July is “take your EHR strategy to lunch month”

Several have written suggesting I toss my hat into the ring to serve as the EHR Strategy wonk or czar.  I was in the process of thinking it through when I was awakened from my fuegue state by a loud noise–my ego crashing to the floor.

Some have suggested that a camel is a horse designed by a committee.  Their point in saying that has something to do with how committees function less well than individuals–the problem with “group thinking.”  Personally, I think the camel design seems rather functional.

Some have asked, what is it about the EHR universe that has you dehorting the EHR process as though you are some sort of savant–nobody really asked that, but I wanted a segue and that’s all I came up with.

It’s the committees.  I feel a little like Quasimodo repining about the bells.  Raise your hand if you are on an EHR committee.  See?  Now, if you think that not only has the committee not accomplished much, but believe that it may never accomplish much, lower your hand.  Now look around.  Not many hands still up.

Please take a look at this for a moment.  Don’t try to understand it–it will only make your teeth hurt.

2011 requirements

  • For hospitals, 10% of all orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) directly entered by an authorizing physician must be made through a computerized physician order entry process. Individual physicians still must use CPOE for all orders, even if electronic interfaces with receiving entities are not available. The initial draft did not specify the required percentage for hospitals and did not address the electronic interface issue.
  • Physicians must be able to check insurance eligibility electronically from public and private payers, when possible, and submit claims electronically. This was not in the initial draft.
  • Patients must receive timely electronic access to their health information, including lab results, medication and problem lists, and allergies. The initial draft did not include the word “timely.”
  • Physicians must implement one clinical decision rule relevant to specialty or high clinical priority. This was not in the initial draft.
  • Physicians must record patient smoking status and advance directives. This was not in the initial draft.
  • Physicians must report ambulatory quality measures to CMS. This was not in the initial draft.
  • Physicians must maintain an up-to-date list of current and active diagnoses based on ICD-9 or SNOMED. The initial draft did not specify use of the two classification sets.

2013 requirements

  • Specialists must report to relevant external disease or device registries that are approved by CMS. This was not in the initial draft.
  • Hospitals must conduct closed-loop medication management, including computer-assisted administration. This was not in the initial draft.
  • All patients must have access to a personal health record populated in real time with health data. This was moved up from 2015 in the initial draft.

Additional provisions

  • Patients’ access to EHRs may be provided via a number of secure electronic methods, such as personal health records, patient portals, CDs or USB drives.
  • CMS will determine how submitting electronic data to immunization registries applies to Medicare and Medicaid meaningful-use requirements.
  • CMS may withhold federal stimulus payments from any entity that has a confirmed privacy or security violation of the Health Insurance Portability and Accountability Act, but it may reinstate payments once the breach has been resolved.

Source: Health IT Policy Committee

See?  Take a few minutes and work this into your EHR task time-line for processes, work flows, change management, training.  Need more time?  I’d need more time than I have, and when I finished I guarantee I couldn’t explain it to anyone.  This is what happens when people get into a room, have a charter, and try to do something helpful.  I am sure they are all nice people.  But be honest, does this make your day, or does it make you want to punish your neighbor’s cat–you may have to buy them a cat if they don’t already have one.

What to do?  Here’s my take on it.  Plan.  Evaluate the plan.  Test the plan.  Know before you start that the plan can handle anything any committee tosses your way.  Let people who know how to run large projects into the room.  Seek their counsel, depend on them for their leadership.  If the plan is solid, the result has a better chnace of surviving the next committee meeting

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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What did you budget for EHR?

Okay, so today was going to be one of those days when I wasn’t going to allow myself to be stupified–at least no more than was really required.

Then it sneaks up smack dab in the middle of a call, and from what I’ve been able to determine, people find it annoying if you burst out laughing on the call.  (They are not annoyed at all if you simply write about them provided they don’t read it.)

What got me going is this statement, “We’ve budgeted $X for EHR.”

Really?  You did this all by yourself?

The facts as I understood them are as follows:

  • Never bought an EHR
  • Don’t know how big they are, if they are blue or green, come gift-wrapped, or if you need two people to carry it
  • No input from vendors about EHR
  • no discussions with others abot what an EHR system costs

So, with absolutely no information how does one determine how much they need to spend?  This is not like going to the supermarket for a gallon of Soy Milk–not that anyone would want to do that.

