Strategy

Puppy Training Your Vendor

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Carrie Vaughan, a senior editor of HealthLeaders Magazine published an article in the December 8, 2009 issue titled, “Tips to Build a Successful Vendor-Provider Partnership.”  The link to her article is http://www.healthleadersmedia.com/page-2/MAG-243167/Avoid-the-Vendor-Upsell.

The points about which Carrie wrote are spot on.  I asked Carrie if she would permit me to use those same points as a foundation for this posting, to which she was kind enough to agree.  The four points come from her article.  I encourage you to read her piece, as any points with which you may take umbrage are mine, not hers.

To ensure we take an accurate look at the provider-vendor relationship, we must be willing to acknowledge that healthcare providers are from Mercury and the EHR vendors are from Pluto.  They exist in different orbits, and their business models are very far apart—they never intersect; not in space, and not on your project.

1. Have your own inside expert. Don’t rely on the vendor to tell you what you should be doing.  Never.  Ever.  Unless of course you think the vendor knows more about how you want to run your hospital than you do.  Remember, you select them—not the other way around.

Bringing a vendor into your hospital is a lot like bringing home a new puppy. Both need to know who runs the show. Don’t roll over.  They may not be looking to be led, but if you don’t lead them they will lead you.

You should have the expert on board at the outset, before you select the EHR vendor.  The expert should be your advocate.

2. Establish a specific executive liaison with your vendor.  This is not your new tennis partner.  This should be the person who has the authority to ensure your quantifiable wishes are being met, and whose responsibility it is to deliver the message to his troops, and marshal the resources necessary to get the job done.

3. Specify your contractual objectives. Ensure that the contract is aligned with the clinical and business objectives of the healthcare organization, not the vendor.  Before you can accomplish this, you have a lot of work to do with your team.  You must define your clinical and business objectives.  Often these two groups also have a Mercury and Pluto relationship.  Once you have these, your next task is to deliver these objectives to the vendor and have the vendor tell you in writing what they will meet, what they might meet, and what they can’t meet.  It would be nice to know these before you sign their contract.

4. Involve more people than just the IT staff. Need a rule of thumb, involve as many users as IT people—Mercury and Pluto.  You will need new processes, not just to squeeze an ROI from the EHR, but because many of your old ones have probably been around since the invention Band-Aid.

Each of these recommendations will actually help you and help your vendor be successful.  It will not be an adversarial relationship as long as you manage it.  If you don’t manage the relationship, you won’t have to worry about meeting Meaningful Use—you’ll be too busy selecting a replacement vendor.

One final thought, don’t let the vendor loose unsupervised on the oriental rugs.

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

Users are from Mercury, IT is from Pluto

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The two groups are often far apart.

I learned an interesting word which led to some very interesting reading on the topic.  The word and topic are qualia (pl).  There are several wordy explanations with which I won’t waste your time.

Daniel Dennett identified four properties that are commonly ascribed to qualia. According to him, qualia are:

  1. ineffable—they cannot be communicated, or apprehended by any other means than direct experience—see, touch, taste, hear, smell.
  2. intrinsic—they are what they are independent of anything else.
  3. private—interpersonal comparisons of qualia are impossible.
  4. directly or immediately apprehensible in consciousness—to experience a quale is to know one and to know all there is to know about that quale.

Got it?  That didn’t do it for me either.  Here are a few examples that helped me understand it.

  • How does wet feel?
  • What does blue look like?
  • What is the smell of mowed grass?
  • How does salt taste?
  • What is the sound of a whisper?

Common things.  Our brain knows what they are, yet to describe them to someone who has not experienced them, almost indescribable.  Your brain processes it one way, your mind processes it another.  Take a look at these pictures.

Now let’s look at healthcare IT projects, to be more particular, implementing an electronic health records system, an EHR system.  When you pictured the implementation in your mind, when you studied the implementation plan it painted a nice picture.  All the pieces made sense—sort of like the picture on the left.

At some point after most EHR implementations, the IT department still sees a pony.  The users can’t see the pretty picture.  Trying to explain what went wrong to the steering committee is like trying to describe to them the color blue.

IT people are able to look at the picture on the left and visualize the picture on the right.  When IT people talk to users, to the users it sounds like the picture on the left…

…and it feels like this.

