Finally, an EMR worthy of a T-shirt

Those who are regular readers know I’ve commented on more than one occasion that you never see anyone at the HIMSS convention walking around wearing a T-shirt imprinted with the slogan, “I love my EPIC”, or one stating, “McKesson forever”–unless they were talking about the implementation plan.

Today, my perspective changed–I’m going to start selling T-shirts printed with the phrase, “SRS-Soft Rocks my Docs.”

You may ask, ‘Who is SRSSoft’?  Fair question.  I could not have given an adequate response to that question prior to today.

I spent some time with them, ran their demo–I played doctor but they stopped me before I was able to insert a chest tube.  I ran the demo.  Why is that important?  It went like this.

“So, if you were a doctor, what would you do?”

With enthusiastic anticipation, I searched for my scalpel–that wasn’t what he meant.  “I’d see who my next patient is.”

“Do it.”  (Mind you, all of what I am doing happens on one screen faster than a sneeze.)  I clicked the schedule and up popped all the patient’s information.


“I’d probably want to review their chart.”

“Do it.”  (Don’t try this at home unless you are a devotee of Scrubs or other medical training.

Same screen, up pops the chart.


I click on the notes from their last visit, compare their labs by pulling up a comparison chart–new versus old; scan the X-RAY, and review their list of medications.  I did this all on one page and figured out in less time than it took you to read this.  We did the demo using two screens.  That way, if I am describing what I am seeing to the patient on their X-RAY, instead of holding the film up at the ceiling and hoping my patient understand what I am talking about, I point to it with my mouse and let the patient see it one their screen.

Tomorrow I was going to issue an EHR RFP for a small clinic.  Not any more.  No point in having them pay me to hunt down a solution when I’ve already found one.  Did I mention you can also get it with a world-class practice management system?

So what makes me think this EMR can handle a practice size of up to a few hundred doctors?  Let me try to summarize its benefits with the following.  If we separate healthcare into two arenas–the business of healthcare (the business side) and the healthcare business (the clinical side)–this EMR is so well designed, it makes the mundane business tasks almost invisible to the doctor.  Instead of spending twenty percent of each day moving charts, filling out forms, sending faxes, dictating and transcribing notes, the clinical team can either spend more time with their patients or see more patients.

Now, let me tell you about their secret sauce, part of what makes it so special.  You are going to think I’ve lost my mind when you read this.

One of the first questions most doctors are going to ask a vendor is whether or not the system is certified.  (Do not repeat this to anyone–that is why I am writing in parentheses–this system is not certified.  They have no plans to get it certified.)  Why?  Because certification is as relevant to the value of an EMR as agriculture is to bull fighting.  Certification will not improve care, will not enhance the doctor patient relationship, it will not improve the patient experience, it will not increase productivity.  Certification does one thing.  It enables you to get a check provided that your EMR implementation does not fail, provided that you pass the Meaningful Use audit, and provided you are willing to upgrade your existing system to your vendor’s new and improved certifiable version.  That certifiably makes little to no business sense.

Anyway, if you want a system that makes the stuff you hate doing go away, take a look at this.

I’ve also written about way hospital EHRs fail.  A big reason for their failure is the drop in productivity they experience, and a lack of acceptance from the doctors.  Sort of makes me wonder if they could use this tool as a front-end for those big pricey EHRs.

Me, I printing T-shirts.  PayPal accepted.

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 RHIO Answer

It may be helpful as you read this to use your highlighter on the screen to accentuate the important parts or some white-out for the parts you don’t favor.

Do you ever kick an idea around, speaking about it, writing about it, until at some point you finally capture it in a way that makes sense to you?  That’s how I reason things through.  I write like I’m talking aloud and sometimes it lands in my lap.

That just happened to me as I was trying to get my arms around what it is about the concept of the RHIOs that has been bothering me.  Bear with me.  I was on LinkedIn emailing someone using the ‘send a message’ feature.  I was returning an email which she was returning which I had initiated.  The process works like this.  I get an email from LinkedIn telling me I have a message.  I go to LinkedInm read the message and send a reply via LinkedIn.  She receives an email indicating she has a message, goes to LinkedIn, and so forth and so on.