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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The Joy of Sox–deliver a great presentation

It is an interesting exercise taking apart a one hour speech and repackaging it as a five minute talk—Twitterizing.  It goes to the quote, “I would have written less if I had more time.”  The corollary for presentations may be, if it does not fit one slide, it’s not properly thought out.

I think what a lot of presenters miss is having an understanding of what makes for a good presentation.  Here are a few of mine.

Presentation Rule 1—never bore the audience.  They are pulling for you to do well for your sake and theirs.

Presentation Rule 2—the audience can read.  If your slides are filled with text and bullet points, their natural inclination is to read what you’ve written.  They are doing this while you are reading aloud the very same text.  If they are reading, you become superfluous.

Presentation Rule 3—the audience cannot walk and chew gum at the same time (they can’t read your words and listen to you.)  For those presenters who favor text on their slides there is two choices; read from the slides, or try to offer commentary about the slides.  For those who do not read directly from their slides and want to offer commentary it gets even more awkward.  You look at the audience and see them reading the slide.  Your natural tendency is not to interrupt their reading because you are trying to be polite and you do not want them to miss your words of wisdom.  Then your mind starts to wonder if what you are about to say is so important if you should have written it on a slide.

Presentation Rule 4—if you wear wild looking socks, you had better be delivering one heck of a good talk.

Seth Godin’s philosophy about presentations is not wanting people taking notes based on what is on his slides, hence he uses pictures to convey an idea.  I have adopted his approach, choosing to hand-draw concepts from which I can then speak.  Since there is nothing of import on the slides, people start staring at you, something which will make a lot of presenters even more nervous.

The downside of this approach is that since everyone will now be listening instead of reading or writing, you better have something to say.  The issue then becomes how to craft your words in a way to get your audience to remember your message.

I favor analogies, examples, and the occasional cliché.

Will these steps work for you?  I hope they do.  I felt they were working pretty well for me last night right until the end.  An attractive woman approached me and said, “You look like Jack Nicholson, only not as unattractive”—so at least I’ve got that going for 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

Is the C-suite fiddling while EHR burns?

There is an adage in the military—different spanks for different ranks.  If speaks to a double standard, the less egregious their punishment for similar offenses, similar misjudgments.

We see that every day in business, and we see it a lot in healthcare, especially in hospitals.  Physicians are held accountable for medical errors.  Hospitals pay millions for malpractice insurance knowing that mistakes will be made and people will be held accountable for their mistakes.

But what about on the business side?  Who is held accountable for business mistakes?  An acquisition that failed to deliver.  An expensive new service offering that bled the company dry.  A decline in the number of patients. The failure of a major IT initiative to deliver results.

Take EHR.  Some of you are saying, “Yes, please take it.”

  • Around sixty percent of the large EHR projects have failed in one respect or another
  • Most will not receive ARRA incentives
  • A large number of hospitals are on their second implementation of EHR
  • Some have productivity losses of thirty percent

Who is going to be fired for the two hundred dollar misstep?  The board?  Never.  The CEO—no.  The COO or CFO?  Unlikely.  The CIO?  That is the safe bet.

Did the CIO authorize the expenditure?  Nope.  Did the CIO get all the dollars needed to be successful, all the user support?  Unlikely.

In most cases the CIO has all of the responsibility and only some of the authority.  There are a handful of people in each organization tasked with the oversight of the large project.  They are the ones who should be asking the right questions, the ones who should be demanding answers.

A failed project, a failed strategy should not come as a surprise.  The only people who will be wearing EHR 2.0 T-shirts are those who authorized EHR 1.0.  How come these individuals are not accountable?

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 Experience (Mis)Management (PEM)

Patient Experience (Mis)Management (PEM)–my new post for @healthststemCIOhttp://ow.ly/22uEj

EHR Czar posting

One summer in college, I worked for the state roads commission in Maryland.  If you like being outdoors, getting a lot of exercise, driving around in the back of dump trucks drinking beer it was the perfect job.

The average day went like this.  Each morning we’d report to the facility at seven, and sit around for an hour as the supervisors received their assignments for the day.  It would take another hour to gather the tools needed to complete whatever project we were given.  On the road by nine, the two full-time employees inside the truck, my friend and I laying in the back on burlap bags..

