Why bother with an RFP for EHR?

HIT Strategy; without one, do not take out your checkbook.  Buying what your neighbor bought, and assuming they did their homework, is not a strategy.  Buying something because the sales-rep told you they had an amazing list of client references is not a strategy.  These are shortcuts.  Have you noticed none of the EHR providers were not wearing “I love my EHR” T-shirts at the last HFMA meeting?

My rule of thumb about Google is that if I cannot find something it is because it does not exist.  There are no good EHR RFPs available on Google.  Here are a few thoughts on RFPs in case you want to use one—by the way, a good RFP makes a great addition to a vendor contract as it provides a written audit trail of what they contracted to do.

  1. The RFP should have an exhaustive list of requirements.  It is designed to separate one vendor from another, not make them all appear to be equally capable.
  2. The requirements should be addressed in a way to help a provider know what business capabilities the vendor offers, not to show how pretty their screens are.
  3. The RFP should not mirror your current business.  Your goal is not to simply automate what you do, but to do it better.  That means change.  Without change your EHR will simply be an expensive scanner.
  4. Along that same thinking, I have yet to see an RFP that mentions a single requirement about making the provider’s business more efficient or more effective.  Here’s why.  if each provider tells you their system can perform the same tasks as the other systems, you have not learned anything to cause you to pick one vendor over another.  If they say their system is efficient, make them supply you with details about the number of clicks, screen navigations, and times needed to do the ten tasks you do most often.  If they say they are twice as fast as Vendor A, make them prove it, make them prove it in your office.  Contact vendor A and find out who is telling the truth.  If they each have the same functionality, and one vendor takes half the time to perform a task, that fact should be included in your decision.  How important is 30 seconds?  How many 30-second improvements are there with each patient?  If there are four, and you see 30 patients a day, and your practice has eight doctors, you’ve either just saved a total of eight hours a day to spend more time talking to your patients, or to add patients.
  5. The other important part of the RFP that is often either overlooked or under assessed is the specialization of the EHR.  Warning: A large vendor has probably has at least one implementation covering each specialty; cardiology, orthopedics, urology.  Having one or a few clients in a specialty does not mean their product was designed to serve that market.  It may mean their clients did not do a very good job selecting tem as their vendor.
  6. That brings us to references.  A large vendor may have a thousand or more providers installed.  When you ask to check their references, which ones are they likely to parade in front of you—the ones who like their product.  The other 990 are kept in their lock-box.  Whoever they give you to talk to will be those who they feel are least likely to say something negative.
  7. How should you check references?  Most vendors will give you as a contact either a top administrator or someone in IT.  That will tell you very little.  Once you learn the name of the organization, call them.  “This is doctor so-and-so, and I am calling to speak with one of your physicians.”  Whatever this person tells you will be of much more value than having someone who not use the system tell you how much they like it.

Anyway, those are my thoughts.  There are a range of savings available if you have a good EHR strategy, pick a good system, and implement it correctly.  If you pick the wrong one, you do not need to worry about calculating your ROI—there won’t be one.

Some vendors are like a fine wine

Have a vendor for dinner tonight.

Fashion can be reinvented every 6 months, healthcare can’t.

That’s plenty of reason to try to get EHR/HIT right.  Remember this little principle; DIRT-FIT–Do It Right The First Time.  Don’t know how?  There are some who do.  There is even a larger group who think they do.  If you look pretenders in the eye, sometimes they blink.  Some vendors are like a fine wine—you have to stomp on them and keep them in the dark until they’re ready to have for dinner.  To be fair, they may feel the same way about me.

A vendor client of mine mentioned their customers told them the vendor did not understand their customer’s business. The vendor thought the customer’s comments were unfounded–their basis for believing this is that they had been in the business for years.  I told the CEO I would buy dinner for everyone in their firm who previously worked on the clinical side of a healthcare provider.

