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.

“Next?”

“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.

“Next?”

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
paulroemer@healthcareitstrategy.com

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
       paulroemer@healthcareitstrategy.com 

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

Comparing EHRs–like measuring how wet is water

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

EMR Key Differentiators.  http://www.emrandhipaa.com/emr-and-hipaa/2010/03/07/emr-key-differentiators/comment-page-1/#comment-122817

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.

Click…click…click

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.