By ten, we had unloaded the tools, and scoped the work.  Most days we’d forget one or two tools needed to complete the work, radio back to the facility to have someone deliver it to us, and practice sitting on our shovels until we were fully outfitted.  It didn’t make sense to start the work knowing lunch was only thirty minutes out, so on most days we would simply wait until after lunch.  By one o’clock, our bellies full, we began our assignment—fix a guardrail, shovel some gravel, install a road sign, scoop a dead deer of the road.

The foreman, Butch, knew the location of every liquor store in the county.  Happy hour in the dump truck usually began at three—one case of beer for the two men in the front, one case of beer for my friend and me in the back.  We’d lay there with our shirts off as the supervisor chauffeured us around the county trying to kill time until we could return to the service bay.

I wonder if they need any help this summer.

One of the things I remember about that summer was a job posting in the service shed.  The posting was for a supervisor/foreman.  The single qualification was the requirement of having completed education through grade five—the “Are you smarter than a fifth grader” test.

I have no segue.  I am wondering if there is a posting in the ONC service shed for an EHR Czar.  If there were, what would be the requirements?

WANTED: EHR Czar—Fourth graders need not apply.

Count me in.

When you need something different–From thinkgeek.com

Savory Unicorn & Heirloom Tomato Bruchetta Recipe

  • 14 ounce can of Unicorn Meat
  • 6 or 7 ripe plum tomatoes (about 1 1/2 lbs)
  • 2 cloves garlic, minced
  • 1 Tbsp extra virgin olive oil
  • 1 teaspoon balsamic vinegar
  • 6-8 fresh basil leaves, chopped.
  • Salt and freshly ground black pepper to taste
  • 1 baguette French bread or similar Italian bread
  • 1/4 cup olive oilChop the tomatoes and mix with garlic, olive oil, vinegar, salt, pepper and basil leaves. Toss well. Slice baguettes on the diagonal about 1/2″ thick. Brush each slice with olive oil and add a full rounded tablespoon of Unicorn Meat, spreading over each piece. Toast in a 450 degree directly on over rock for 5-6 minutes. Do a little funky dance by yourself until it’s toasted. Serve with tomato mixture and some flaming Absinthe.

Social Media–a few thoughts on its power

The web never ceases to amaze me. I’ve gotten to the point if I can’t find something I’m looking for, no matter how obscure, I figure that I did something wrong in how I framed the search.

For example, I was trying to connect to a high school classmate, someone I hadn’t spoken with since before Al Gore invented the internet. This guy got a pair of boxing gloves for his 14th birthday. We each wore one, and jousted only long enough for us each to land a blow on the other’s nose. It hurt—a lot. We gave up boxing. In tenth grade biology, we bet him five dollars that he wouldn’t jump out of the second floor window. The teacher, who knew of the bet, turned her back to write on the blackboard. He jumped. Go straight to the office, do not pass GO, do not collect $200. We used to see how fast his red and white Mach II Mustang would go railing down Route 40. He was the guy you voted best person to keep away from bright shiny objects. The last I heard he went to a teaching college.

Anyway, I Googled him—from the imperative verb Google—I Google, you Google, he, she or it Googles. I can’t tell you his name for reasons that will soon become apparent. Google returns links to things like military intelligence, think tank, counterinsurgency, small wars, and army major. I think I’ve made a spelling mistake and add his middle initial to the search criteria. Up pops a link to CNN’s Larry King. The topic of the show, the hunt for Osama Bin Laden. To quote Lewis Carroll, “things keep getting curiouser and curiouser.”

The web. Social networking. A great tool if you’re one the outside searching, deadly in the hands of your customers. If your firm is targeted, you are pretty much defenseless. Each customer is capable of creating its own digital perception of your firm. True or false, makes no difference. They’re like little thunderstorms popping up everywhere. Companies scurry around like frightened mice passing out umbrellas and pretending it’s not raining. They’re late, their customers are wet, and they are telling everyone. Very few firms have learned that they can’t put the rain back into the clouds.

Sort of reminds me of the line in the movie Young Frankenstein, “Could be worse, could be raining.” It’s raining, and even the best firms have run out of umbrellas. What is your firm doing about it?

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

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

Is the Internet good or bad for you?

