CIOs, Others React To Meaningful Use Final Rule

CIOs, Others React To Meaningful Use Final Rule. InformationWeek Healthcare–my comments http://ow.ly/2bS4D

Now on Healthcare Professionals, HCPLive.com

Other places to find my posts:

http://www.hcplive.com/primary-care/articles/roemer_meaningful_use

healthsystemCIO.com

HospitalImpact.com

Fiercehealthcare.com

EHR–where do you place the emphasis?

You said I stole the money. Sometimes it all depends on what you emphasize. For example, say the sentence aloud to a friend, and each time place the emphasis on a new word. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. The meaning changes as you change your emphasis. You said I stole the money? You can even change it so that it reads like a question.

The same is true with providers and the level of success a firm has working with EHR. Where is your emphasis? If you believe there is a correlation between emphasis and spending, I bet we can prove your firm’s is much more closely aligned to technology than it is to process. What does technology address? Let’s list how deploying technology makes your firm better, or does it?  Millions followed by millions more. Redesign the patient portal.  Add EHR. Mine the data—heck, strip mine it. Show me the ROI. Isn’t that a lot of money to spend without a corresponding business justification?

The technology that is tossed at the problem reminds me of the scene from the “Wizard of Oz” when the Wizard instructs Dorothy and the others, “Pay no attention to the man behind the curtain.” When Toto pulls the curtain aside, we see a nibblet—I love that word—of a man standing in front of a technological marvel. What’s he doing? He’s trying to make an impression with smoke and mirrors, and he’s hoping nobody notices that the Great Oz is a phony, that his technology brings nothing to help them complete their mission.

From whose budget do these technology dollars usually come? IT. From the office of the CIO. What did you get for those millions?  Just asking.

Part of the problem with doing something worth doing on the EHR front is that it requires something you can’t touch, there’s no brochure for it, and you can’t plug it in. It’s process. It requires soft skills and the courage to change your firm’s emphasis. They won’t like doing it, but they will love the results.

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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Why buy an EHR system?

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.

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

Tidbits

I rarely write on Sunday, but with my wife and the kids in Miami for the month while I serve as the EHR Czar, I thought I would share a few thoughts with you.

I went to a reception a few nights ago with some healthcare executives in the Philly area.  It was one of those events whereby the caterer thought the chi-chi crowd would do back-flips over canapés of fava beans stuffed with cheese made from the breast milk of yaks.  One of those events where you can’t complain without being as obvious as someone walking the streets of Tehran wearing a Star of David T-shirt.

Sometimes  you get an ah-ha about life which is so profound it must be shared with friends.  I got one of those today while making a breakfast of smoked salmon, capers, and New York bagels.  I retrieved a clean plate from the dishwasher.  I knew when I finished breakfast I would have to empty the dishwasher–a task that always irks me.  The lights brightened, the sky opened, and I learned something most consultants would try to kiss their elbows to understand.

We have two dishwashers–machines, not people.  Naturally, that cuts down on the number of times we have to empty the dishwasher.  Mind you, my discovery only works for people whose spouse is out T town and for homes who have two dishwashers.  Here’s the deal.  Wash the dishes in one dishwasher.  Sooner or later you get hungry.  You think about going to the cabinet to grab a plate and the it occurs to you that you already have a clean plate in the dishwasher; along with a drinking glass, and utensils.  Why not use them?  And after dining–and this is the revelation–place the newly soiled dishes in the other dishwasher.  Guys, this re-engineering of the traditional kitchen processes eliminates the need to ever empty the dishwasher.  Everything in the dishwasher is caught in an infinite loop, eliminating the need for kitchen cabinets.

This new process brought to mind an episode of ‘Happy Days’ when The Fonz explains to Ritchie how bachelors make a salad to conserve wasting time on extraneous business processes.  The Fonz told Ritchie to hold the head of lettuce above the sink and pour salad dressing on the lettuce, thereby eliminating the need for a plate.

Where were we?  That is unplanned an alliteration.  Given that, how do I make this worth your time?

Permit me to address the C-suite.  Does it seem to you that those people in your firm are paid for working hard, or for delivering results?  I think they are paid for working hard, for looking like they are working hard, for doing the things people in their esteemed position ought to be doing.

They are busy.  Why?  Because those who are not perceived as being busy are fired.

Who at your firm is delivering results?  Who is defining what the results needs to be?

Someone needs to define the ah-ha moments for your organization.  Somebody needs to take charge, to know that it is possible not to unload the dishwasher, to know that there is no value in stuffing the fava beans with the cheese.

