Who's Running the Show?

EHR: How to purchase an EHR

Posted by

0

shoppinggirlAre you really going to where that?  Do these pants really make my…

Did you ever have one of those non-halcyon days when you felt the need to ask someone “Did a house fall on your sister?”  Try to stay with me, it will come to you.  Enough about falling houses Toto.

I sought the counsel of a friend before heading down this path, and I’ve decided to choose the road less traveled anyway.

I may have written that I have observed differences between men and women.  You too?  Here are a few examples from my side of the gated compound.

  • We are willing to make mistakes as long as someone else is willing to learn from them
  • A good excuse is almost as good as getting it right
  • Good intuition will often make up for a lack of any facts
  • We refine our personality flaws, for without them we may not have a personality
  • Peter the Great heard the voices too

I regret that I am unable to share my list about women, for I am a coward.

While shopping the other day, I noticed that women shop for clothing differently from men.  For women, shop is a participatory verb—whatever that is—involving all twelve senses, for men it’s something we’d rather do online while watching the game.  From what I’ve observed, in fostering the she-conomy women:

  • Do their homework—what’s in, what’s not, what’s on sale
  • View shopping as a competitive sport, for some, a blood sport
  • Try on things, often more than once
  • Buy something they may need in case they someday find some other thing they may need that may go with it
  • There is no rule about having too many shoes—buy in volume
  • There is no rule about having too many black shoes

So, let’s see if we can segue beyond this jingoistic tractate on one to something more in line with the lofty subscription fee you paid for this site.

Permit me to employ two definitions which help me keep my ideas cogent.

  • IntraEHR—EHR statements that relate mostly to the healthcare provider
  • InterEHR—EHR statements that relate mostly to the movement  or transport of the EHR record from point A to point B

EHR and shopping.  Can one be at one with this duality?  How can one not be?  From having spoken with a number of healthcare providers about their IntraEHR selection, my take on a lot of the process is that more often than not there is no process.  It’s a lot like watching men shop.  It’s over and done with without much reasoned or substantiable—I was afraid I’d have to invent this word but I found it on Google—thought.  Over and done with, now back to the game.

Maybe EHR scholars will one day be able to trace speed buying of IntraEHRs back to that whole Neanderthal hunter gatherer thing in the Pleistocene epoch.  Sort of a think fast on your feet or you’ll be eaten approach to software selection—an awful metaphor, however CNN ran a feature with that title, so it has some legitimacy.  Maybe the hospital’s executive committee will be able to trace the hastily made IntraEHR purchase back to a lack of a plan, the lack of business requirements, and the lack of an adequate request for proposal RFP.  Maybe your successor will figure it out.

For those who haven’t contracted for their IntraEHR, it may be better to approach this like a woman.  To those who are women—you should know who you are—you are probably already approaching it that way.

Now, where did I leave my black pumps?  And no, I am not going to finish my thought about the pants.

pastedGraphic.tiff.converted

How large is the reform effort?

Posted by

0

dr_evil_one_million_dollarsA trillion dollars.

What does a trillion look like?  A dollar bill is about six inches long.  Stacked end to end, a trillion dollars would go from the earth to the sun, and back, twice.

Healthcare is one fifth of our economy.

One fifth of our GDP is larger than the GDP of five of the G8 countries, including France and the UK.  Would we try to reform the entire economy of the UK?  Would we succeed?

We have about six million miles of paved roads in the US.  How long do you think it would take the government to repave twenty percent of them, 1.2 million miles?  Could they do it?

Maybe we really should have a plan before we write a check.

pastedGraphic.tiff.converted

Your EHR –Do you neeed to change the threat level?

Posted by

0

escapekeyboard“Step away from the wall,” Veronica yelled through her ear microphone, loud enough so everyone could hear her.

I knew if I released my grip, the chances of me remaining upright weren’t very good.  Permit me to roll back the clock thirty minutes.  Friday morning in Philadelphia.  It’s raining.  In Texas they call this much rain a frog-floater.  Two and a half hour delays at the airport.  A cold biting rain, the kind that sees you in Gortex and simply laughs at you for being too silly to be indoors.

I cancelled my run and decided to sit in on one of the classes at the gym, take a break, rest up for a long run tomorrow.  The only class scheduled was kickboxing, and it’s being led by the mother of my seven year-olds best friend—not exactly my biggest physical threat. She wore her hair like Veronica in the Archie comic books, and because I couldn’t remember her real name, for purposes of this narration, that’s how we will address her.  I don’t even know what kickboxing is, but I know it doesn’t get any easier than that.  I’d finished my lifting, finally got to thirty pull-ups today—yes, in a row, and I was pumped.