It matters what the users think, and see, and feel.  If IT waits until the end to involve the users, the users will never see a pretty picture.  I’ll let you in on a secret.  In many hospitals the users (doctors and nurses) do not think IT has any understanding of their business.  Why prove them correct by keeping them out of the loop.  Their input is at least as important as IT’s and the vendor’s—probably more so.

“Look what we built for you” is not what the users need to hear.  “Look what we did together” has a much better chance of succeeding.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942
paulroemer@healthcareitstrategy.com

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

How to handicap selecting your EHR

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Several years ago I was invited to go on the ultimate boys’ toys, weekend getaway. A dozen of us flew from Denver to Utah, and then drove to a point somewhere west of Bozeman Montana. It was to be a weekend of sport, a weekend of competition, and a more than occasional libation. To say that the people who organized the trip came from money would be a major understatement. They were in the oil bid’ ness. The father of one of the guys was the CEO of the second or third largest petroleum company in North America. We stayed at his ranch, a 12 bedroom log cabin in the middle of Nowhere, Montana, which is about 20 miles west of Next to Nowhere, Montana.

The weekend’s activities included fly fishing, duck hunting, and Gin Rummy. Each participant was given a handicap rating in each event. The idea behind the rating was that if you are weak in one event, you were paired with an individual who is skilled in that event. In theory, that would level the playing field among the teams. Since I have never fly-fished or hunted I was odd man out. But I was game, and it’s amazing how good one can become at something when one has to fight their way through it.

Let the games begin. We started the competition with a full day of fly-fishing. Our destination was the Madison River, an impressive, fast running, expanse of snow melt. The stretch we would finish was about 150 feet wide, and its average depth was somewhere between waist and chest high. As I would soon learn the bottom was covered with what appeared to be the equivalent of moss covered bowling balls. I was instructed by one of the more experienced fishermen to tie a nymph to the end of the tippet. For those of you who are as novice to the sport as I was, a nymph is an artificial lure which mimics an insect larva. It is designed to lure fish who feed along the bottom, not the nubile young woman referenced in Greek mythology.

We fished for several hours. My legs ached from trying to maintain my balance in the strong current. I was about ready to admit defeat when the tip of my rod bent sharply into the water. Standing perpendicular to the current, I could see as the brightly speckled back of a large rainbow trout turned upstream. Naturally, I turned upstream with it and began to try to reel him in. First mistake. It was at that point that I first realized that the height of the water was now about level with my chest waders. Second mistake. The guys on the other part of the river and along the bank were yelling at me. I thought it was words of encouragement. Final mistake. As it turns out, they were trying to convince me not to turn upstream. At the exact moment that I faced stream head on, was the exact moment my feet lost purchase with those moss covered bowling balls of which I wrote. Turning yet again to my physics, I quickly recalled the equation; force equals mass times acceleration. Instantaneously, I was swept downstream, still clutching my fly rod in my right hand.

Wayne Newton’s first law of fluid mechanics took over; waders, no matter how good they are, if positioned in a plane that is horizontal to the river will fill rapidly with water, just as mine did. The choice with which I was faced was do I save myself and lose the fish, or do I try and land the fish? One of the shortcomings of maleness—I was going to use maledom until I Googled it—is that we rarely have actual choices, especially when we are around other males or for that matter, females. Naturally, I opted to land the fish. My reel had become dislocated from my rod. I remember grabbing the reel and stuffing it down my waders, and as I tried to float my body as though it was a raft without a rudder towards the river’s nearest bank, I began to reel in the monofilament with a hand over hand motion. After several minutes I was standing dripping wet and proudly displaying a 19 inch rainbow trout.

We cooked the fish and played Rummy until about three in the morning, awoke at four, grabbed our shotguns and headed out into the darkness without so much as a cup of coffee. Round three of the competition was to be duck hunting. To this day I’m still unclear as to why we had to hunt ducks while it was still dark. Weren’t there any ducks who needed shooting at brunch time, I inquired? Twelve guys, who collectively smelled like a distillery, and who are operating on an hour of sleep, armed with loaded shotguns, trod through a willow thicket as dawn approached. As I neared the river bank, a startled duck shot skyward. I raised my over and under twelve-gauge shotgun, sort of took aim, and fired a volley. The duck seemed to pause in midair, and then fell like a rock into the racing water. I watched helplessly as my quarry floated away from me. I looked downstream and was pleased to see two men fishing from a rowboat. The duck floated right towards them. A man reached down, retrieved my duck, and dropped it in his boat. He then waved to me. Thinking he was being friendly I returned his wave. He then rowed away with my duck.