I ate by myself, no wine.  A nice Chianti served with a side of fava beans would have been nice.  Clarice?
Kind Regards,


Paul M. Roemer
Managing Partner, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

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

The most relevant EHR/EMR piece you will ever read

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

The definitive EHR Buying Guide

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

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

EHR market share

The link below takes you to a post written by Software Advice’s Chris Thorman regarding the market share for inpatient and outpatient EHRs.  It is designed to be a collaborative piece, and Chris is asking for feedback and correction.  I found it to be a well-written and helpful piece, perhaps you also will.


saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

The User’s Role in EHR–a PowerPoint presentation

This link will take you to a slideshare,net presentation that defines how healthcare providers can take control of the EHR project.  I welcome your comments.


saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Puppy Training Your Vendor

Carrie Vaughan, a senior editor of HealthLeaders Magazine published an article in the December 8, 2009 issue titled, “Tips to Build a Successful Vendor-Provider Partnership.”  The link to her article is http://www.healthleadersmedia.com/page-2/MAG-243167/Avoid-the-Vendor-Upsell.

The points about which Carrie wrote are spot on.  I asked Carrie if she would permit me to use those same points as a foundation for this posting, to which she was kind enough to agree.  The four points come from her article.  I encourage you to read her piece, as any points with which you may take umbrage are mine, not hers.

To ensure we take an accurate look at the provider-vendor relationship, we must be willing to acknowledge that healthcare providers are from Mercury and the EHR vendors are from Pluto.  They exist in different orbits, and their business models are very far apart—they never intersect; not in space, and not on your project.

1. Have your own inside expert. Don’t rely on the vendor to tell you what you should be doing.  Never.  Ever.  Unless of course you think the vendor knows more about how you want to run your hospital than you do.  Remember, you select them—not the other way around.

Bringing a vendor into your hospital is a lot like bringing home a new puppy. Both need to know who runs the show. Don’t roll over.  They may not be looking to be led, but if you don’t lead them they will lead you.

You should have the expert on board at the outset, before you select the EHR vendor.  The expert should be your advocate.

2. Establish a specific executive liaison with your vendor.  This is not your new tennis partner.  This should be the person who has the authority to ensure your quantifiable wishes are being met, and whose responsibility it is to deliver the message to his troops, and marshal the resources necessary to get the job done.

3. Specify your contractual objectives. Ensure that the contract is aligned with the clinical and business objectives of the healthcare organization, not the vendor.  Before you can accomplish this, you have a lot of work to do with your team.  You must define your clinical and business objectives.  Often these two groups also have a Mercury and Pluto relationship.  Once you have these, your next task is to deliver these objectives to the vendor and have the vendor tell you in writing what they will meet, what they might meet, and what they can’t meet.  It would be nice to know these before you sign their contract.

4. Involve more people than just the IT staff. Need a rule of thumb, involve as many users as IT people—Mercury and Pluto.  You will need new processes, not just to squeeze an ROI from the EHR, but because many of your old ones have probably been around since the invention Band-Aid.

Each of these recommendations will actually help you and help your vendor be successful.  It will not be an adversarial relationship as long as you manage it.  If you don’t manage the relationship, you won’t have to worry about meeting Meaningful Use—you’ll be too busy selecting a replacement vendor.

One final thought, don’t let the vendor loose unsupervised on the oriental rugs.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Published on HealthSystemCIO.com–vendor darts

Below is the full article I submitted to HealthsystemCIO.com, Anthony Guerra’s outstanding site for healthcare leaders.  As always, I am flattered that he finds my contributions worthwhile.

Is there a best Electronic Health Records system? Perhaps Cerner, EPIC, GE, or McKesson?  For those who have followed my writing, you’re probably thinking my answer is “None of the above.”

I’ll do one better, and I write this with the utmost sincerity—it does not really matter which vendor you select.  As the EHR vendors reading this pull themselves off the floor, permit me to explain why.  Researching the question this is very little information to support the notion that any of the major hospital EHR systems quantitatively stands out from the others.

