EHR throws a curve ball

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

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

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

Now on Healthcare Professionals, HCPLive.com

Other places to find my posts:

http://www.hcplive.com/primary-care/articles/roemer_meaningful_use

healthsystemCIO.com

HospitalImpact.com

Fiercehealthcare.com

EHR–where do you place the emphasis?

You said I stole the money. Sometimes it all depends on what you emphasize. For example, say the sentence aloud to a friend, and each time place the emphasis on a new word. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. You said I stole the money. The meaning changes as you change your emphasis. You said I stole the money? You can even change it so that it reads like a question.

The same is true with providers and the level of success a firm has working with EHR. Where is your emphasis? If you believe there is a correlation between emphasis and spending, I bet we can prove your firm’s is much more closely aligned to technology than it is to process. What does technology address? Let’s list how deploying technology makes your firm better, or does it?  Millions followed by millions more. Redesign the patient portal.  Add EHR. Mine the data—heck, strip mine it. Show me the ROI. Isn’t that a lot of money to spend without a corresponding business justification?

The technology that is tossed at the problem reminds me of the scene from the “Wizard of Oz” when the Wizard instructs Dorothy and the others, “Pay no attention to the man behind the curtain.” When Toto pulls the curtain aside, we see a nibblet—I love that word—of a man standing in front of a technological marvel. What’s he doing? He’s trying to make an impression with smoke and mirrors, and he’s hoping nobody notices that the Great Oz is a phony, that his technology brings nothing to help them complete their mission.

From whose budget do these technology dollars usually come? IT. From the office of the CIO. What did you get for those millions?  Just asking.

Part of the problem with doing something worth doing on the EHR front is that it requires something you can’t touch, there’s no brochure for it, and you can’t plug it in. It’s process. It requires soft skills and the courage to change your firm’s emphasis. They won’t like doing it, but they will love the results.

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 buy an EHR system?

Do you ever wonder why people buy drills?  Because they need a drill?  No.

They buy drills because they don’t sell holes.

Why buy an EHR system? Because you need an EHR?

I hope you have a better reason than that.  If you’re interested, I sell holes.

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

Tidbits

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

Where workflow goes to die

There are two types of business processes; easily repeatable processes (ERP), and Barely repeatable processes.   Most of the real work that needs to be done in EHR workflow improvement happens in the blank white space between the boxes on the org chart.  That’s where you’ll find a lot of the BRPs–Barely Repeatable Processes.

It is easy to automate the ERPs, and nearly impossible to automate the BRPs.  If you can’t reform either set of processes with your EHR all you have implemented is a very expensive chart scanner.

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

Patient Relationship Management (PRM)-grab the ball

My newest post on healthsystemCIO.com.  http://healthsystemcio.com/2010/07/07/patient-relationship-management-prm-grab-the-ball/

Why can nobody lead?

EHR’s Gordian Knot

There were four of us, each wearing dark suits and sunglasses, uniformly walking down the street, pausing at a cross-walk labeled “consultants only”—I think it’s a trick because a lot of drivers seem to speed up when they see us. We looked like a bad outtake from the movie Reservoir Dogs. We look like that a lot.

Why do you consult, some ask? It beats sitting home listening to Michael Bolton or practicing my moves for, So You Think You Can Dance, I tell them.

Listening to the BBC World News on NPR whilst driving, there’s one thing I always come away with—they’re always so…so British. No matter the subject—war or recession—I feel like I should be having a proper pot of tea and little cucumber sandwiches with the crusts removed; no small feat while navigating the road.

Today’s conversation included a little homily about the Gordian knot with which the company Timberland is wrestling, questioning whether as a company Timberland should do well, or do good. (Alexander the Great attempted to untie such a knot, and discovered it had no end (sort of like a Möbius strip, a one-sided piece of paper–pictured above. (For the truly obtuse, among which I count myself, the piece of paper can be given a half twist in two directions; clockwise and counter-clockwise, thereby giving it handedness, making it chiral—when the narrative gets goofy enough, sooner or later the Word dictionary surrenders as it did with chiral.))) I’m done speaking in parentheses.

Should they do well or good? Knowing what little command some people have of the English language, those listeners must have wondered, why ask a redundant question. Why indeed? That’s why I love the English, no matter the circumstances they, they refuse to stoop to speaking American.

Back to Gordo and his knot. That was the point of the knot. One could not have both—sorry for the homonym. Alexander knew that since the knot had no end, the only way to untie it was to cut it. The Gordian knot is often used as a metaphor for an intractable problem, and the solution is called the “Alexandrian solution”.

To the question; Well or good. Good or evil. Are the two choices mutually exclusive? For an EHR? They need not be. The question raised by the BBC was revenue-focused (doing well) versus community or green-focused (doing good). My question to the reader is what happens if we view EHR with this issue as an implication, a la p→q.Let’s review a truth table:

if P equals if Q equals p→q is
define requirements increase revenues TRUE
play vendor darts increase revenues FALSE
ignore change management increase revenues FALSE
no connectivuty increase revenues FALSE
new EHR software increase revenues FALSE
change processes increase revenues TRUE
eliminate waste increase revenues TRUE
decrease redundancy increase revenues TRUE
Strong PMO increase revenues TRUE

From a healthcare provider’s perspective the answers can be surprising; EHR can be well and good, or not well and not good.  The Alexandrian solution for EHR is a Alexandrian PMO.

Have your people call my people–we’ll do lunch.

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