It was a great three days. Part of what made the weekend fun with not having to excel at each event. It helped knowing that in areas where my skills were not as good, I could count on the skills of others and vice versa. The idea behind this approach was to build competitive and level teams. That approach works well in mano y mano events like those I described. It works much less well in EHR, HIT and healthcare reform in general.  I’m trying to recall if I wrote previsouly about a meeting I attended with a former hospital CEO.  His take on EHR was the total inability of his peers to have any precience regarding their approach to EHR.  According to him, very intelligent people were making very unintelligent decisions, committing their entire institution to strategies made with almost no data.  Some people can give a better explanation for why they bought their car than they can for why they selected their EHR.   That’s the wrong way to handicap this event.

There are two ways to handicap your EHR.  One way is to look at the program from the perspective of risk assessment and assess–handicap–the risks.  The other way to to be a detriment to the program’s success.  One of these is bad.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942
paulroemer@healthcareitstrategy.com

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

Patient Relationship Management (PRM): Left Brainers, Right Brainers, and No Brainers

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Sometimes I feel a little like the ambassador from the planet Common Sense, and unfortunately very few of us speak the same language. Let’s see if we can segment the Patient Relationship Management (PRM) population into left brainers, and right brainers. I am wrestling with an issue that I believe is a no-brainer.

One point, upon which both sides seem to agree, is that without the patients, PRM would be superfluous. The breakdown is that for a hospital to flourish in the long term, hospitals should re-engineer their business processes to facilitate the dissolution or substantive reduction of traditional customer service.  This extends beyond the cordial relationship of a nurse or a doctor and their patients in hospital beds.

In many, if not most instances, the very existence of traditional customer service provides a vehicle which acts as an enabler for failure. It gives hospitals permission to be mediocre in dealing with their interactions with their patients and physicians. In effect, traditional customer service is a tacit admission to the employees and the patients, “We don’t always get it right. We don’t always do our best.

Before deciding not to read further, ask yourself a few questions. The purpose of the questions is to try and articulate a quantifiable business goal for customer service, PRM.

1. Does customer service have planned revenue targets
2. Does it have its own P&L?
3. Does it have a measurable ROI?
4. What is the loaded cost for each patient and doctor interaction?
5. Could the costs of those interactions be eliminated by fixing something in operations?

If the answers to 1-3 are no, the answer to 4 is unknown, and the answer to 5 is yes, your hospital inadvertently made the decision to ignore revenues and to incur expenses that provide no value to your organization. I believe this premise can be proved easily.

The careers of many people are directly tied to the need to have customer service and call centers. Big is good. Bigger is better. Software, hardware, telecommunications, networks—more is better. Calls are the lifeblood of every call center. Without those calls, the call center dies. Calls are good, more calls are better.

When was the last time you were in a meeting when someone said something like, “In the last three years our patient call volume has continued to increase,” or, “Calls have gone up by forty percent.” That part may sound familiar. The phrase nobody has heard is, “We can’t continue to add that many calls.” Tenure and capital. That part of the business is managed with the expectation that the number of calls will continue to grow. And guess what? It does. How prophetic is that? Or is it pathetic? You decide.

Given that, how does the typical healthcare provider manage their customer service investment? Play with the numbers. In many organizations, if customer service management can show that patient satisfaction is holding steady, no matter how bad it is, and they can use the numbers to show that some indicator has moved in a favorable direction, other areas of the business are led to believe that customer service is performing well.

Memo to those executives who are authorizing customer service expenditures—I want to make sure there is no mistaking how I view the issue. If that is what you are hearing from your customer service managers, they either don’t understand their responsibility, or they understand it and they don’t want you to understand it.

To be generous, if patient satisfaction with regard to customer service is below ninety-five percent, your customer service is in serious need of a re-think. Just because patient satisfaction is not tanking faster does not mean customer service is functional.

Most executives know how to get numbers to paint whatever picture they need to paint. Beware the sleight of hand. Any time the customer service manager comes to you and says he is improving operations by reducing the average amount of time someone spends on the phone talking to a patient (average handle time), don’t believe anything else he tells you. Allow me to translate. When the customer service budget is tight (too many interactions and too few people with which to interact) the way to make it fit the budget is to make your people end the call quicker. Shorter calls mean more calls per hour. Note—speed buys you nothing, except for more repeat calls, less resolution, less patient satisfaction. It’s a measure of speed—IT IS NOT A MEASURE OF ACCOMPLISHMNET.

