do not wish to speak, those who glance the other way as you pass them on the street.  I must admit, sometimes I do it just because I know it will make them uncomfortable.  It costs nothing to say hello.

And so, as I await my appointment as EHR Czar, or to be the Grand Poobah of one of those Middle Eastern countries lacking poobahs, I am practicing civility.

 

EHR Failure Factors–step away from the computer

Posted by

0

There are days when it doesn’t pay to be a  serial malingerer, and when it does, the work is only part time, but I hear the benefits may be improving as I think I heard somebody mention healthcare is being reformed.

I don’t know if you are aware of it, but there are actually people who have taken an Alfred E. Newman, “What, me worry” attitude towards EHR.  For the youngsters in the crowd, Alfred was the poster child for Mad Magazine, not Mad Med.

Just to be contrarian for a moment–as though that’s out of character for me–most providers have no need to fear–does this happen to you?  You are writing aloud, trying to make a point, and the one thing that pops into your mind after, ‘there’s no need to fear’ is “Underdog is here.”

Anyway, since many providers haven’t begun the process, or even begun to understand the process, there is still time for them to lessen the risk of failure from an EHR perspective.  Many don’t want to talk about it, the risk of failure.

Here’s another data set worth a look (The Chaos Report).  They went a little PC on us calling them ‘Impaired” factors.  EHR impairment.  Step away from the computer if you are impaired, and take away your friend’s logon if they are.  These are failure factors.

Project Impaired Factors % of  the Responses
1. Incomplete Requirements 13.1%
2. Lack of User Involvement 12.4%
3. Lack of Resources 10.6%
4. Unrealistic Expectations 9.9%
5. Lack of Executive Support 9.3%
6. Changing Requirements & Specifications 8.7%
7. Lack of Planning 8.1%
8. Didn’t Need It Any Longer 7.5%
9. Lack of IT Management 6.2%
10. Technology Illiteracy 4.3%
11. Other 9.9%

My take on this is with overall “failures” so high, several respondents could have replied to “all of the above.”  Also of note is that these failure reasons differ from the ones listed previously.

Who knows, maybe if we multiply them by minus one we can call them success factors.

 

EHR-Do not use as a flotation device

Posted by

0

EHR potentially will offer a number of benefits.  It won’t offer much at all if you don’t install it correctly.

However, EHR is not a panacea.  Without having a detaile understading of the business problems you are trying to solve, it may not be of much more value than a Xerox machine.

Can you make color copies with your EHR?

 

The Physics of EHR

Posted by

2

To read and complete this post you may use the following tools; graph paper, compass, protractor, slide ruler, a number two pencil, and a bag of Gummy Bears—from which to snack.  The following problem was on the final exam in my eleventh grade physics class.  Let us give this a shot and then see if we can tie it into anything relevant.

A Rhesus monkey is in the branch of a tree thirty-seven feet above the ground.  The monkey weights eight pounds.  You are hunting in Africa, and are three hundred and twenty yards from the monkey.  You have a bolt-action, reverse-bore (spins the shell counter-clockwise as it leaves the gun barrel) Huntington rifle capable of delivering a projectile at 644 feet per second.  The bullet weighs 45 grams.  The humidity is seventy percent, and the temperature in Scotland is twelve degrees Celsius.

At the exact moment the monkey hears the rifle fire it will jump off the branch and begin to fall.  Using this information, exactly where do you have to aim to make sure you hit the monkey?

I used every piece of information available to try to solve this.  I made graphs and ran calculations until there was no more data left to crunch, computing angles and developing new formulas.  I calculated the curvature of the earth, and the effect Pluto’s gravitational pull had on the bullet.

The one thing that never occurred to me was that since the monkey was falling to the ground, so was the bullet—gravity.  The bullet and the monkey both fall at the same rate because gravity acts on both the same way.  So, where to aim to hit the monkey?  Aim at the monkey.

All of the other information was irrelevant, extraneous.  The funny thing about extraneous information is that it causes us to look at it, to focus on it.  We think it must be important, and so we divert attention and resources to it, even when the right answer is staring us in the eye.

Attempting to implement EHR is a lot like hunting monkeys.  We know what we need to do and yet we are distracted by all of this extraneous information that will hamper our chances of being successful with the EHR.  Two of the most obvious distractions are Meaningful Use and Certification.  The overarching goal of EHR is EHR; one that does what you need it to do.  If the EHR does not do that, everything else has no meaning.

 

What do processes have to do with EHR success?

Posted by

12

As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Let’s agree for the moment that workflows can be parsed into two groups—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs). (I read about this concept online via Sigurd Rinde.)

An example of an ERP industry is manufacturing. Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.

ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.

How can you tell what type of process you are trying to incorporate in your EHR? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss ERP and BRP in the same sentence with EHR? The reason is simple. The taxonomy of most, if not all EHR systems, is that they are designed to support an ERP business model. Healthcare providers are faced with the quintessential square peg in a round hole conundrum; trying to get BRPs into an ERP type system. Since much of the ROI in the EHR comes from being able to redesign the workflows, I think either the “R” will be sacrificed, or the “I” will be much higher than planned.