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

Where workflow goes to die

There are two types of business processes; easily repeatable processes (ERP), and Barely repeatable processes.   Most of the real work that needs to be done in EHR workflow improvement happens in the blank white space between the boxes on the org chart.  That’s where you’ll find a lot of the BRPs–Barely Repeatable Processes.

It is easy to automate the ERPs, and nearly impossible to automate the BRPs.  If you can’t reform either set of processes with your EHR all you have implemented is a very expensive chart scanner.

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

May God continue to bless America

This is America

There is a reason why we love this country, although at times it is difficult to put it into words.  We watch the news, and no matter the channel, the mission of the news is to tell us what is wrong with our country.  Shame on them.

My story is no different from most of yours.  I grew up in Maryland.  I grew up when Pong was the most amazing thing on the planet.  Like you, my world was put on hold to watch the landing on the moon—spectacular in black and white on a television that was so heavy it required the strength of two men to move it.

Maryland, Iowa, Oregon.  I have had the good fortune to have been to forty-seven states.  I am missing Alaska, Idaho, and Maine, and I would move to them sight unseen in a minute.  What makes my state special is the same as what makes yours special—I spent my youth there.

Cut grass in Maryland has a certain smell to it, as I’m sure yours does.  There is a certain mystique to the Maryland’s fireflies, its humidity, and its sport teams.  I knew the stats for every player on the Orioles and the Colts.  I was a devoted member of the Junior Orioles.  I collected soda bottle caps showing the names of the players of the Baltimore Colts.  Collectively, we gathered around a radio to listen to games of our teams.  At night I listened to the O’s on a transistor AM radio with an attached ear plug.

The most Maryland thing about Maryland is something most of you have never tasted—steamed crabs.  Not Dungeoness, not King, nor Snow…not Stone.  Blue crabs.  Caught in the Chesapeake Bay and its tributaries.  Caught by kids hanging chicken necks from a row boat.  Caught by men and women setting crab pots from rickety wooden boats.

Maryland was a summer’s day eating steamed crabs.  We would buy the live crabs and steam them in beer and vinegar.  The crabs were seasoned with a combination of Old Bay and the purveyor’s secret mix of spices.  Our senior class party was a crab feast.  Crabs were the de rigueur offering at cookouts, and after a game of softball.  Part of the attraction of eating steamed crabs was the informality of the feast.  You could not buy them in a “fancy” restaurant.  The etiquette of eating crabs required a picnic table covered in butcher paper or newspapers, a wooden mallet, a role of paper towels, and pitchers of beer or unsweetened iced tea.

Some would waste time with the accoutrements; corn, coleslaw, and hush puppies.  Fillers.  Eating steamed crabs required the discipline of a prize fighter—stay the course.  Set aside several hours.  Pace yourself.  Your fingers will endure cuts from the claws.  The seasoning will enter the cuts and sting—that is part of the ritual.  The meal was akin to a dance marathon.  The weaker players eventually fade away; the stalwarts press forth, maintaining a rhythm until there are no more crabs.

My wife and children are in Miami for the month.  As compensation, I bought a half bushel of crabs.  Eating crabs requires a bit of a religious fervor, a devotion to the task.  The coffee table in the family room is prepared for the event—covered with a large black trash bag, a roll of paper towels, a knife and a wooden mallet.  I lick the seasoning from each shell, remove the legs, find the hidden meat, and then vivisect the body.  I place the empty shells in a large pot, along with a mirepoix of vegetables to make a crab stock.

This is Maryland, my Maryland.  In some respect, this is a tiny portion of America, an exercise repeated thousands of times across the country.  Different states, different fares.  Slow cooked pork ribs, burgers and dogs, sweet corn, watermelon.  To an outsider, our sense of Americaness may not make much sense.  To Americans, these singular rituals—our traditions, handed down from generation to generation—are part of the fabric that unites us.

So, on this Fourth of July, enjoy what you are doing.  Plan on enjoying it again next year and the year after.  Remember those who came before you, for it was their traditions that you now commemorate.  Few countries celebrate the right of the individual—your right to be you.  That is what is special about this place.  Independence Day  is a celebration of your right to be you.

The EHR Certification Myth

EHR certification inspectors will be dropping in on hospitals like UN inspectors looking for WMDs, only they’ll be slightly less congenial–like Kojak without the warmth.

Why is this a part of the overall plan?  Is this planned failure?  Do they have reason to believe that a certain percentage of EHRs will fail the inspection?

Of course they do.

Let’s describe two failure types; certification and Full test.  The certification test, by definition, is necessary.  The Full test is both necessary and sufficient.  It is possible to pass certification without passing the Full test.  Therefore, the Full test is a stricter test.  Build out to pass the Full test, and by default, one should pass the Certification test.