I’d be willing to bet that somewhere between twenty-five and fifty percent of calls from your patients and physicians can be addressed better via a combination of social media and the Internet.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS

I hate to be a pest…

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…but I inadvertently just proved my own point, albeit to myself. I have been fooling around–with my old MP3 player, and I couldn’t get it to turn off or on–that’s why my wife hides the power tools.

I ducked into a nearby phone booth and put on my SSCC (self-service customer care shirt)–do you realize most kids under the age of ten have never seen a phone booth? Sorry.

Off to Google. I never even considered going to the manufacturer’s web site. I typed, “Remove battery from Creative Vision:M.” Up pop several YouTube videos, each done by one of Creative’s customers, showing step-by-step with voice instructions explaining how to correctly remove the battery. I place a lot more faith in what a customer tells me than I do in what they firm tells me.  Your customers (patients and doctors) do the same thing.

The user manual that came with the device never mentions how to remove the battery.

And this is my point. Your patients know what your other patients need, and in what form it will be most useful. And, they are providing it. Now, how difficult would it be for a hospital, say your hospital, to start thinking about your patients as though you were a patient? Not very.

Of the few hospitals which have a Patient Relationship Management (PRM) strategy or social media (SM) strategy, not too many are effective.  I’ve only seen one which uses those to increase revenues.  Most hospitals use PRM and SM to manage spin, to try to counteract what their patients are saying about them.  One can only imagine the impact a hospital could have by starting the spin, starting conversations about itself using these tools.

You know what?  You don’t have to imagine it.  It is probably the easiest project you will undertake.

Here’s a link to a PowerPoint deck on the subject of PRM.

http://www.slideshare.net/paulroemer/good-CEM-deck

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS

What do you tell the Steering Committee about EHR?

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Success and failure are often separated by the slimmest of margins. To succeed, sometimes you have to be prepared to think on your feet.  You have to outthink unfavorable circumstances. Often, success or failure hinges on how you present an idea.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw some frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory was correct. Noah would already have been building an ark.  Grabbing every towel I could find, I sopped the puddles from the hardwood floor.  While mopping I thought about how I might answer my wife if she returned to a kitchen that looked like Water World.  My first instinct, admittedly poor, was to tell her I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles were removed, and believing the major threat from her had passed, my wits slowly returned.  I worked on version two of the story—how do I explain all the wet towels.  I arrived quickly at a more believable version of the truth—I would tell her I decided to wash the towels—all of them.  Why not get bonus points instead of getting in trouble?

Version three sounded even better. Since I’d wiped the floor with the towels, instead of simply telling her I washed the towels, why not double the bonus points? I’d tell her I washed the floor, and washed the towels. Husband of the year can’t be far off.

A few hours have passed since the indoor flood. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking and deft presentation.

Back to healthcare.  A few of you have written and asked, how do you propose we turn around our EHR implementation, turn the focus to solving business problems, not simply implementing an unwieldy system simply to collect the ARRA ransom money?

All kidding aside, it comes down to presentation. Clearly you can’t walk into a steering committee meeting with a just a slide deck showing that the current EHR implementation strategy will decrease productivity.  If there are problems with what you are doing, or the support you are receiving, or the immediacy with which the committee wants to the project to end, present the consequences of the action.  Then present what could be accomplished and what you need to make it happen.  EHR is not done just because the vendor is no longer in the building.  All you can conclude from that is that there are a few freed up parking spaces.  Your goose may be cooked.

So, what happened with my chicken dinner? I was confident I had sidestepped to worst of the threat. Overconfident, as it turned out.  My son hollered from the basement, “Dad, why is all this water down here?”

Are you “The Hospital of Perpetual Implementations?”

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“There is no use trying,” said Alice;
“one can’t believe impossible things.”
“I dare say you haven’t had much practice,” said the Queen.
“When I was your age, I always did it for half an hour a day.
Why, sometimes I’ve believed as many as
six impossible things before breakfast.”

There are a number of people who would have you believe impossible things.  I dare say some already have.  Such as?

“My EHR is certifiable.”

“They told me it will pass meaningful use.”

“We’re not responsible for Interoperability; that happens at the Rhio.”

“It doesn’t matter what comes out of the reform effort, this EHR will handle it.”

