Who's Running the Show?

Your brand ain’t what it was

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Many brands have been redefined by a hospital’s patients through their patients’ use of social media.  Your brand is now what their patients—their social mediaphiles—say it is.  How’s that for a wakeup call?

Hospitals spend millions of dollars each year marketing to build their internal and external image; to what end?  At best, a hospital’s only barometer for how well they are getting their message across is a metric for name recognition.  Do more people know your name than they did a year ago?

I bet they do.  I would also bet most hospitals would have the same recognition factor if they did not spend a dollar on marketing.  Many organizations have no return on their marketing investment.  Installing a billboard on a highway a mile away from the hospital depicting a picture of smiling urologists is not bringing new patients or helping you retain current patients.

It may be time to figure out what the market and your employees are saying about your organization.  Chances are good that many of their messages are far different from your hospital’s vision statement and mission.  Chances are also good that their bandwidth and access to your customer base is significantly higher than yours.

We made it to the bigs

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Somehow, my social media article healthsystemcio.com made the top story of Chime Healthcare CIO SmartBrief.  http://ow.ly/2snrU

Not bad for a metaphorical tomato thrower.

Thanks for playing along.

Expert: Providers must make IT investments on their own, have new implementation strategies

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Here is the link to an article in HealthcareITNews that quotes a few of the things we have been discussing on this site.

http://www.healthcareitnews.com/news/expert-providers-must-make-it-investments-their-own-have-new-implementation-strategies

Should you meet Meaningful Use?

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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

Failed EHRs: Maybe it’s the jeans

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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

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

EHR: when you are in a hole, stop digging

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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

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

EHR: Got a few minutes?

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

How’s the national EHR roll-out going?

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I just fell out of the stupid tree and hit every branch on the way down. But lest I get ahead of myself, let us begin at the beginning. It started with homework–not mine–theirs. Among the three children of which I had oversight; coloring, spelling, reading, and exponents. How do parents without a math degree help their children with sixth-grade math?

“My mind is a raging torrent, flooded with rivulets of thought cascading into a waterfall of creative alternatives.” Hedley Lamar (Blazing Saddles). Unfortunately, mine, as I was soon to learn was merely flooded. Homework, answering the phone, running baths, drying hair, stories, prayers. The quality of my efforts seemed to be inversely proportional to the number of efforts undertaken. Eight-thirty–all three children tucked into bed.

Eight-thirty-one. The eleven-year-old enters the room complaining about his skinned knee. Without a moment’s hesitation, Super Dad springs into action, returning moments later with a band aid and a tube of salve. Thirty seconds later I was beaming–problem solved. At which point he asked me why I put Orajel on his cut. My wife gave me one of her patented “I told you so” smiles, and from the corner of my eye, I happened to see my last viable neuron scamper across the floor.

One must tread carefully as one toys with the upper limits of the Peter Principle. There seems to be another postulate overlooked in the Principia Mathematica, which states that the number of spectators will grow exponentially as one approaches their limit of ineptitude.

Another frequently missed postulate is that committees are capable of accelerating the time required to reach their individual ineptitude limit. They circumvent the planning process to get quickly to doing, forgetting to ask if what they are doing will work. They then compound the problem by ignoring questions of feasibility, questions for which the committee is even less interested in answering. If we were discussing particle theory we would be describing a cataclysmic chain reaction, the breakdown of all matter. Here we are merely describing the breakdown of a national EHR roll out.

What is your point?  Fair question.  How will we get EHR to work?  I know “Duh” is not considered a term of art in any profession, however, it is exactly the word needed.  It appears they  are deciding that this—“this” being the current plan that will enable point-to-point connection of an individual record—will not work, and 2014 may be in jeopardy—not the actual year, interoperability.  Thanks for riding along with us, now return your seat back and tray table to their upright and most uncomfortable position.

Even as those who are they throw away their membership in the flat earth society, those same they’s continue to press forward in Lemming-lock-step as though nothing is wrong.

It is a failed plan.  It can’t be tweaked.  We can’t simply revisit RHIOs and HIEs.  We have reached the do-over moment, not necessarily at the provider level, although marching along without standards will cause a great deal of rework for healthcare providers.  Having reached that moment, let us do something.  Focusing on certification, ARRA, and meaningful use will prove to be nothing more than a smoke screen.

The functionality of most installed EHRs ends at the front door.  We have been discussing that point for a few months.  When you reach the fork in the road, take it.  Each dollar spent from this moment forth going down the wrong EHR tine will cost two dollars to overcome.  To those providers who are implementing EHR I recommend in the strongest possible terms that you stop and reconsider your approach.

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

How to Revive a Failed EHR Implementation

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My latest post on www.healthsystemCIO.com.  Here’s an idea I think merits consideration.

http://healthsystemcio.com/2010/07/30/how-to-revive-a-failed-ehr-implementation/

What do you think?

How can you solve the EHR puzzle?

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Seth Godin wrote about the “Perfect Problem.”

A perfect problem, in its existing state, is unsolvable.  The way most of us handle it is to click our heels together three times and hope it goes away.  We tend to work on imperfect problems, those that can be solved.

What is the difference between the two?  The first step is the ability to understand what makes the perfect problem uniquely unfixable.  Perhaps a few examples would help.

  • The CEO imposed a deadline for the implementation of EHR.
  • CMS Meaningful Use rules do not fit with our operational strategy.
  • If we do not implement EHR by this date, we do not get the money.
  • We must meet Meaningful Use
  • We do not have enough resources from the EHR users to understand their processes.
  • We cannot continue to support these low-margin services
  • We do not have enough time to define our requirements
  • We cannot afford to spend the time required to assess our processes before we bring in the EHR vendor.

What can be done?  The easy answer is to plan for failure and do your best to minimize it.

What is another way to describe the above examples?  They are constraints.  They can all be rewritten using the word “can’t”.  Rewritten, we might say, “We had a chance to succeed, but because of X, Y, and Z we can’t.”  If that assessment is correct, you will fail, or at least under-deliver at a level that will be remembered for years to come.  That’s a legacy none of us wants.

There are a few solutions to this scenario.  You can eliminate the seemingly intractable constraints; the organization can determine to re-implement EHR and hope for different results; or they can simply find someone else to solve the perfect problem.

Experience teaches good leaders really want reasoned advice.  They want the members of the C-suite to tell them what must be done to be successful.  Good leaders do not accept “can’t”—not on the receiving end, not on the delivering end.

Some will argue, “This is the way our organization works.”  Even if that is true one must consider what is needed to make an exception to the constraint.  Would you accept this logic from a subordinate?  Of course not.  You’d demand a viable solution.  If you are being constrained in your efforts to solve a perfect problem, perhaps it is time to restate the constraints.

One of my college professors—way back when we still had inkwells on our desks—told me that if you cannot solve the problem the way it is stated, it is to your advantage to restate the problem.  Maybe the solution to the perfect problem is to restate it in a manner that makes it imperfect—solvable.

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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