Paul Roemer

(This is a guest column submitted by Paul Roemer, who blogs at 

 in iHealthBeat wrote, “Report Says Hospitals Could Save Billions by Implementing Health IT.” Indeed they could. Continuing to quote, U.S. hospitals 

 reap a total of $40 billion in annual savings if facilities effectively set up 

—a phrase curiously resonant with the name of my consulting firm&mdash;according to a recent McKinsey report

I agree with the statements in that paragraph, but permit me to split a few hairs. 

 have nothing to do with whether healthcare IT (HIT) 

 do anything other than drain the purses of providers. The ‘

’ comes down to the strategy—as a sidebar, I encourage you to read Dr. Alberto Borges’ post, 

"A day in the life of a Physician EHR Meaningful User

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.

		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.

		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.

		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.

		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.

		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.

		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.

		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.

Paul Roemer is a healthcare strategist with more than 25 years of experience in executive management. He is managing partner of 

 in Downingtown, PA, and is also Chief Imaginist of the Healthcare Idea Lab.

Articles

Before purchasing an EHR, physicians need to make sure it will deliver a return on investment, and that means asking some tough questions, says guest blogger Paul Roemer.

What Can Your EHR Do for Me?

This guest column by Paul Roemer, who blogs at 

I have been invited to write a piece on the implications of electronic health records (EHR) and the new "Meaningful Use" standards for private practitioners.

Short answer: Meaningful Use, if used as a way to obtain incentive money is at best meaningless, at worst -- without numerous other initiatives -- it can disrupt your business. It seems to violate the dictum, “Do no harm.”

There is a groundswell building against meaningful use. How do I know? Because I am starting it. Meaningful Use is an early adopter of the KISS principle: Keep It Stupid, Simple.

In Greek mythology, there was a not-so-nice man named Procrustes. He had an iron bed in which he invited wayfaring strangers to spend the night. Some of the strangers were too long for the bed and others were too short.

Apparently, Procrustes liked things orderly and could be a tad anal when learning his guests did not fit. He would set on them with his smith’s hammer, to stretch the shorter ones to fit. If the guest proved too tall, Procrustes would amputate the excess length. Truth be told, nobody ever fit the bed exactly because Procrustes had two beds.

In contemporary terms, a Procrustean Bed is an arbitrary standard to which compliance is forced. A Procrustean Solution involves fitting a business problem to a preconceived set of strictures.

Raise your hand if you have already figured out where this is headed. Preconceived. Arbitrary. Compliance. Strictures.

Do you spell Meaningful Use with an upper case Procrustean or one in lower case? I prefer the upper case. The business problem being fitted is the implementation of EHR. The preconceived sets of strictures are the Meaningful Use standards.

This in turn leaves the healthcare provider in what is best described as a Morton’s Fork scenario. Shall I explain? A Morton’s Fork is a choice between two equally unattractive alternatives -- a dilemma. The concept originated in 1487 under the rule of Henry the VII as a result of policy to ensure everyone paid taxes. The argument was because the rich had enough money to buy things they must have enough money to pay taxes, and the poor who had bought nothing had saved their money, and thus had money with which to pay taxes. The two prongs of the fork -- back then forks only had two prongs. Q. E. D.

The healthcare provider must choose between -- as one may not choose among -- two alternatives. Attempt to meet Meaningful Use -- a Procrustean Solution -- and turn their business model inside out to meet the government’s Gossamer standards.

Attempting to meet the standards does not ensure they will in fact meet the standards. Should a practice only meet 99 percent of the standards, it loses. The Pareto principle does not apply. There is no 80:20 rule. The practice will not receive any incentive money, as Meaningful Use is an all-or-nothing game.

The second alternative is to not meet Meaningful Use. This choice may be voluntary, or involuntary -- trying to meet Meaningful Use and failing. Alternative Two, it is said, will result in reimbursement penalties from Medicaid and Medicare.

I do not think those penalties will be implemented, or at least they will not be implemented in the documented timeframe.

I also do not think there is a Morton’s Fork, because I think Meaningful Use will disappear because it is so arbitrary and capricious --- and because the number of large providers who will meet it could all drive to lunch at Morton’s in a Yugo, at which time they could dine with a fork from Morton’s.