“We don’t have to worry about our workflow, this system has its own.”

Sometimes it’s best not to follow the crowd—scores of like-thinking individuals following the EHR direction they’ve been given by vendors and Washington.  Why did you select that package—because somebody at The Hospital of Perpetual Implementations did?

There is merit in asking, is your organization guilty of drinking the Kool Aid?  Please don’t mistake my purpose in writing.  There are many benefits available to those who implement an EHR.  My point is is that there will be many more benefits to those who select the right system, to those who know what business problems they expect to address, to those who eliminate redundant business functions, and those who implement proper change management controls.

How should a provider approach Meaningful Use?

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New Headquarters?

The following is my reply to a post in HealthcareITNews from March 8.  The title of the post is, CONSUMERS WEIGH IN ON TOP 10 MEANINGFUL USE ARGUMENTS.  The link is, http://www.healthcareitnews.com/news/consumers-weigh-top-10-meaningful-use-arguments#comment-574

Of cabbages—and kings—

And why the sea is boiling hot—and whether pigs have wings. Lewis Carroll, Out of the Looking Glass. It is a nonsense story, one which cannot be argued.

As are Electronic Health Records (EHR) and Meaningful Use (MU)—at least to date. Measured against any reasonable set of standards, except on a one-off basis, the national rollouts of EHR and MU have failed. I expect it will be even more so next year.
You, the public, have the right to comment, and we have the right to tell you why your comments hold no water. I think it is the inverse of you have the right to remain silent, you just don’t have the ability. I am writing about the ONC and the bone they tossed calling for public comment. They are required to provide for public comment in order to remove the N and the P from the NPRM.

Who among us believes the rule making will markedly shift direction as a result of any of the public comments? That is unfortunate for if they were to shift direction they might find a direction. We don’t know where we are going, but we are making good time getting there. Figures suggest a failure rate of EHR implementations of somewhere between fifty and seventy percent. As healthcare IT resources become scarcer, I expect the failure rate to increase. As providers rush into EHR without a detailed strategy simply to grab the incentive money, there will be more expensive failures. More failed EHRs is not a way to measure progress.
The current cover of Government Health HIT magazine depicts a foot race to meet MU. There is no race if there are no entrants. There may be more people on the cover than will actually qualify for the race, even fewer who will reach the end.

We would be better served if the plan for national rollout of EHR were not written on an Etch-A-Sketch. We don’t know what will be included in Stages 2 and 3 of MU. When will fifty percent of providers have an EHR, not just the software, but one that actually boosts productivity? How about 70% or 80%? Ten years? I ask the same question of the Health Information Exchanges (HIEs). Without unilateral adoption there will be large gaps. Will the national network function with these gaps? To what extent? Will the records only make it part of the way from Patient A to Doctor X?

Having not solved the EHR program on their own, and having no viable plan, the government laid the burden of making EHR successful on the backs of the providers. The government tries to offset the burden by offering financial gratuities—and penalties—to the providers. Not exactly the second coming of the Three Wise Men. Trying to hit the ONC’s targets is a little like playing the confidence game, the shell game. Under which shell will providers find the rules, the plan?
What to do?

It is easy to criticize. Permit me to offer a few suggestions. To the hospitals, if you are not well along the EHR path, do not make a difficult effort more difficult by chasing Gossamer incentive dollars. Stick to your plan. You have multiple failure points which three years from now will make chasing those dollars look like a pipe dream. The failure points? Your plan, the implementation, meeting the MU requirements, passing the MU audit. It does not look very promising to me.

To those hospitals which haven’t started their EHR initiative, or are less than halfway through the passing the failure points, don’t cancel your summer vacation. You have a lot more time to get it right then you have to get it wrong. Pay no attention to the man—or woman; even I can have a moment—handing out the Monopoly money. You won’t be receiving any. From where I sit, that is good news. It will cost a lot more to perform disaster recovery on a poor implementation than the funds you would have received by meeting MU.

How long does a hospital spend planning to build a new hospital wing? For large hospitals, the cost of your EHR will likely exceed the cost of the new wing. Plan accordingly. Invest six or nine months building a plan that might succeed.

For medium and small practices and solo providers you have nothing to lose by waiting a year months other than the resource problem. By then you will find very viable ASP and shrink-wrapped solutions.

