Counting me, there were six of us; college spies. Maybe that is a grammatical error; we were spies who happened to be in college. Well, maybe that%u2019s a half-truth. We were co-op students with rather high security clearances, working at a place in the DC area which made the type of things of which Nancy Pelosi would deny having any knowledge. I was a mathematics intern–not a bad step on the rungs of the career ladder given that the dean of my math department had tried on more than one occasion to get me to change majors. Everyone I worked with had at least a PhD in math. At least I had enough firing synapses to know I would never be their intellectual peer.

During the summers, we six would report at one of the complex’s gates, flash our badges at the marine guards, make our way past the military weapons testing facilities, and head to our basement offices. At lunch time we would break out our briefcases, and take out our tools of the trade–Frisbees, bag lunch, sun tan oil (this was in the days before anyone could spell SPF, pure Hawaiian Tropic.) Within minutes we would be stripped down to our cutoffs, running across the field where the helicopters landed, and dripping with sweat. After lunch we would help draft differential equations whose aim was to read target signatures sent from one of our missiles at a Soviet or Chinese aircraft. Not a bad gig if you can get it.

That was then. Now we are aging adolescents clinging woefully to rapidly fading images of summers past, whose idea of getting wasted is drinking multiple espressos. Gone are the days where we could abnegate responsibility. We matured, at least a lot of us. We have learned pretending you know what you are doing is almost the same as knowing what you are doing. We have accepted it to the extent that we act like we know what we are doing even if we do not and, we do it.

Pretending is a skill. Guys do it all the time, secretly hoping no one will notice. People who answer your hospital phones do it too. Sometimes patients will settle for an answer; any answer. It is sort of like bluffing in Trivial Pursuit–you bluff with enough confidence, your opponent may not even check your answer. For some patient questions, there are three states of being; not knowing, action and completion. The goal is to move as rapidly as possible from the first state to the third. If the patient proves to be a problem, the patient care rep should finish each sentence with the phrase, In accordance with the prophecy.

Of course, if face-to-face interaction proves to be too much, you can always tighten up the dialog. For example;

RING….

*click*

Welcome to the Patient Care Hotline.

If you are obsessive-compulsive, please press 1 repeatedly.

If you are codependent, please ask someone to press 2.

If you have multiple personalities, please press 3, 4, 5 and 6.

If you are paranoid-delusional, we know who you are and what you want.

If you are schizophrenic, listen carefully to the little voice until it tells you which number to press.

If you are manic-depressive, it does not matter which number you press. No one will answer.

If you are delusional and hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.

Thanks for calling.

Paul Roemer, Managing Partner, Healthcare IT Strategy

I was wondering how CIOs would approach the implementation of EMRs if they had never heard the term Meaningful Use. The more I thought about the question, the more I felt it merited discussion. If I were a CIO, I would not let these outside regulatory influences dictate my strategic decision making. As a member of the executive team, my responsibility is two-fold; to facilitate and improve patient care, and to contribute to the business as an advisor, someone whose actions positively impact the bottom line.

Some CIOs have been forced to abdicate their responsibility and to approach EHR as order takers. Sometimes the CEO/CFO/COO creates a directive mandating EHR. That said, their guidance may end. In other, more problematic cases, it doesn%u2019t, and they also supply the name of the EHR vendor that must be used. The worst reaction to this pressure is to not challenge the issue of whether your organization will attempt to meet Meaningful Use. The concept is much more novel than it may appear.

What if Meaningful Use didn%u2019t exist? Many hospitals undertook EHR without any hint of the fact that MU was coming %u2014 coming with money, penalties, and constraints. Many completed the implementation only to learn that to meet MU they are not done, far from it. In fact, they have just begun modifying their implementations, and paying big time for those changes.

Those who started EHR early did so under the notion that their efforts were working in concert with an established set of business goals. This is the right way to operate. Remember, EHR is voluntary %u2014 really. By default, that makes meeting MU voluntary. There is no hidden directive that states all those who implement an EHR must meet MU. Not meeting it may subject your organization to penalties, and these should be factored into your ROI calculation.

Let%u2019s assume you have, or are going to implement, an EHR system. For large providers, it is difficult to develop a business argument for not having EHR. Now assume that MU does not exist. We already have seen examples of how having MU impacts HIT strategy, how would not having to plan around MU impact your EHR and HIT strategy? What other projects would be at the top of your list? What initiatives could you own if you did not shuffle resources away from your preferred strategy simply to chase MU? Instead, would you be addressing patient and physician churn? Implementing managed services opportunities? Aligning workflows? Developing a social media platform?

There is nothing wrong with assessing what you would be doing to support your hospital if there were no Meaningful Use. You can and should undertake that assessment and calculate its ROI. Then, instead of having a lone MU ROI, you have something else against which to compare it.

Tags: Blogs, Paul Roemer

This entry was posted on Saturday, February 20th, 2010 at 3:28 PM and is filed under Acute EMR, Ambulatory EMR, Meaningful Use. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.