Do you see it?  In this scenario, what is the added value provided by LinkedIn?  Nothing.  It’s all hat and no cowboy.  LinkedIn serves simply as a pass through, contributing nothing.  I wrote in my message to her, “Send me your email address, I feel like I’m in my own RHIO.”

When is a RHIO not aRHIO?  When there’s no need for it.  Is there any functionality intended for the hundreds of RHIOs which couldn’t be dealt with at the N-HIN?  What do you think?

What if our EMRs were portable?

I am wondering how much of the cost of a hospital’s EHR system includes building in the functionality of individuals’ EMRs and making them transportable.

What if EMR’s were made portable and they could be carried around by patients on super smart devices?

Any thoughts?

saint       Paul M. Roemer
       Chief Imaginist, Healthcare IT Strategy
       1475 Luna Drive, Downingtown, PA 19335
       +1 (484) 885-6942 

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Comparing EHRs–like measuring how wet is water

The following is a reply I wrote to John’s post at on

EMR Key Differentiators.

You are spot-on with your comment about the requirement that they be measurable.  Otherwise everyone will be arguing something as nonsensical as how wet is the water.

Even on the second group of differentiators, one can argue that they are too easily qualified.  “Excellence” and “easier” are difficult terms to measure.  Stating that an EHR was designed for a specialty may be of no more value than stating a Yugo was designed for the sports car enthusiast.

I’d look for differentiators along the lines of the following, and then see if they result in business improvements:

  • Our system requires 25 % fewer clicks per process than systems A, B, and C
  • Our system uses 1/3 less screens to enter X than systems A, B, and C
  • Productivity at hospitals H1, H2, and H3, as measured by factors E, F, and G, is up 12%
  • We are able to see an average of 12% more patients since we started using XYZ
  • Rework and errors by our clerical staff is down 8% since we started using XYZ

These differentiators each translate to measurable increased revenues and decreased costs.

But, for how long will this matter?  The business driver towards EHR seems to be to ameliorate today’s problems.  I believe the future of healthcare is not the EHR, HIE & NHIN.  The future of healthcare is post-EHR, electronic medical records will be in a cloud, and will be here before the paint on the NHIN has dried.

A scathing rebuke of EHR

I encourage anyone with an EHR or thinking of getting an EHR to read this.  I do not think it is a unique story.

I recently spent an hour with my cardiologist.  He is employed by a very large teaching hospital.  After checking my vitals, listening to my heart, and asking a few questions, he moved from the exam table to the keyboard—where he remained.


The focus of our conversation quickly moved away from me and onto him—more accurately to his Hospital’s three-year-old EHR system.  I learned quickly from him that calling it a system was somewhat optimistic.

Here is what I learned from him about the hospital’s EHR:

  • It is possible to take your most expensive and most trained resource away from what they do and have them spend forty-five minutes of the hour performing a clerical task—data entry.
  • Productivity is down at least thirty percent.
  • He called EHR the “Silent intruder in the room.”
  • “What are the benefits?” I asked.  “It does a great job collecting data for those who may want to use it against us in a law suit.”
  • “What about interoperability?”  “Not in my lifetime,” he replied.
  • “It makes everyone’s job easier but mine and the nurses.”
  • “Did anyone speak to you about what you needed from an EHR?”  He is still laughing.
  • He needed his nurse to help him schedule my next appointment.
  • “How would you react if I asked if what the hospital implemented was nothing more than a hundred million dollar scanner?”  “I would not disagree with that assessment.”

The good news is that he is arranging a meeting for me with the hospital’s CEO to see what I can do to help.

My take?  I was the other intruder in the room.  

Some hospitals have more than one EHR–Why?

I wrote this reply in response to a blog written by Jay Fischer titled,

Do Multi-EHR Hospitals fulfil Meaningful Use Compliance more Easily?

It is interesting that for such a “new” addition to the support systems and processes that support the business of healthcare, and for the relatively few of them that have been implemented in hospitals, we can have the discussion of whether there is enough merit in having more than one EHR.

Leading hospitals are discovering they do not need multiple departments to perform similar functions.  Some hospitals have more than one admissions department, payroll, human resources, information technology, and pharmacy.  The individual groups which “own” those functions argue strongly for why they need to maintain ownership.  I have yet to see an argument which is upheld under examination.

