Here are links to two presentations I wrote on the topic. Please let me know what you think.
http://www.slideshare.net/paulroemer/should-you-meet-meaningful-use
http://www.slideshare.net/paulroemer/nyc-health-20
Best – Paul
Rants & Musings
Just for fun, I started a new blog
The blog has nothing to do with work. It’s title is Lamentations of a Drive-by Muse: My Apocryphal.
The link is http://paulroemer.wordpress.com/
I look forward to reading your comments.
Paul
What are you selling? Is anyone buying?
If your answer is nothing, let me challenge you to rethink your position.
A good professional is always selling, and it has nothing to do with whether or not it is in your job title. The question that must be answered is are others buying what you are selling?
First and foremost, you are always selling yourself. You do that by how you are dressed, how you comport yourself, how you express your ideas in a document, presentation, email, or over the phone, to how you relate to others in a meeting or social setting. This is happening even when you are not aware of it. Moreover, guess what—you are either doing a good job of selling yourself, or a poor job. Those around you are either buying what you are selling—you—or they make the decision not to buy.
They make their purchase decisions quickly. Are they buying what you are selling? Maybe not.
What are you selling? Here’s a list of what is available to others to purchase.
- You
- Competency
- Willingness to listen
- Ability to communicate
- Interpersonal skills
- Your organization
- Your ability to serve as an ambassador
- Its honesty
- Its friendliness
- Your ideas
- Belief in them
- Are they half-baked
- Willingness to take risks
- Ability to lead
- Are they convincing
- Your approach
- Does is fit within the boundaries of your organization
- Does it account for the others’ ideas
- Can you deliver
When a meeting concludes, whether it was with a patient or a group of colleagues, someone either did or did not buy what you were selling.
Failed EHRs: Maybe it’s the jeans
There I was listening to NPR while driving home from the airport. Their lead story was about Levis’ announcement of a new line of custom-fit jeans for women. They developed the line after studying the shapes of more than 60,000 women—I guess that is good work if you can get it. Levis somehow determined that 80 percent of all the women on the planet fall into three distinct categories, Curve IDs. (Does that mean the other twenty percent fall into roughly 3,752,841 body types?)
Why did Levis go through all this effort? Apparently 87 percent of women say they can’t find a pair of jeans that fits them. Fifty-four percent stated they try on at least ten pairs of jeans before deciding on a pair. I concluded from a few of the things I read on Google that for those whom believe the jeans don’t fit—must be a lot of bad jeans out there.
There are a lot of failed EHR implementations out there. How do I know that to be true? I studied the shapes of more than 60,000 failed EHR implementations and, guess what? They fall into three failure categories—EHR Failure IDs—lack of due planning, lack of process change, and lack of user involvement. I guess it’s difficult to get an EHR to fit…Kind of like finding a good pair of jeans.
Here’s my take on the matter. Chances are that whatever EHR does not seem to fit in Provider A is fitting just fine at Provider B. How could that be? Same system. Same code. The functionality of the system has not changed in the time since it was selected. Maybe the reason the EHR does not fit is not the fault of the EHR.
That said, there are those of you who think I may tie this discussion back to the discussion of the jeans, and write something like, “Maybe the reason the jeans do not fit is not the fault of the jeans.” I may be dumb, but I am not that dumb.
Kind Regards,
Paul
Paul M. Roemer
Managing Partner, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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EHR: when you are in a hole, stop digging
I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school. The camp was for high school students of varying backgrounds and their counselors. On more than one occasion, the person on the other end of my rope would freeze and I would have to talk them down safely.
Late in the day, a thunderstorm broke quickly over the mountain, causing the counselor on my rope to panic. No amount of talking was going to get her to move either up or down, so it was up to me to rescue her. I may have mentioned in a prior post that my total amount of rappelling experience was probably no more than a few more hours than hers. Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her.
The sky blackened, and the wind howled, raining bits of rock on us. I remember that only after I locked her harness to mine did she begin to relax. She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.
That episode reminds me of a story I heard about a man who fell in a hole—if you know how this turns out, don’t tell the others. He continues to struggle but can’t find a way out. A CFO walks by. When the man pleads for help the CFO writes a check and drops it in the hole. A while later the vendor walks by—I know this isn’t the real story, but it’s my blog and I’ll tell it any way I want. Where were we? The vendor. The man pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.
I walk by and see the man in the hole. “What are you doing there?” I asked.
“I fell in the hole and don’t know how to get out.”
I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole. “Why did you do that? Now we’re both stuck.”
“I’ve been down here before” I said, “And I know the way out.”
I know that’s a little sappy and self-serving. However, before you decide it’s more comfortable to stay in the hole and hope nobody notices, why not see if there’s someone who knows the way out?
Merely appointing someone to run your EHR effort doesn’t do anything other than add a name to an org char
Kind Regards,
Paul
Paul M. Roemer
Managing Partner, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
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Contact me: paulroemer paulroemer paulroemer
EHR: Got a few minutes?