I walked into the mirrored room.  The floors were recently shellacked—I love the smell of shellac in the morning.  Spandex clad women decked out in puce—isn’t that a great word—purple, lime green, and hot pink were everywhere.  The music—some sort of electronic something or other—started to blare and bodies started to move.  Knowing that I wouldn’t be sucking wind, I thought about asking Veronica to put on some music with words so we could sing along.  She gave me one of those looks that said, “In five minutes you will be so mine.”

The class is scheduled to last sixty minutes.  We began by jumping rope and I almost broke both of my legs—I am the poster boy for the theory that white men can’t jump.  I grabbed a pair of dumbbells to do with the exercises, just to make sure I got a bit of a workout.  Twelve minute into the class and I looked like the rain had followed me inside.  At minute thirteen, I dropped the dumbbells.  By minute sixteen, I no longer had any feeling in my shoulders.  I thought I saw a few of the participants checking me out, one advantage of being the only Y chromosome in the class—the one closest to me came over to ask if I was okay.

A twenty-second break for a sip of water—I had already downed my liter.  The colors of the spandex outfits had started to blur into what looked like a Peter Max painting that had been left out during a downpour.  Minute twenty-two, thighs are burning.  Twenty-four, I am found clinging to the wall.  I would not have made the twenty-fifth minute.  I reached for my cell phone and pretended that I had a voice message.  Two minutes later, I crawled out of the room.

I had under estimated the threat level, under planned, and under delivered, surpassing even my own inadequacies.

My fall from grace was short lived.  A fall from grace once you get beyond seven figures of cost implementing your EHR won’t be so short lived.  Those names will echo down the commercially carpeted hallways for a long time.

What’s being under planned?  The plan for one thing.  Once you’re into eight figures, I hope you have a written and signed-off plan.  That sign-off may be your life jacket, unless they decide to parole only those above you.  Once you get into even the potential of a nine-figure spend, I’d plan on a planning process of three to six months.

Anything less may find you clinging to a wall.

021_18A

How does the healthcare business mix with the business of healthcare?

Posted by

0

Remember when using language correctly while speaking and writing provided a common ground for understanding?  I write what I mean.  Nothing I ever wrote will be used as eleventh grade English Lit class assignment to ferret out my intent.  A few responded to the my discussion questioning if I felt involving business people in reform meant giving them carte blanche to mess in areas where they have no expertise.  I wouldn’t recommend that any more than I would recommend involving its reverse.

I am not a clinician or medical professional, don’t intent to be, don’t play one on TV.  I have not offered, nor will I offer my opinion on anything medical.  There will be no critiquing of who should be seen, what procedure should be performed, how to perform them better, or is entitled to what.  That’s all outside my pay grade.  If I cross that boundary, do us both a favor and take away my crayons.

That said; let met share what I think is being left out of the discussion about EHR and reform, a topic some treat as an unspoken side issue.  It’s almost as though this is the black sheep of reform, the part of the rug we want to sweep under the carpet—how’s that for mixing a metaphor?  There are those who think of healthcare as a business, those who begrudgingly think of it as a business, and those who never will.

Those at both extremes have contributed to healthcare’s present circumstances and an ill-managed rush to change.  Those in the business only camp, instead of making healthcare more effective have opted to make it more efficient, cutting costs by cutting jobs, and services.  The payors have added to the ineffectiveness by managing to the price of their stock instead of the public trust—these need not be mutually exclusive.

Effectiveness is all about quality, efficiency is all about speed.  Poor business leadership has helped some hospitals do a lot of ineffective things very quickly, but not well.  I’ve never met an executive who didn’t know how to cut costs—it doesn’t take a village to raise a cost slasher.  I, like you, have met very few who know how to increase revenues or increase quality.

Then there are those who will never see healthcare as a business, yet some of them hold senior business positions, positions which call upon expertise they do not have or do not find particularly necessary.  Just as business people shouldn’t perform open heart surgery, there are some better suited to medicine than to IT or P&Ls.  Curiously, those words are not mine; they were told to me by healthcare executives, some with MDs and PhDs.

The healthcare business is uniquely intertwined with the healthcare mission.  Should it be subservient?  That is a question better answered by the ethicists than by me.  I conclude that there are ways to make the business better that will make the mission.  That’s what I look to uncover.

Can EHR be used to improve healthcare?  It depends.  If properly planned and executed, yes.  If done simply in the belief that all things automated are better than those that are manual, no.

Think about a hospital you know well.  How many human resource departments does it have?  Registration?  Payroll?  IT?  What else is duplicated?  How many duplicate departments are required?  Can duplication be removed without simultaneously harming the business or clinical side?  If done correctly.

I think much can be done to improve the healthcare business without impeding the business of healthcare.  To me, that is the part of the mission with which reform should come to grips.

saint