Rants & Musings

Why do you think projects fail?

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Again on the project failure?  Yes.  Why?  Trying to head it off at the pass.  Source, The Bull Report.

Failure_Cause_Survey.264

Fifty-seven percent of failures are due to bad communication.  What’s that?  Poor grammar?  No.  Not enough meetings?  Doubtful.

It’s about PMO.  A hired gun?  Perhaps.  An advocate who will manage the vendor on your behalf.  What’s the rest of the hired gun’s job description?  All the blue stuff in the graph..

The good news is that being a bad dresser will not hurt the project.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

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Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The Services We Offer

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

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

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

Program Management:

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

Operational Efficiency:

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

Change Management:

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

Patient Relationship Management (PEM):

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

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

Do you need to fire Ferguson?

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It may be time to fire Ferguson.

I was listening to Imus the other day as he was interviewing the famous promoter, Jerry Weintraub.  The promoter relayed a story about one of his clients, John Denver.  Mr. Denver was constantly complaining about a number of things on one of his European tours, and he demanded the promoter come speak with him.  Here’s a replay of the conversation.

“Yes. Well, he was in Europe, and he was on tour. And everything was wrong. He hated everything. He hated the venues. He hated – the airplanes were no good. The sound systems were no good. Everything was no good. And he said to me, you know, I’m going to fire you; everything is wrong here. I said, yeah, I know, I know.

I sat down with him; I said, John, everything is going to be fine. He said, why? Why? I said, because I fired Ferguson. He said, why did you fire Ferguson? Why? What does firing him – going to do? I said, he’s been responsible for all the things that you’re troubled by: the hotels, the sound system, the venues, da, da, da, da. And he said, it’s going to be OK now? I said, yes, I’m putting other people in. Great.

And that evening, Denver and I went out to have something to eat. At dinner, I said to him, John, you know, I feel really terrible about firing Ferguson. He said, why? I said, because it’s not like you and it’s not like me. And John Denver said to me, I agree with you; it’s not like us. What can we do to help the guy? It’s really not like me. I got to help him. I said, I’ll put him in another area in the company. He’ll be fine. We’ll take good care of him. He said, that’s great, I feel so much better. Of course, there never was a Ferguson.”

Sometimes you need to shake things up a bit.  Do you need to fire Ferguson?

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

Have I erred on the side of stupidity?

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

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

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

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

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

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

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

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

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

The most relevant EHR/EMR piece you will ever read

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According to the New England Journal of Medicine, somewhere north of fifty percent of EHR implementations fails.  Your odds of success are no greater than the flip of a coin.

What if there is a tool whose use can stop the failure of most EMR system implementations?  The purpose of this post is to let you know that there is a definitive solution to help small providers, clinics, IPAs, and hospitals.

What tasks of the EMR process is the primary cause for failure?  They are the tasks that are under budgeted, neglected, haphazardly addressed, or addressed by people who have no earthly idea how to perform them.

They are the same tasks that cause systems projects in other industries to fail.  If you do these tasks wrong, nothing else you do will make any difference—do-overs cost twice as much as your first failure.

The laundry list of those tasks is:

  • Defining your requirements—for physicians, nurses, staff—all of them.
  • Putting those requirements into an operable framework.
  • Ranking the requirements in a way to enable you to pick a good solution.
    • Technology Evaluation
    • Clinical Workflow Evaluation – Analysis of current clinical workflows.
    • Gap Analysis – Comparing current technical capabilities to desired capabilities.
    • EMR/Practice Management needs evaluation
    • ARRA Incentive Estimation
    • Qualified EMR vendor list
    • Vendor competitive bid assessment
    • Hardware requirements

I recently asked a hospital CEO, “What would you have done differently regarding your EHR selection?”

Here is a paraphrase of his response.

  • Invested much more time in understanding what system we should select and how we would use it.
  • My peers assumed someone else had already done all the up-front stuff (see the above list), and they selected their system solely on what others were using.  Alternatively, they picked a system based on a golf course conversation or something they saw at a trade show.

How many of your business and clinical requirements do you need to meet for your EHR selection to have any chance of succeeding?  The best answer is “All of them”.  How many requirements are needed to define your needs; one hundred, two hundred?  Not even close.

Try this exercise.  Search Google for “CRM RFP” or “ERP RFP”.  There are hundreds of useful responses.  Now search Google for “EHR RFP” or “EMR RFP”.  There are no useful responses.  (If you cannot find something on Google, it often means it does not exist.)  The healthcare industry is usually very good at sharing useful information.

I’ve been coaching executives for thirty years about how to get these tasks right.  In doing so, I developed something that made the software selection task winnable.  (This piece is not a Tony Robbins narrative, it is not about me; I am not selling anything.)