There are a few sites that offer user assessments across a range of functions, but those have at most three opinions—not enough to consider statically significant.  There are plenty of EHR scorecards and comparison tools, just not many scores.  The vendors’ sites do a poor job of differentiating themselves from their competitors.  Vendors use superlatives and qualifiers in an attempt to differentiate themselves.  When one considers the basic functions that make an EHR an EHR, the top vendors all have them.  No vendor highlights major clinical or business problems that their solution solves that another vendor does not solve.  Instead, they state they do something better, easier, more flexibly—none of which can be measured by prospective clients.

Imagine, if you were an EHR vendor, and you knew that your product did things to benefit a hospital better than the other vendors, wouldn’t you have an independent competitive assessment, some sort of “Consumer Report” chart and evidence to support why you are better?  Of course you would.  You would highlight your superlatives.  I have not seen one that would be very helpful.  The only information I found that might be worth a read comes from Klas Research, http://www.klasresearch.com/.  However, the names of the modules rated are vendor specific, and none of the vendors use the same names.  It will give you a feel for how a small sample rated features within a given vendor, but there is no data to suggest how those ratings compare among vendors.

Even if there was a good comparison, the other thing to learn from this is all the areas that aren’t listed imply that the vendor is either no better or perhaps worse than the competition.  Cream rises to the top—we are left to choose among brands of milk.

One vendor may have a better medical dictionary than another, yet that same vendor will lack rigor in decision support.  No single vendor seems to have their customers doing back flips in their testimonials.  Some score high in their ability to deliver a complete inpatient solution and fail in their ability to integrate with other vendors.  Others hurt themselves during the implementation, user support, response time, and the amount of navigation required to input data.  Some EHR vendors posit their systems as being better at meeting Meaningful Use or passing all of the Certification requirements.  Ask them to name a single installed client for which they have met these.

Why doesn’t matter which vendor a hospital selects?  The reasoning holds not because all hospitals are the same, rather, it holds because were one to perform a very detailed comparison of the leading EHR vendors with a Request for Proposal (RFP), they would prove to be quite similar.  You might find significant separation if you only compared ten functional requirements.  You would expect to find less separation by comparing several hundred, and quite a similarity if you compare a thousand or more requirements.  The more you look, the more they seem the same.

Although the vendors will differ with respect to individual requirements, when evaluated on their entire offering across a broad range of requirements I would expect each to score within one standard deviation of the other.

Reason 2.  It is possible to find hospitals who will give outstanding references for each of the leading vendors.  It is equally possible to find users in hospitals who have implemented one of the “leading” vendors’ systems who will readily tell you that the purchasing the system is the worst business decision they ever seen.  More to the point, every vendor A has probably had at least one of its implementations uprooted and replaced by vendors B, C, or D.  The same can be said for vendors B, C, and D.

If this is a fair assessment, what accounts for the difference?  How can we account for why one hospital loves a given EHR system and another one hates the same system?  Chances are they both needed about the same solution.  Chances are they received about the same solution.

Here’s the difference.  The hospital who thinks they made a good choice:

  • Had a detailed strategy and implementation plan
  • Paid as much or more attention to process alignment, change management, and training as they did to the implementation
  • Managed the vendor instead of being managed by the vendor.

Simply put—the problem is not the EHR system.

One other thought.  “Pay no attention to the man behind the curtain—the Great Oz.”  Do not put your scarce capital into a solution just because it offers or promises either Certification or Meaningful Use.  Yes, there is much discussion about both of these.  The industry stops and holds its collective breath each time a new set of stone tablets are brought forth from the ONC or CMS.  You can meet Meaningful Use with a Certified system and still wind up with a system the users hate and that does not support your business model.