One HR department should be sufficient.  In a market where hospitals are scrambling to cut costs, we will see hospitals reducing the number of EHRs to a single EHR.  This will happen as other hospitals are implementing EHR on top of EHR.  Who knows, perhaps as hospitals work to get down to a single EHR, they will find a market for slightly used, previously owned EHR.

For sale, one EHR, used by a grandmother from Des Moines.  Make offer.  

AN EHR introspective–my cardiologist and me

I apologize for the formatting, it got away from me and I could not fix it

The doc did not smile
Nor did I on that day.
So we sat in his office
Wondering each what to say
It was me and my Doctor.
We sat there, we two.
And he said, “How I wish
You had something to do!”

“You drove all this way                                                                                                                                                                                           Your one visit a year.
You sit there like a plant                                                                                                                                                                                            This must seem quite queer.”

So all we could do was to
Sit! Sit! Sit! Sit!
And we did not like it.
Not one little bit.

And then
something went WHIRR!
How that whirr made us stir!

We looked
Then we saw her step in through the door
We looked
And we saw her
And we waited for more
And Nurse said to us,
“Why do you sit there like that?
I know this is clerical
You don’t know how to type.
But they said this would work
That it wasn’t just hype.”

The vendor’s fibs fooled the Nurse,                                                                                                                                                                       The doc patted her head,                                                                                                                                                                                             “It isn’t your fault                                                                                                                                                                                                           We have all been mislead”

“I know some good games we could play,”
Said the Nurse.
“I know some new tricks,”
Said the Nurse as she stewed.
“A lot of good tricks.
I will show them to you.
Your Doctor
Will not mind at all if I do.”

Then Doctor and I
Did not know what to say.
My doctor was out of ideas
For this day.

“Have no fear!” said the Nurse.
“I will not let you fail.
For you see, here’s a pen                                                                                                                                                                                           And over here is some mail

With a pen in my hand!
I can write on this part                                                                                                                                                                                               And before anyone knows it                                                                                                                                                                                     This will look like your chart.

“Look at me!
Look at me now!” said the Nurse.
My doc was still typing                                                                                                                                                                                                     And he uttered a curse,

“We have had this dumb system                                                                                                                                                                                    We have had it three years                                                                                                                                                                                       And I like it less now                                                                                                                                                                                                         It still brings me to tears”

“And look,” said the Nurse!
“Your EKG is taped to the wall!
But that is not all!
Oh, no.
That is not all…”

“Look at me!
Look at me!
Look at me NOW!
Charting is a lost art                                                                                                                                                                                                     And you have to know how.
I can take your B P
The doc will listen to your heart!
And between the two of us                                                                                                                                                                                       We’ll annotate your chart.”

And I sat on the bed.
My shirt askew on the chair                                                                                                                                                                                             I asked, “Do I like this?”
“Oh, like you really care.”
“This is not a good deal,”
Is what I said to my doc.
“I came here to see you                                                                                                                                                                                               Not to stare at the clock.”

“You sit there and type                                                                                                                                                                                                      But you haven’t a clue                                                                                                                                                                                                 This is not the same work                                                                                                                                                                                                As you used to do.”

“There were times when I’d come here                                                                                                                                                                   And you’d take off your hat,                                                                                                                                                                                      Times when I’d come here                                                                                                                                                                                       And we’d sit here and chat”

“We’d talk how I feel                                                                                                                                                                                                         And things that would matter                                                                                                                                                                                    But now your sit there and type                                                                                                                                                                                  And I hear the keys clatter”

“You’d ask of my meds                                                                                                                                                                                               And inquire of my health                                                                                                                                                                                           And now with this system                                                                                                                                                                                             The conversation’s gone stealth.”

“I must use the system.
We’ve paid quite a lot!”
Even though I don’t care                                                                                                                                                                                               It can sit there and rot.”
“It will NOT go away.
I cannot make it work!
Did not ask what I wanted
Makes me look like a jerk.”

And my doc he ran out.
And, then, fast as a fox,
My doc in his Cole Haans
Came back in with a box.

A big EHR box.
And I gave it a look                                                                                                                                                                                                              “Now along with this box,
All we got was this book.”