Here is what I did.  I built a Request for Proposal (RFP) for CRM and ERP.  I started with 1,000 requirements for each.  I license it to clients and work with them to edit it, to add new requirements, to delete requirements that did not apply to their organization.  They would use the result to select the application best suited to their firm.

This process never failed to benefit my clients.  I would take whatever new requirements they created and add them to my RFP.  My RFP became more robust.  Each time the RFP was issued I collected the responses from each of the vendors and built a database of what their applications could deliver.  I now have a few thousand functional and technical requirements, and up to date responses on what the applications vendors could deliver.

Why did I build this RFP?  The answer is simple.  I needed to create a reason for a firm to hire my firm instead of hiring one of the name-brand multi-national consulting firms.  The RFP served as a cost differentiator.  Instead of spending a million dollars to hire a name-brand firm to develop something from scratch, they could be months ahead, and at a lower cost by using a proven tool.

Therefore, here’s my point.  There is a firm that built a tool similar to mine, a tool to add to the probability of you selecting the best EMR/EHR for your firm.  It will not guarantee your success, but it will significantly reduce the chances of failure.

Clearly, even if you select the right system there are still many opportunities to fail.  The converse is that if you select the wrong EHR, it will fail.  That statement is not an opinion; it is a fact.

I’ve arranged a Go-to-meeting conference call with the CEO of that firm for the week of July 26.  This organization has built what I described; an RFP with more than a thousand unique requirements, an automated way to analyze the vendor responses, and a way to match your prioritized requirements to a short list of EHR vendors.  It will not be a sales pitch.  It is designed to be a question and answer session.  Who should participate?

  • Smaller providers whose only other option is to hire the person who set up their web site to manage their EMR selection
  • IPAs whose members are looking for advice about selecting a system to meet their specialization
  • Hospitals struggling with finding a defensible position for their selection.

If you are involved in the selection of an EMR/EHR, you should find an hour to assess the tool.  If you do not have the resources to make use of the tool, they do.  They can help you help yourselves.  I promise you, this will be the best use of sixty minutes you have had in a long time.  If you know someone who might benefit from this session, please forward this and have them contact me.  If you could benefit, simply respond to me.

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

EHR 2 a-days

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It’s hot and muggy; a hazy pall seems to levitate before me.  We call it Pennsylvania in summer.  Chest pain yesterday, nitro in gym bag.  Intervals today.  I hate running intervals as much now as I did in high school, but they’re better for the heart than just running distance.  Twenty-four 110’s.  Did I mention it was hot?

I am on the high school track.  The football team is/are—where are all the English majors when you need them—going through their drills.  Running and thinking.  That’s a good combination for me.  After two laps I’m glistening, after three I’m soaked through.  That’s when it hits me.

Practice.  Offensive and defensive drills.  Blocking and tackling.  Run the option.  Block the punt.  Come back tomorrow and do it again.  Do it until you get it right.  Do it until you can get it right in the game.  Pretty neat idea all this practicing.

Know where this is headed?  See, that wasn’t too difficult—remember, the desk is hard, the task is difficult. (My one takeaway from eighth grade English.)  Who doesn’t get to practice, doesn’t even have a coach?  Bingo, the EHR Project Management Executive.  It would be better if they did.  Imagine this conversation:

“Sorry Charlie, hit the showers.”

“Why Coach?”

“Your change management isn’t working for you today.  You’re leaving processes untouched.”

“It was the docs’ fault.  They just toy with me.  Treat me like a wonk and tell IT jokes behind my back.”

“Your game plan is coming apart.”

“But I didn’t get to practice, we didn’t even get to warm up.  I’ll do better next time.”

“Which next time is that Charlie?  With whose money?  These are The Bigs, Charlie.  Only grownups play here.  I’m afraid I’m going to have to send you back down to Single A.”

“Private practice.?”

“Sorry Charlie”—sounds like the tuna commercial.

You’ve got one shot at this, no warmups, no practices; there are no do-overs, and you are gambling millions.  DIRT-FIT  Do It Right The FIrst Time

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

EHR: How do you know if vendors tell the truth?

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At the beginning of my final year of graduate school, during a prior administration, the school sponsored a seminar on how to dress for interviews.

The take away from the seminar is the following:

  • If you are interviewing with a financial institution wear a pin-stripe suit, white shirt, and a power tie.
  • If interviewing with an advertising agency, go with wider lapels, slightly faired pants—ok, it was the eighties—and a tie with as much verve as you can muster.
  • Accounting firms.  A Khaki suit whose pants and sleeves are an inch or two short, a frayed button-down shirt, and a dull tie.  Roll them all into a ball; place them under your pillow, and go to sleep.