What do you think?

 

Family Experience Management–not just the Patient

Posted by

0

If you are at all like me, when you need information on a topic, you go to Google.  Moreover, if the information you seek does not appear on Google, my mindset tells me the information does not exist.  Google is perceived as the repository of all things written since a caveperson—although I do not think cavepersons are thought of as being politically correct—painted the design of the first iPad on the wall of the cave with the foreskin of a newt.  If a particular idea or bit of information is not on Google, I tend to think the bit for which I am looking does not exist.

Because of the breadth and width of all the collected data, it is difficult to come up with a data request for which there is no response.  Experience shows even if you search on a meaningless phrase, Google will return to you several links that match.

Until yesterday, at least for the search I entered—Family Experience Management (FEM).  Of all the billions of bits of information, my search yielded one hit.  Being curious, I clicked on the link, and the result did not even include the phrase.

So, we are entering unchartered territory, defining a new concept.  This is a little like getting to name a new planet.

Patient Experience Management (PEM) is what got me thinking about the FEM concept, or the lack of the concept.  As we discussed per the McKinsey study, PEM is at the top of the mind of most hospital CEOs and COOs for the next several years.  The study also reported that although PEM is of such high priority, few hospitals are doing anything about PEM because hospital executives do not know who within their organization “owns” the patient.

Ignoring for the moment that this says something about one’s ability to lead, the value of a PEM initiative is it leads to patient retention, lower costs, and is good for business.  PEM, as I look at it, is not limited to streamlining the ER, or allowing patients to park closer to the hospital.  Good PEM enhances and improves every interaction the patient has with the hospital.  The more interactions your PEM program touches, the more benefits to the hospital; at least that is the theory.

But, what if there is more to it?  Is there a way to bring about more benefit by redefining and subsequently implementing a PEM program?  I think there is.

Unlike other services people purchase, healthcare, purchased via a hospital, is purchased and “used” collaboratively; patients, family, and friends are all involved in many aspects of the service.  People other than just the patient help with scheduling appointments, transportation, visiting, care, picking up medications, talking with doctors and nurses, billing, and interfacing with payers. It is kind of like MCI’s Friends and Family program, only the bill is much larger.

So, when hospitals begin to think through how to ‘manage’ the patient experience, managing the patient is but one of the stakeholders they ought to address.  The other interesting takeaway from looking at FEM instead of simply PEM are the social CRM and social networking implications.  As the number of stakeholders increases, so does the size of the social network that is willing to make their experience with the hospital the talk of the town.

 

EHR’s Gordian knot

Posted by

0

There were four of us, each wearing dark suits and sunglasses, uniformly walking down the street, pausing at a cross-walk labeled “consultants only”—I think it’s a trick because a lot of drivers seem to speed up when they see us. We looked like a bad outtake from the movie Reservoir Dogs. We look like that a lot.

Why do you consult, some ask? It beats sitting home listening to Michael Bolton or practicing my moves for, So You Think You Can Dance, I tell them.

Listening to the BBC World News on NPR whilst driving, there’s one thing I always come away with—they’re always so…so British. No matter the subject—war or recession—I feel like I should be having a proper pot of tea and little cucumber sandwiches with the crusts removed; no small feat while navigating the road.

Today’s conversation included a little homily about the Gordian knot with which the company Timberland is wrestling, questioning whether as a company Timberland should do well, or do good. (Alexander the Great attempted to untie such a knot, and discovered it had no end (sort of like a Möbius strip, a one-sided piece of paper–pictured above. (For the truly obtuse, among which I count myself, the piece of paper can be given a half twist in two directions; clockwise and counter-clockwise, thereby giving it handedness, making it chiral—when the narrative gets goofy enough, sooner or later the Word dictionary surrenders as it did with chiral.))) I’m done speaking in parentheses.

Should they do well or good? Knowing what little command some people have of the English language, those listeners must have wondered, why ask a redundant question. Why indeed? That’s why I love the English, no matter the circumstances they, they refuse to stoop to speaking American.

Back to Gordo and his knot. That was the point of the knot. One could not have both—sorry for the homonym. Alexander knew that since the knot had no end, the only way to untie it was to cut it. The Gordian knot is often used as a metaphor for an intractable problem, and the solution is called the “Alexandrian solution”.

To the question; Well or good. Good or evil. Are the two choices mutually exclusive? For an EHR? They need not be. The question raised by the BBC was revenue-focused (doing well) versus community or green-focused (doing good). My question to the reader is what happens if we view EHR with this issue as an implication, a la p→q.Let’s review a truth table:

if P equals if Q equals p→q is
define requirements increase revenues TRUE
play vendor darts increase revenues FALSE
ignore change management increase revenues FALSE
no connectivuty increase revenues FALSE
new EHR software increase revenues FALSE
change processes increase revenues TRUE
eliminate waste increase revenues TRUE
decrease redundancy increase revenues TRUE
Strong PMO increase revenues TRUE

From a healthcare provider’s perspective the answers can be surprising; EHR can be well and good, or not well and not good.  The Alexandrian solution for EHR is a Alexandrian PMO.

Have your people call my people–we’ll do lunch.