Three AM. A night not fit for man nor beast. Billowing fog roiled out of the steam grates all but obscuring vast sections of the town.
I arrived early to secure my place in line—my first tail-gate party since leaving college. The trunk of my car was loaded with my gear as I eased to the curb along Independence Avenue. Orange traffic cones and blockades were scattered along the street in anticipation of the crowds. The traffic officer checked my permit and directed me to my parking spot.
“We are anticipating a huge crowd,” he said. “It looks like you are the first to arrive.”
“You look like you have done this before,” I remarked.
“Pretty much every day. Ain’t a day goes by when the feds aren’t giving away truck loads of money for one thing or another.”
I unloaded my car—lawn chair, iPad, boom box, sleeping bag, and enough Starbucks to ensure I would need to use the Port-a-Potty well before the doors opened at eight AM.
I had expected the line to be wrapped around the block several times. “Where are the others I asked?”
“I am not sure. Dr. B. told us to expect to be overwhelmed,” responded the officer as he blew on this hands, and did the “my feet are freezing dance” on the pavement.
Sitting there for two hours I was undisturbed until two vans pulled alongside. A warmly-dressed woman wearing a Mayo North Face jacket set up camp next to me. “You look cold,” she said. “In Minnesota, weather like this reminds us of spring.”
Disembarking from a big pretty white van with red stripes, curtains in the windows that looked like a big Tylenol was a man wearing shorts, flip-flops, with his hair tied back in a pony tail. All he carried was a skate board. “Rex Kramer,” he said as he extended his tanned hand to shake mine. “You can call me ‘Dude’. I’m from Kaiser.” (As though the skate board and shorts were not a dead giveaway.)
“Where are the others?” I inquired.
Dude Kaiser and Spring Mayo looked at me like I had just told them I had implemented EHR on my MP3 player. “Nobody else is coming,” quipped Spring.
“Surely, you jest.”
“I jest you not…and please don’t call me Shirley.”
I was worried for a moment whether she would ask me if I liked movies about gladiators. Instead I asked, “Nervous?”
“Yes.”
“First time?”
“No. I’ve been nervous before.” She slapped me back to reality and causing me to drop my poor imitation of Ted Striker.
Dude gave me his take on the EHR rebate situation. “Nobody else is coming because nobody else can collect.” I looked into his blue eyes with a stare of my own that suggested I was the deer that had just been run over by the pair of headlights to which everyone always references.
“When you factor in all of the critical success factors about EHR, certification, the RECs, HIEs, CPOE, and the N-HIN, a lack of standards, and interoperability, one thing is always overlooked. And that one thing takes precedence over all the others. KM.”
“And just what is KM?”
“Kaiser Money—any number that is followed by nine zeros. It took us a long time to decide between spending that kind of cha-ching. I tried to get them to buy a country from South America, but got no takers.”
“How much will you get for your investment?” I inquired.
I could see him doing the calculations in his head as he applied another coat of Hawaiian Tropic to his skin hoping the glow of the moon might enhance his tan. “Well, it’s difficult to say with any degree of certainty. But when all is said and done, I estimate we’ll see somewhere between one-ten point four and one-ten point five.”
“Million?”
“No silly, dollars. By the way, you ever been to a Turkish prison?”
(Leslie Nielsen, you will be missed.)
Many organizations have a Program Management Office and a Program Steering Committee to oversee all aspects of the EHR. Typically these include broad objectives like defining the functional and technical requirements, process redesign, change management, software selection, training, and implementation. Chances are that neither the PMO or the steering committee has ever selected or implemented an EHR. As such, it can be difficult to know how well the effort is proceeding. Simply matching deliverables to milestones may be of little value if the deliverables and milestones are wrong. The program can quickly take on the look and feel of the scene from the movie City Slickers when the guys on horseback are trying to determine where they are. One of the riders replies, “We don’t know where we’re going, but we’re making really good time.”
paulroemer 
paulroemer 
paulroemer
Paul M. Roemer
Pale Rhino Consulting 