We have now come full circle. My work here is through.

One last point, if I may. Practice Management System (PMS) -- get one, and get a good one. If it comes with an EHR, that is okay. There are need-to-haves, and nice-to-haves. EHR is the latter. A PMS is the former. The physician practices with which I am familiar are terribly inefficient; paper is everywhere and is handled multiple times. A single practice sends and receives more faxes per day than Boeing. Physicians started their practice to provide care, not to run a business, and this is quite visible.

Sure there are some success stories. Some. For most, the first step is to triage your practice. Install a PMS, and then pop in an EMR. Start with the eLab/eRx portion to build the patient data base, and then add the EMR functionality.

Paul Roemer is a healthcare strategist with more than 25 years of experience in executive management. He is managing partner of Healthcare IT Strategy in Downingtown, PA, and is also Chief Imaginist of the Healthcare Idea Lab. 

"Meaningful use," if used as a way to obtain federal incentive money is at best meaningless, at worst -- without numerous other initiatives -- it can disrupt your business. It seems to violate the dictum, "Do no harm."

Meaningful Use, Procrustes, and the Morton's Fork

I have been invited to write a piece on the implications of EHR and the new Meaningful Use standards for private practitioners.

Short answer: Meaningful Use, if used as a way to obtain incentive money is at best meaningless, at worst, without numerous other initiatives; it can disrupt your business. It seems to violate the dictum, “Do no harm.”

There is a groundswell building against Meaningful Use. How do I know? Because I am starting it. Meaningful Use is an early adopter of the KISS principle—Keep It Stupid, Simple.

In Greek mythology, there was a not so nice man, Procrustes. He had an iron bed in which he invited wayfaring strangers to spend the night. Some of the strangers were too long for the bed and others were too short.

This in turn leaves the healthcare provider in what is best described as a Morton’s Fork scenario. Shall I explain? A Morton’s Fork is a choice between two equally unattractive alternatives—a dilemma. The concept originated in 1487 under the rule of Henry the VII as a result of tax policy to ensure everyone paid taxes. The argument was because the rich had enough money to buy things they must have enough money to pay taxes, and the poor who had bought nothing had saved their money, and thus had money with which to pay taxes. The two prongs of the fork&mdash;back then forks only had two prongs. Q. E. D.

The healthcare provider must choose between—as one may not choose among&mdash;two alternatives. Attempt to meet Meaningful Use&mdash;a Procrustean Solution&mdash;and turn their business model inside out to meet the government’s Gossamer standards.

Attempting to meet the standards does not ensure they will in fact meet the standards. Should a practice only meet 99% of the standards, they lose. The Pareto principle does not apply. There is no 80:20 rule. They will not receive any incentive money as Meaningful Use is an all or nothing game.

The second alternative is to not meet Meaningful Use. This choice may be voluntary, or involuntary—trying to meet Meaningful Use and failing. Alternative Two&mdash;it is said&mdash;will result in reimbursement penalties from Medicaid and Medicare.

I also do not think there is a Morton’s Fork, because I think Meaningful Use will disappear because it is so arbitrary and capricious—and because the number of large providers who will meet it could all drive to lunch at Morton’s in a Yugo, at which time they could dine with a fork from Morton’s.

One last point, if I may. Practice Management System (PMS)—get one, and get a good one. If it comes with an EHR, that is okay. There are need-to-haves, and nice-to-haves. EHR is the latter. A PMS is the former. The physician practices with which I am familiar are terribly inefficient; paper is everywhere and is handled multiple times. A single practice sends and receives more faxes per day than Boeing. Physicians started their practice to provide care, not to run a business, and this is quite visible.

. For most, the first step is to triage your practice. Install a PMS, and then pop in an EMR. Start with the eLab/eRx portion to build the patient data base, and then add the EMR functionality.

 in Downingtown, PA, and is also Chief Imaginist of the Healthcare Idea Lab. 

Blogger Paul Roemer says meaningful use, if used as a way to obtain incentive money, is at best meaningless, and at worst, can disrupt your business.

Author | Paul Roemer

Articles

What Can Your EHR Do for Me?

Meaningful Use, Procrustes, and the Morton's Fork

Meaningful Use, Procrustes, and the Morton's Fork