Before we get started…I am on the plane yesterday, sitting in a middle seat. An attractive woman fights her way down the aisle and sits next to me. Five minutes later it happens again. I felt like I had just won the USAir lottery. The man who sits directly in front of me looks like the Taliban’s Mullah Omar, including the black turban. Across the aisle is a screaming four-year-old. For a second, I thought about executing a Jet-Blue exit strategy and deploying the emergency exit slide.
At a business dinner last night, we got into a conversation about driving habits. The young woman across from me was explaining an incident for which she was pulled over for driving 94 miles an hour in her convertible Mercedes. When the police officer asked her why she was driving so fast she told the officer she was trying to dry her hair.
Let’s roll back a few hours. Got the time?
I am sitting at the airport holding my two two-dollar bottles of water scanning my options from among the array of shops. Fast food. The guy sitting across from me looked like he was eating Jell-O made from kelp.
Sundries. Clothing, MSNBC—when did they get into retail? Shoes, laptop devices, every possible cell phone accessory. A nifty collection of watches at some kiosk.
A few years back I bought a Polar watch to help me track my running. It measures heart rate, altitude, temperature, distance, rate, laps, and tracks and calculates my average pace. What do I use it for when I run—the time—never took the time to learn how to use the other functions?
I also have a few antique watches—the kind you have to wind. The only thing they do is keep time. Then there is my Tag Heuer—a name I am not able to pronounce. It is waterproof down to 300 meters. I quit diving four years before I even found the watch—but it seems to work well in the shower. It appears to have more Jewels in the back than the crown of a dictator from a third-world country.
The next time you are in a meeting, or sitting across from someone, look at their watch and see if you can read the time. You may be able to estimate how much they paid for it by how much exposure it has on their wrist. Some watches look like they have enough gadgetry to have been a prop in a Bond movie. Altimeter, lunar phases, time zones in countries to which they have never traveled. The face of the watch is so decked-out with features and functions that have nothing to do with keeping time that you may as well settle for knowing the moon is waxing.
My Polar watch is an allegory for EHRs that are failing and underperforming. Lots of features, very little utility. EHR implementations that do well seem to be those designed to go shallow on functionality and cut a wide swath utility. Those that go deep into the functionality and narrow on utility are gathering dust.
Is there any good news? Sure—when you turn on the computer monitor, you’ll notice a little digital clock in the lower right corner. You may have wasted $200 million on the EHR, but you’ll always know the right time.
Kind Regards,
Paul
Paul M. Roemer
Managing Partner, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
My profiles:
Contact me: paulroemer paulroemer paulroemer
EHR: What’s in it for me?
Field of Dreams. Best guy movie of all times? Forgive me, but I don’t usually start my day being PC. (I don’t end it that way either.) Pardon me as I wipe a tear. Want to have a catch Dad? For those of you whose minds don’t immediately shift to the shooting of Old Yellar, you’re on the wrong blog.
First there’s the field. It’s green. The same green God made when he made green. There’s a cross-hatched pattern to the cut, the white lines brilliantly juxtaposed. The air smells of peanuts and dogs.
Baseball, as spoken by James Earl Jones:
“Ray. People will come, Ray. They’ll come to Iowa for reasons they can’t even fathom. They’ll turn into your driveway, not knowing for sure why they’re doing it. They’ll arrive at your door, as innocent as children, longing for the past. Of course, we won’t mind if you look around, you’ll say. It’s only $20 per person. They’ll pass over the money without even thinking about it: for it is money they have and peace they lack…And they’ll walk off to the bleachers and sit in their short sleeves on a perfect afternoon. They’ll find they have reserved seats somewhere along one of the baselines where they sat when they were children, and cheered their heroes. And they’ll watch the game, and it’ll be as if they’d dipped themselves in magic waters. The memories will be so thick, they’ll have to brush them away from their faces… People will come, Ray…The one constant through all the years, Ray, has been baseball. America has rolled by like an army of steamrollers; it has been erased like a blackboard, rebuilt, and erased again. But baseball has marked the time. This field, this game, is a part of our past, Ray. It reminds us of all that once was good, and it could be again. Ohhhh, people will come, Ray. People will most definitely come…”
This is the twelve step nightmare for anyone who had a father. At the end of the movie there is a dialog between Ray Kinsella and Shoeless Joe Jackson:
Ray Kinsella: I did it all. I listened to the voices, I did what they told me, and not once did I ask what’s in it for me.
Shoeless Joe Jackson: What are you saying, Ray?
Ray Kinsella: I’m saying? What’s in it for me?
Amidst all the confusion, amidst all the regulation, where does that leave you? Ask, “What’s in it for me?” What’s in it is whatever you put into it. Drive this process to your benefit. Build an EHR because it benefits you, not because it’s forced upon you.
EHR Short Cuts
How able are you to conjure up your most brainless moment—don’t worry, we aren’t on the EHR part yet.
As I was running in San Diego I was passed by a harem of seals—Navy Seals. Some of them were in better shape than me, I couldn’t judge the fitness of the others as they ran by me too fast. That got me thinking. For those who having been regular readers, you’ll know this is where I have a tendency to drive myself over a cliff.