Things have changed since them.  Nowadays, I think most interviewers are content to see that the interviewee is dressed; at least that covers the tattoos.

Maybe a similar seminar ought to be available on how to select vendors.

Unfortunately, judging them by how they are dressed, there is now way to know if they are telling the truth.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The definitive EHR Buying Guide

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EHR Buying Guide—Vendor darts

So, here’s the thing with what a lot of EHR vendors seem to view as the lower end of the food chain, chum worthy customers—Hospitals, IPAs, group and individual practices.

Vendor darts.  I can’t tell you the number of providers with whom I’ve spoke who’ve had to navigate the chum-filled water of vendors trolling for dollars.  Unfortunately, when they come to your door, most of you are ill equipped and ill prepared to know whether you need what they’re selling.

It’s like playing EHR vendor darts—by the way—you’re practice is the dartboard.  Vendors fling their offering at you and hope they stick—the other way to play is to use the vendors as the darts, but you have to sharpen them or they’ll simply bounce off.

Just between you and me, or among us—if you’re a stickler about English—I’ve played vendor darts for years, and it’s always difficult for the dartboard to win.  (I am speaking parenthetically so they can’t hear us.)  We both know this is meant to be somewhat tongue-in-cheek.  The EHR vendors are professionals, and they have the utmost belief in their product, just as they will if they change firms and have to sell another product—this is the unspoken dirty linen of software.

There are a few hundred purported EHR solutions.  Each is a little different.  Which one is best for you?  Do they know which one?  If we are honest, the answer is, no, they don’t.  They do not know, they cannot know what features their competitors offer.

For those of you with any background in selecting software, any kind of software,I want you to do something for me.  Go to Google Search and enter “EHR RFP” and see what you find.  You won’t find anything helpful, anything that will help you select an application.  Big hint–if you cannot find something on Google, it does not exist.  That begs the question, what have providers been using to select an EHR vendor–rock, paper, scissors?

Vendors want you to stay focused on features.  Guess what?  Almost all of the leading products have just about the same features.  I want you to stay focused on business problems.  What business problems of your do their features solve?  It’s a fair question.  They should be able to answer it, and you should be able to answer it.

Rule number 1:  Any time a vendor tells you, “This is how we get our system to do that”, means their system doesn’t do it.  Those words signal a workaround, not a workflow.  It means they want your business to adapt to their way of manipulating how your business runs.  Have they ever run your practice; don’t think so.

Rule number 2: Vendors hope you don’t know about Rule 1.

What can you do?

  1. Work with someone who can spell out your requirements in detail.
  2. Work with someone who can navigate the chum field on your behalf.
  3. Assess some of the free EHR systems

Or, without meaning to be too gauche, contact me.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

EHR throws a curve ball

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There are not many things which when they work, work to the exclusion of all others.  (Word tried to let me know I can’t use the same word twice in a row in the same sentence.  Word underestimates my abilities.)

I recently watched the movie *61.  The movie documents the 1961 Yankees as Roger Maris and Mickey Mantle both chased Babe Ruth’s longstanding record of 60 home runs in a single season.  Great movie if you happen to think baseball is a metaphor for America.

I wrote in a prior posting that I grew up in Baltimore, grew up with the O’s—that’s the Baltimore Orioles for those of you who regard synchronized swimming as a real sport.

So before I lose you, the let us get down to why I am writing and why you are reading.

Baseball is full of stats and facts.  That is why those of us who love the game do in fact love it.  Baseball knows how a right-handed batter from Dubuque with a three ball two strike count is likely to fare on Tuesdays at an away game at night with a full moon with a left-handed pitcher with a one run lead in the late innings with two men on base.  There are more stats on arcane matters like this than there are on how Hillary wore her hair and the color of her polyester pantsuit when she met with the Bosnians.

That in and of itself makes baseball relevant.  America will continue if Hillary never again meets with the Bosnians.  It will not continue without baseball—it is important to pronounce the word “base—-ball,” the way James Earl Jones spoke it in Field of Dreams.  (I am not familiar enough with the rules of grammar to know if the name of the movie should be italicized or in quotes, but I know you get the point; grammar be dammed.

Here’s something most of you may not know.  Before every game, in the bowels of the stadium, the umpires perform a decades old ritual.  When baseballs arrive from the factory, they arrive with the sheen on them that all newly manufactured products have—forgive me for ending in a preposition—a sheen that makes it difficult for the pitcher a gain proper purchase on the ball.

Baseball tested a number of solutions—tobacco juice, shoe polish, sauces, oils—to enable pitchers to grab the ball.  In the mid-1930’s a baseball player discovered a solution.  He found a mud in a tributary of a river in Palmyra New Jersey that did the trick, and he started marketing the mud to the American League.  Why the American League?  Because he hated the National League.

