Who's Running the Show?

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

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

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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

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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

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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

CIOs, Others React To Meaningful Use Final Rule

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

Tidbits

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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

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Why is EHR not the right answer?

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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