What is the full test?  Same as always.  Fully functional, on time, within budget, and user accepted.  Functional, for purposes of this discussion includes updated workflows, change management, and interoperability, and a slew of other deliverables.

Here’s what can be concluded just based on the facts.

Fact:  One-third to two-thirds of EHRs are listed as having failed—this statistic will get smaller over time.

Opinion:  The reason the failure rate will get smaller is that the failure rate will be artificially diluted by a large number of successful small-sized implementations.  Large implementations, those have far-reaching footprints for their outpatient doctors, Rhios, and other interfaces requiring interoperability will continue to fail if their PMO is driving for certification.  (Feel free to add meaningful use to the narrative, it doesn’t change the result.)

Fact:  Most large, complex, expensive IT projects fail—they just do.  This statistic has remained constant for years, and it is higher than the percentage of EHR projects that have failed.  Even a fairly high percentage of those projects which set out to pass the Full test.

Opinion:  Failure rate for large EHR projects—let’s say those above $10,000,000 (if you don’t like that number, pick your own)—as measured by the Full test, will fail at or above the rate for non-EHR IT projects.)

Bleak?  You bet.  Insurmountable?  Doesn’t have to be.

What can you do to improve your chances of success?  Find, hire, invent a killer PMO executive out of whole cloth who knows the EHR Fail Safe Points.  EHR Fail Safe Points?  The points, which if crossed unsuccessfully, place serious doubt about the project’s ability to pass the Full test.  The points which will cause success factors to be redefined, and cause one or more big requirements—time, budget, functionality—to be sacrificed.

This person need not and perhaps should not be the CMIO, the CIO, or an MD.  They need not have a slew of EHR implementation merit badges.  The people who led the Skunk Works had had zero experience managing the types of planes and rockets they built.  They were leaders, they were idea people, they were people who knew how to choose among many alternatives and would not be trapped between two.

The person need not be extremely conversant in the technical or functional intricacies of EMR.  Those skills are needed—in spades—and you need to budget for them.  The person you are looking for must be able to look you in the eye and convince you that they can do this; that they can lead, that these projects are their raison d’etre.  They will ride heard over the requirements, the selection process, the vendors, the users, and the various teams that comprise the PMO.

What do you think?

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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Why is EHR not the right answer?

The reason I chose to share this story is my belief that it is de rigueur among practitioners.  I have been spending some of my time working on behalf of a small clinic.  Four doctors, two offices, small lab, x-rays, some surgeries.

Great people, great mission.  Every physician spends several weeks each year doing unpaid missionary work in Africa and South America.  Their focus is caring, not dollars.  It is not my job to change their focus.  They do not turn away anyone who cannot pay.  Staff at the front desk help patients pay for their meds.  The four physicians routinely offer services and perform procedures for which they know they will not be paid.  I feel a real sense of pride helping them, and have slashed my rates to make sure they get the help they need without taking money unnecessarily from their coffers.  Their patients love them, and they add about a hundred new patients a month.

The business side of their practice could have been designed by Rube Goldberg.  As I interview the doctors, the nurses, the lab, and the front desk about the practice, I try to do so with a straight face, try not to betray the part of me that wants to say, “You’re kidding, right?”

They meet with about fourteen-hundred pharmaceutical reps each year.  I tried to pin down why they do it, but could not come up with an answer to support a business reason.  Since the pharma reps can no longer offer trinkets equivalent to those needed to purchase Manhattan, they give away lunch.  Enough lunches to ensure that everyone in the practice should weigh eight-hundred pounds.

They use the F-word a lot—faxes.  Two fax machines running often enough that without proper cooling they would melt through the floor.  The average fax is handled eight times before it is placed in the patient’s chart.

There is no email, no web site.  There is no triage—docs and nurses do not screen patient phone calls to determine who needs to be seen.  Seventy-five patients a day, two and a half people are full time on billing.  Three people man—actually, it should be “woman”, the front desk.  (Is that an intransitive verb, or simply poor writing on my part?)  The staff wants more staff.

I have been hired to help them with the selection and implementation of their EHR.  I can solve the EHR problem in five minutes, but I won’t.  Having an EHR will solve none of their problems, at least not until they turn what they do into a business.

Realigning their business processes will do more for their mission than any EHR.  Processes are inefficient and ineffective.  I cannot figure out how they collect money or pay bills.

I am willing to bet they are not alone in having these issues.  I’d bet that these problems can be extrapolated to hospitals.  Is Practice Management more important to physicians than EHR?  My guess is that the right answer is yes.

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

Why EHR would not have worked in the 1960’s