Since that time every baseball for every MLB (Major League Baseball) game has been rubbed down using this mud, rubbed down, a gross at a time, by and prior to the umps calling the game.  That is a lot of rubbing—you do the math.

What in the wide-wide-world-of-sports can this have anything to do with healthcare?  Thanks for asking.  It has to do with finding a solution, a singular solution.  EHR.  EHR is FUBAR—you figure it out.  There are as many hospitals who swear by the solution you selected as those who do not.  Your solution as to how to take the sheen from your EHR are being replaced by other hospitals who claim to have found a better solution.

Roemer’s Rule One—all complex problems have simple solutions.  Got milk?  Got EHR?  It is not about the specific EHR…it is about what you choose to do with it.  CIOs and CEOs do not often select the wrong EHR—they select an implementation strategy that would fail if all they were doing was implementing the latest version of Microsoft Office.

As complicated as Washington makes EHR appear, there are simple solutions.  It has almost nothing to do with the software; it has to do with what your organization does with the software.

What do you need?  You need the New Jersey mud, the mud that places all reasonable EHRs on the same playing field, the mud that solidifies that the results you will achieve depends not on the EHR you selected, but if what you decide to do with the rubbing compound—the mud.  Anyone can pick an EHR.  Few can figure out why the one they have chosen makes a difference.

Baseball fans know an obscure fact.  Prior to every major league game, every baseball in every stadium is rubbed down with mud, a mud unique to a single spot on New Jersey.  The baseballs are all the same, the mud is the same.  Yet, some teams win, and some lose.  What does this tell you?  It tells me it is not the ball, and it is not the mud.

The difference between the winners and the losers must be attributable to something else.  What else?  I guess it has something to do with what they do with the ball.

Kind ‘a like EHR.  I guess it depends on what you do with it once the ball is in your hands.  How is your EHR team doing?  A lot of teams are asking the ump for another ball, another $200 million dollar ball.  Think that will work?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

EHR-Shift Happens

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When my youngest daughter, who is also my oldest daughter was two, we had her straight-jacketed in her car seat as we headed off to run a few errands.  Cute as a button and immobile—just like the book says.  My wife had nicely fixed what was left of her hair—to our surprise, her four-year-old brother had given her a haircut the day before—with a pink beret.  As she had nothing else to do in the back seat, she toyed with the beret, eventually removing it.

After a few miles, checking on her via the rear-view mirror I noticed the beret was nowhere to be seen.  Ninety-nine times out of a hundred, that would mean she had dropped it out of reach, or tossed it to one of her invisible friends in a one-way game of catch.  I asked her where the beret was—sorry for ending in a preposition, but I have a call with a client in a few minutes and do not have the time to ensure I am writing this with the proper King’s English.

Her reply was to simply point to her mouth and giggle.  I repeated the question and she repeated her response.  Being the Super Dad; my son’s term for me, I eased to the side of the road.  We checked the floor of the car, check her car seat, and under her blankets—no beret.  We replayed the question for the third time and received the same response.  We checked her mouth—no beret.  We were hesitant to believe the charade-like communications of a two-year-old.  Nobody in their right mind would swallow a beret.  Then we started to think about the situation.  Bright, shiny, colorful things probably all look like candy to a two-year-old.

We called my sister-in-law, a pediatric nurse practitioner, and an executive at Children’s Hospital of Philadelphia.  She made it clear that we needed to head to the hospital, do not pass Go; do not collect two hundred dollars.

We drove to the ER.  They did their magic, and we were soon looking at her image of her tummy—that’s the most clinical term I know to describe the situation.  There was the beret—we could not tell if it was pink, but we were hopeful that this had to be the same one about which I am writing.

As it turns out, the problem did not lay with her ability to communicate, it lay with our inability to believe that someone without an MBA—feel free to substitute MD or PhD—could define the situation accurately.

I do not have time for a segue, so let us jump into this.  It is easy to ignore what others are saying when a bunch of acronyms a printed on a business card after the presentation of your name.  Been there, done that, too well educated for whatever opinion you may care to offer on the topic.

My docs, and goodness knows I have several of them, I trust with my life—and I have.  These same docs, I would not trust to manage the P&L of a lemonade stand.  This has nothing to do with their IQ, it has to do with their training.  They would not trust me to insert a chest-tube, even though I have watched several episodes of Life in the ER.

At some point, we need to take a hard look at who is best to do what for whom.  Acronyms, in and of themselves, do not qualify one to make business decisions, especially in a virulent environment like healthcare.  Reform, EHR, ONC, Meaningful Use, Certification.  Shift happens, and is happening.

Sometimes there is value in listening to the two-year-old.

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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