I wrote this reply to Kent Bottles’ post on whether the Internet is good or bad for you.  http://icsihealthcareblog.wordpress.com/2010/06/21/kent-bottles-is-the-internet-good-or-bad-for-you/#comment-354

That’s quite a mindful—my email just beeped and my MP3 died, so I am going to put this on hold for a second.

Where were we?  A few observations if I may.  Instead of concluding we have difficulty being in the moment, since the way we’ve lived since the infusion of all digital all the time, perhaps the meaning of being in the moment has changed.  Were there similar discussions at the invention of the phone, the radio, the turntable, and the television?  Goodness knows did not we go through many of the same changes—listening to the radio while doing homework, watching TV while conversing with family?

On the issue of multi-tasking, studies suggest we are able to function less effectively while being mutli.  Does that not depend somewhat on the nature of the task?  Let us consider the question, function less at what.  If it has to do with a task of doing ones taxes while checking email and speaking on the phone; that may be true.  If the same functions are considered in light of someone who hates doing their taxes, and has no pressing deadline, no hard stop, perhaps the diversions make the onerous task seem a little less so.

Perhaps there are certain tasks we were unable to do before the internet engulfed our approach to our waking hours.  Perhaps, there are tasks made easier by multi-tasking.  I can be in a group discussion on Google Wave, giving assignments.  The group can be updating and discussing a presentation stored in a cloud—all in real-time.  While downloading a .rar file of a chapter of an audio book for a key deliverable, instead of having to rush to Borders and read it, I may have Pandora running in the background, and may get a text message from someone in the group about a comment they did not wish to share with the group.

That same group can be assigned individual tasks to be completed within the next twenty-four hours.  Members will be assigned to “post” their deliverables to the group at various times for individual comment, and a final meeting invite will be sent by the last person to finish their task.  Pretty efficient.  Certainly better than the days when we felt fortunate simply to be able to FedEx a draft of the deliverables to each of the members, some of whom are overseas, and wait 48 hours to view their feedback.

Perhaps the relevancy of good versus bad internet depends more on what you are trying to do.  Some people who have self-diagnosed ADHD—I barely have time to focus on having AD, let alone all four letters—may find this a blessing.  I have the attention span of a half-life of a fruit fly.  I bore easily, and on occasion bore others easily.  Stuck in this digital cornucopia, I am able to function at a higher level.

As I write this, I have eleven browser windows open, am synching my cell phone, downloading music on LimeWire, am working on a new blog post—not this one, and writing the first two chapters of my book on leadership.  This approach relaxes me.  If I had to do just one of those knowing I could not do something else until the first was complete, I’d be in therapy.

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

What benefit is there to meeting Meaningful Use?

Commercials bug me.  Big surprise.

You have probably seen the commercial for the Sleep Number Bed.  A bare mattress, a glass of wine on the mattress, a bowling ball is dropped on the mattress.  The glass of wine does not spill.  That makes some people rush out and buy the mattress.  Why?  For the security in knowing that just in case they leave a glass of wine on their mattress and then happen to drop a bowling ball on it, the wine will not spill.

That dog don’t hunt unless you happen to be opening a bowling alley/Motel 6.  The company is trying to entice you on the merits of doing something by asking you to make the leap of faith by equating the bowling ball falling on the bed to having your spouse get in or out of the bed without disturbing your sleep.

A feint.  A maneuver designed to distract or mislead you from the real purpose.  Meaningful Use.  Certification.  A feint.  Designed to distract or mislead you from the reason you need an EHR.  The terms of Meaningful Use, that is, what is meaningful to your organization should be set by your organization, not some national standard applicable to every hospital in the country.  Hospitals are not ubiquitous—the Meaningful Use standards are.  How can a single set of standards be in line with what you require?

What’s the feint?  Certification, cash incentives, Regional Extension Centers.  A full court press trying to get hospitals to do what the feds want it to do in order to meet their goal of a nationwide interconnected healthcare system.

What proof, other than a check, has anyone offered that you benefit from meeting Meaningful Use?

Should you try to meet Meaningful Use?  I think not.  There is no ROI, and the full set of standards have yet to be published.  What should you do?  Have a glass of wine, or better yet—go bowling.  Don’t forget to buy one of those snazzy bowling shirts.

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