Here is something else I cannot explain.  For those hospitals replacing a one hundred million dollar EHR with another hundred million dollar EHR, why do they think the second system will be any better?  If the systems are not materially different, the only way to get a different result is by changing behavior, not changing systems.  Why make the same mistake twice?  What could be so wrong with the first implementation that an expenditure of far less than another hundred million could not solve?

What is the cost of EHR 2.0 not working?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Users are from Mercury, IT is from Pluto

The two groups are often far apart.

I learned an interesting word which led to some very interesting reading on the topic.  The word and topic are qualia (pl).  There are several wordy explanations with which I won’t waste your time.

Daniel Dennett identified four properties that are commonly ascribed to qualia. According to him, qualia are:

  1. ineffable—they cannot be communicated, or apprehended by any other means than direct experience—see, touch, taste, hear, smell.
  2. intrinsic—they are what they are independent of anything else.
  3. private—interpersonal comparisons of qualia are impossible.
  4. directly or immediately apprehensible in consciousness—to experience a quale is to know one and to know all there is to know about that quale.

Got it?  That didn’t do it for me either.  Here are a few examples that helped me understand it.

  • How does wet feel?
  • What does blue look like?
  • What is the smell of mowed grass?
  • How does salt taste?
  • What is the sound of a whisper?

Common things.  Our brain knows what they are, yet to describe them to someone who has not experienced them, almost indescribable.  Your brain processes it one way, your mind processes it another.  Take a look at these pictures.

Now let’s look at healthcare IT projects, to be more particular, implementing an electronic health records system, an EHR system.  When you pictured the implementation in your mind, when you studied the implementation plan it painted a nice picture.  All the pieces made sense—sort of like the picture on the left.

At some point after most EHR implementations, the IT department still sees a pony.  The users can’t see the pretty picture.  Trying to explain what went wrong to the steering committee is like trying to describe to them the color blue.

IT people are able to look at the picture on the left and visualize the picture on the right.  When IT people talk to users, to the users it sounds like the picture on the left…

…and it feels like this.

It matters what the users think, and see, and feel.  If IT waits until the end to involve the users, the users will never see a pretty picture.  I’ll let you in on a secret.  In many hospitals the users (doctors and nurses) do not think IT has any understanding of their business.  Why prove them correct by keeping them out of the loop.  Their input is at least as important as IT’s and the vendor’s—probably more so.

“Look what we built for you” is not what the users need to hear.  “Look what we did together” has a much better chance of succeeding.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Your EHR contract–Until death do us part?

That’s a long time. There are those who suggest that statement sort of takes away any incentive they had to live forever. They wonder why it couldn’t be somewhat less restrictive like, “for the foreseeable future,” or “until one of us gets bored,” or “renewable every four years.”

Till death do you part. Sort of like you either just purchased or are about to share your future with. Once the figures get beyond two commas, you’re pretty much locked in—for better or for worse. It makes no difference if you’ve outgrown it, no longer need it, figure out you never needed it, found something better. Perhaps next time you can suggest more friendly language as you stroll arm in arm down the EHR contract aisle.

First, you must make the other party think that they need you more than you need them.
The best contract is an agreement that is binding on the weaker party—hopefully your EHR vendor. Here’s a little twist for the next contract negotiation with the EHR vendor.

Vendor: Will you manage my EHR with all your heart?

Manage it till death you part?

C-suite: Yes, I’ll manage with all my heart,

From now until death do us part,

And I will manage it when it breaks,

And when my boss over the coals me rakes,

And when it’s fit, and when it’s sick,

(Oh, CAN’T we finish this contract quick?)

And we will own it when it’s bad,

And we will own it when I’m mad,

And I will still own it when it’s broke,

When all our patients want me to choke,

And when if fails Meaningful Use,

And when its failure cooks my goose,

And I will be none the dapper,

As my career goes in the (you fill in the blank),

While searching the bowels for our old charts,

Since productivity has fallen apart,

I will manage it as you like,

As all our doctors go on strike,

And I will eat green eggs and ham, and I will like them Sam I am.