Then he stood on his desk
And with a tip of his shoe                                                                                                                                                                                               “This time” he said                                                                                                                                                                                                           “I have something to do.”

“My productivity’s down,                                                                                                                                                                                     Thirty percent by my count,                                                                                                                                                                                         And the attributes of this system                                                                                                                                                                         They want me to flount.”

“It’s only good for two things
neither one is for me                                                                                                                                                                                                        It helps payors and auditors                                                                                                                                                                                       So to them it seems free.”

“They can get all our data                                                                                                                                                                                                  And use it to sue                                                                                                                                                                                                                 Yet for me it is useless                                                                                                                                                                                                       I have not a clue.”

“Oh dear!” said the Nurse,                                                                                                                                                                                                 I call this game…Make EHR Fly,
If I kick hard enough,                                                                                                                                                                                                      It will go to the sky.”

“You cannot play that game...
Oh dear.
What a shame!
What a shame!
What a shame!”

Then he shut off the System
Back in the box with the hook.
And the Nurse went away
With a sad kind of look.

“That is good,” said the doc.
“It has gone away. Yes.
But my boss will come in.
He will find this big mess!”
“And this mess is so big
And so deep and so tall,
We cannot clean it up.
There is no way at all!”

The CIO came in
And he said to us two,
“Did you have any fun?
Tell me. What did you do?”

And doctor and I did not know
What to say.
Should we tell him
The things that we did here today?

Should we tell him about it?
Now, what SHOULD we do?
What would YOU do
If your CIO asked YOU?

When reform collides with EHR…

If I remember my physics correctly, there’s no discernable difference between screaming in a vacuum and not screaming in a vacuum, unless of course someone turns it on while you’re in it, and then by default, you’re screaming. That seemed to make sense to me during my run, but seeing it on the screen isn’t doing much for me. Ever since I tore my Achilles I can’t run as far, and I’ve gained a few pounds. I feel like I’m in my first trimester-running for two of us, sort of a Shamu in Nikes.

Enough about me.  Here’s the deal. There seems to be a slight shifting of the winds in terms of those who now believe reform will work.  The winds are blowing more towards the skeptics.  Who among us can articulate what is included in the reform effort in a single PowerPoint slide?  (Can you picture Ross Perot with his slides and wooden pointer?)  If we can’t explain the reform effort to ourselves, how then can we explain the business problem we’re trying to solve with EHR?  Until you’re comfortable articulating the benefits to your organization—not the ones spelled out on a dot-gov web site, you’re better off holding on to your checkbook.

The current EHR/healthcare reform effort violates Keynes’ third law of shopaholics anonymous–just because something you can’t afford and don’t need goes on sale doesn’t mean you have to buy it. (Unless of course it impresses your friends.)  In addition to the trillion dollar stimulus, maybe the government was awarded discount coupons–20% off on EHR if redeemed before the payors own the providers.

How to raise healthcare IT costs without really trying

Like anyone needs my advice as to how to do that. Go ahead, have at it. Go shopping. Shop to you drop. How much do you need? Suppose we open the coffers. How much; another million? Ten Million? Twenty-five, fifty? $100,000,000? This is a one-time offer, so make sure you ask for everything you need

What if I told you this money is available provided you correctly answer a few basic questions. Reasonable? I’d hope so for a hundred million dollars.

1. What will you do with the money that you haven’t already done?

2. Has anyone else every done that?

3. If yes, did it work for them?

4. If no, why not, and what makes you think it will work for you?

5. Will these additional funds;

5a. Get you the ARRA money?

5b. Enable you to see more patients?

5c. Help you retain and attract physicians?

5d. Increase patient safety?

6. What is your mission?

7. Why isn’t your mission the KPIs listed in question 4?

8. Are other hospitals spending the amount you are requesting?

9. Did that amount of funding allow them to meet the criteria specified in question 5?

10. If no, what makes you think you can do it?

If your CFO asked these questions, would you think them reasonable? If not, prepare 3 envelopes (see Google)

If you don’t buy the right EHR and implement it correctly, you’ve just spend a hundred million dollars to scan charts.  Somebody will be held accountable for the money.

Upgrade the coffee to Starbucks-$5. New bedpan-$50. New plasma monitors-$1,200. Knowing what you are doing—Priceless.