Seeing the Seals took me back to my wistful days as a cadet at the US Air Force Academy. Coincidentally, my hair looked then a lot like it looks now. One of the many pastimes they tossed our way for their amusement and our survival was orienteering; sort of map reading on steroids. One night they took us to the foothills of the Colorado Rockies, paired off the doolies, gave us a set of map coordinates, a compass, map, and flashlight. The way training worked, those who proved to be the fastest at mastering skills fared better than those who weren’t. Hence, there was plenty of incentive to outperform everyone; including getting yourself to believe you could do things better than you could, sort of a confidence building program.
We were deposited in a large copse—I’ve always liked that word—of trees—I don’t know, but it seems adding trees to the phrase is somewhat redundant. We had to orient ourselves and then figure out how to get to five consecutive locations. The sun had long since set as we made our way through the treed canyon and back up a steep ravine. After some moments of searching we found the marker indicating we were at point Able. The group started to examine the information that would direct our journey to point Bravo.
While they honed their skills, I was examining the map, taking some bearings with the compass, and trying to judge the terrain via the moonlight. My roommate, a tall lanky kid from Dothan, Alabama asked why I didn’t appear to be helping.
“Look at this,” I replied. “Do you see that light over there, just to the right of that bluff? I think I’ve found us a shortcut.”
“What about it?” Asked Dothan.
“If my calculations are correct, that light is about here,” I said and showed them on my map. “It can’t be more than a hundred yards from point Delta.”
“So?”
“So why go from Alpha to Bravo to Charlie to Delta, if we can go right to Delta from here? That will knock off at least an hour.” I had to show my calculations a few times to turn them into believers, but one by one they came aboard. The moon disappeared behind an entire bank of thunderheads. We were uniformly upbeat as we made our way in the growing blackness through the national forest. Unlike the way most rains begin, that night the sky seemed to open upon us like a burst paper bag.
“Get our bearing,” I instructed Dothan. As it was my idea, I was now the de facto leader. As we were in a gully, getting our bearings required Dothan to climb a large evergreen.
“I don’t see it,” he hollered over the wind-swept rain squalls. I scurried up, certain that he was either an idiot or blind.
“Do you see the light?” They asked me. I looked again. Checked my map. Checked my compass. “It has to be there,” I yelled.
A voice floated up to me. To me I thought it probably sounded a lot like the voice Moses heard from God as he was building the Ark. (Just checking to see if you’re paying attention.) “What if they turned off the light?”
I almost fell out of the tree like an apple testing the laws of gravity. What if someone had turned off the light? There was no ‘what if’ to consider. That is exactly what happened. Some inconsiderate homeowner had turned off their porch light and left us stranded.
Fast forward. We were lost, real lost. We didn’t finish last, but we did earn extra exercise the next day, penalized for being creative. Who’da thunk it?
Short cuts. When they work, you’re a headliner. When they fail, chances are you’re also a headliner—writing the wrong kind of headlines. I hate being redundant, but with EHR we may be dealing with the single largest expenditure in your organization. It will cost twice as much to do it over as it will to do it right. If you haven’t done this before—I won’t embarrass anyone by asking for a show of hands—every extra day you add to the planning process will come back to you several fold. There may be short cuts you can take, but planning should not be one of them. How much should we plan? How long should it take? Who should participate? We will look at each of those questions in some detail. For now, let’s answer those three questions with; more than you think, longer than you’ve planned for it to take, and different skills than you’re currently using.
Paul M. Roemer
Managing Partner, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com
My profiles:
My blog: Healthcare IT Strategy My thoughts on “One EMR Vendor’s View of Meaningful Use”
My thoughts on “One EMR Vendor’s View of Meaningful Use”
What if Meaningful Use turns out to be no more relevant to EHR than agriculture is to bull fighting? Even worse, what if meeting Meaningful Use (MU) damages a provider’s business?
There is a world of difference between EHR and Meaningful Use. It is a square and rectangle proposition. All instances of MU require an EHR. However, all EHRs do not require MU.
When I evaluate changing a business strategy, I like to do so under the following test:
- Is it necessary?
- Is it sufficient?
For the strategy to be beneficial to an organization it must be both necessary and sufficient.
Let us begin with whether MU is necessary. Necessary for what—to make the provider’s caring for its patients better; to make their business better. MU does neither. Implementing an EHR, though it is optional, is important. So is meeting MU. The last time I checked, there were no long queues in Madison to grab an EHR, and no people camping outside of the CMS offices to be first in line for the ARRA money. MU does not pass the test of necessity.
Does MU pass the test of sufficiency? Is it adequate? Again, for what? The way to answer this question is to ask, “How would your organization implement EHR if MU did not exist”? your answer to this question defines what is necessary.
Much of MU has to do with how EHR is implemented and adopted. For all the attention vendors are paying to MU, it is a bit nonsensical. Most of the onus on MU is tied to the provider. The most the vendor can offer is that they will not do anything to encumber a provider’s chances of meeting MU. Many of these vendors are the ones who will require you to implement an upgraded version of their product in order to meet certification.
In closing, will the MU money run out? On the contrary, I think they will not be able to give it away.
EHR: Pass me the wrench
Watching some work with EHR is a lot like watching a chimp trying to use tools for the first time.
Pale Rhino Consulting 