Those who follow my blog, healthcareitstrategy.com, know I don’t write to garner favorable replies from those who think they’ve already got it figured out. I write for those who because of EHR have difficulty sleeping. Thanks for reading. As always, I appreciate your comments and disagreements.  

EHR–the five stages of grief

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The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.  I heard a story about this on NPR, and it made me think about other scenarios where these stages might apply.

My first powered form of transport was a green Suzuki 250cc motorcycle.  My girlfriend knitted me a green scarf to match the bike.  One afternoon my mother walked into the family room, saw me, and burst into tears.  When I asked her what was wrong, she told me that one her way home she saw a green motorcycle lying on the road surrounded by police cars and an ambulance—she thought I had crashed.  I asked her why, if she thought that was me lying on the road, she did not stop.

My girlfriend’s mother, didn’t like my motorcycle—nor did she like me.  Hence, my first car; a 1969 Corvair.  Three hundred and fifty dollars.  Bench seats, AM radio.  Maroon—ish.  It reminded me a lot of Fred Flintstone’s car in that in several places one could view the street through the floor.  Twenty miles per gallon of gas, fifty miles per quart of oil.

Buyer’s remorse.  We’ve all had it.  There is a lot of buyer’s remorse going around with EHR, a lot of the five stages of grief.  I see it something like this:

  • Denial—the inability to grasp that you spent a hundred million dollars or more on EHR the wrong EHR, one that will never meet your needs
  • Anger—the EHR sales person received a six-figure bonus, and you got a commemorative coffee mug.  The vendor’s VP of Ruin MY life, took you off his speed dial, unfriended you in Facebook, and has blocked your Tweets. You phone calls to the vendor executive go unanswered, and are returned by a junior sales rep who thinks the issue may be that you need to purchase additional training.
  • Bargaining—when you have to answer to your boss, likely the same person who told you which system to purchase, as to why productivity is below what it was when the physicians charted in crayon.
  • Depression—you come in at least fifteen minutes late, and use the side door, taking the stairs so you won’t see anyone.  You just stare at your desk; but it looks like you are working. You do that for probably another hour after lunch, too. You estimate that in a given week you probably only do about fifteen minutes of real, actual, work. (Borrowed from the movie, Office Space.)
  • Acceptance—the EHR does not work, it will never work, you won’t be around to see it if it ever does.  Your hospital won’t see a nickel of the ARRA money.  You realize the lake house you were building will never be yours, but the mortgage will be.

The five stages of EHR grief.  Where are you in the grieving process?

True, there are a handful of EHR successes.  Not nearly as many as the vendors would have you believe.  More than half of hospital EHR implementations are considered to have failed.

If you are just starting the process, or are knee-deep in vendor apathy you have two options.  You can bring in the A-team, people who know how to run big ugly projects, or you prepare to grieve.

If it was me, I’d be checking my list of friends on Facebook to see if I was still on my vendor’s list of friends.

Your EHR contract–Until death do us part?

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That’s a long time. There are those who suggest that statement sort of takes away any incentive they had to live forever. They wonder why it couldn’t be somewhat less restrictive like, “for the foreseeable future,” or “until one of us gets bored,” or “renewable every four years.”

Till death do you part. Sort of like you either just purchased or are about to share your future with. Once the figures get beyond two commas, you’re pretty much locked in—for better or for worse. It makes no difference if you’ve outgrown it, no longer need it, figure out you never needed it, found something better. Perhaps next time you can suggest more friendly language as you stroll arm in arm down the EHR contract aisle.

First, you must make the other party think that they need you more than you need them.
The best contract is an agreement that is binding on the weaker party—hopefully your EHR vendor. Here’s a little twist for the next contract negotiation with the EHR vendor.

Vendor: Will you manage my EHR with all your heart?

Manage it till death you part?

C-suite: Yes, I’ll manage with all my heart,

From now until death do us part,

And I will manage it when it breaks,

And when my boss over the coals me rakes,

And when it’s fit, and when it’s sick,

(Oh, CAN’T we finish this contract quick?)

And we will own it when it’s bad,

And we will own it when I’m mad,

And I will still own it when it’s broke,

When all our patients want me to choke,

And when if fails Meaningful Use,

And when its failure cooks my goose,

And I will be none the dapper,

As my career goes in the (you fill in the blank),

While searching the bowels for our old charts,

Since productivity has fallen apart,

I will manage it as you like,

As all our doctors go on strike,

And I will eat green eggs and ham, and I will like them Sam I am.