I hate software demonstrations. They are nearly useless. Here are my primary gripes…

Suspension of disbelief
I cried when I saw ET. That is the magic of movies. Somehow a perfectly rational person can believe that a lost alien has been rescued by children. I think that same aspect of human nature betrays us when we watch software demonstrations. People want to believe. I have seen people swear that they saw something in a demonstration that I know was impossible. Somehow, people see what they want. Perhaps people are too optimistic.

“Cannit”
I know I am trapped in a bad demonstration when a volley begins between participants and demonstrators. Each question begins with “Can it…” Of course each response is “Yes.” Or my favorite “Yes, with customization,” which is vendorspeak for NO.

There are so many problems with this approach I don’t know where to begin. Actually I do. The vendor is lying through his/her teeth until proven otherwise. Any simple question that someone asks can be interpreted in a way to illicit a positive response. Usually the questions are too poorly thought out to really capture the intent. Furthermore, if the vendor is not demonstrating, but just volleying back positive responses is anyone really learning anything?

Watching TV
I guess Americans would rather watch TV than read a good book. That is the true when it comes to the software selection process too. Everyone would rather crowd into a room to see a fraction of the functionality demonstrated than read through the documentation to really learn how the system works. See my earlier post about reading documentation.

Why are we here?
When we do have software demonstrations (which is as seldom as possible) I always make sure we start the meeting by telling everyone why we are gathered. There are two reasons for demonstrations: education and acquisition. Everyone assumes that a software demonstration will lead to a purchase decision, so it is important to strongly emphasize to all parties if you are just window shopping.

It is OK to have software demonstrations just to spark ideas and expand your understanding of what is possible. When that is the case it is critical that the participants and vendors know this and that the message is clear that there is NO commitment beyond today. These demonstrations should have a very limited internal audience.

If the demonstration is part of a selection process at my organization that will be self evident. The demonstrations will be tightly scripted. Everyone participating will have assignments, including:

• completion of evaluations that are tied back to the features/functions required to achieve the project goals;
• documentation feature/functions that need to be pursued; and
• identification of possible gaps.

Bottom Line
If there is no written documentation that is attached to the contract than this whole exercise has limited value. There is no obligation on the vendor’s behalf to provide the client with anything discussed during a demonstration.

In my previous post I emphasized how important it was to have a vision for an electronic health record before you head into a selection process. One should not buy their requirements from a consultant, they should develop them based upon a clear business purpose.

So, I present to you the most recent draft of Affinity’s Electronic Health Record (EHR) Manifesto:

Preface: For the first time in the 100+ year history of Affinity, and it’s predecessors, we are fundamentally changing the way that we practice medicine. This new model is based upon the Affinity Health Management Vision.

How we practice medicine will be hard-wired into the patient encounter: Good care will no longer be dependent upon the physician’s ability to remember the guidelines that vary by patient’s age, gender and existing conditions. Instead, the guidelines will be pushed to the physician via the exam room computer. These will not be generic guidelines, they will be specific to each patient. Consequently, the patient and the physician will know every patient is being treated by the most current and up to date evidence-based guidelines every time without anything being missed due to memory lapse or a lack of guideline awareness. This zero-defect approach will make good doctors great and great doctors even better.

Information systems will support efficient, thorough care: Valuable physician time will not be wasted searching the abyss of today’s electronic medical record. Instead, a new generation of electronic health records will assemble the most relevant test results and vital signs in a way that facilitates the practice of medicine using the guidelines. This presentation of the patient’s electronic health record will be the centerpiece of the exam room visit.

The management of the patient’s health will no longer be limited to the clinic setting: Population management tools will be used to monitor patient compliance with their guidelines and to intervene before care is overdue. These efforts will be coordinated across the system (AMG, NHP disease and case management, Occupational Health, Nurse Direct, etc.) to ensure the most efficient use of resources. As a result, AMG patients will receive all of the appropriate primary care and screening exams, improving their health.

Furthermore, our interactions with the patient will extend to their homes through WISDOM mailings and AffinityConnect, the patient portal.

How patients perceive Affinity will be greatly improved because patients will see us proactively reaching out to them, not just waiting for them.

The patient experience will be more open and personalized: Our WISDOM initiatives will provide patients access to the same personalized health information as the physician. They will more fully understand their plan for care and patients will be more engaged in the physician/patient partnership. AffinityConnect will provide access to their information when they want to review it. Constant feedback will engage the patient and enrich the physician/patient partnership.

Our interactions with the patient will be personalized using the data and new electronic tools. Ironically, the result of this high tech approach will be perceived by patients as more human and caring.

I am going to leave the CPOE topic this week. But, it was a good week to point out that our industry is pursuing CPOE without the proper planning or evidence that it will improve patient safety. So, I will move to the other phrase maxing out the “hype meter.”

I have a new rule. I am forbidding anyone to discuss “Electronic Health Records” unless they can describe three clear expected benefits of an EHR system and how the EHR will accomplish that. Furthermore, “Going paperless” does not count as a benefit.

Luckily, we are pretty much past that phase at Affinity. Certainly at the executive level. I still have some others ask me when I am getting an Electronic Health Record. My standard response is: “You are not allowed to use that phrase.”

I see some CIOs pursuing Electronic Health Records without any vision regarding what they want to accomplish. This is usually in the form of a CIO sending an email to a CIO list-serve asking if anyone has a EHR RFP. There is so much wrong with that request I don’t know where to begin. It is like asking if anyone has a good recipe. Well, I have great recipe for a Green Bay Packer tailgate, but if your medical staff is expecting a 5-course meal you are both heading for disappointment.

I truly believe folks need to develop their own functional requirements. At least the core requirements. But, that should only take place once they have developed a common vision with the leadership and medical staff. Once you know what you are trying to accomplish, then you can decide what features/functions you will need.

We have put together an Electronic Health Record manifesto. I love it, but I love my own cooking. I will post it later in the week to continue the EHR theme.

If CPOE was such a promising technology to improve patient safety, why has the Leaprog Group failed to deliver its CPOE evaluation tool? In November of 2001 Leapfrog promised to collaborate with FCG to deliver an evaluation tool in 2002.

The first version of the CPOE evaluation tool may still be coming. In mid-2005 Leapfrog promised that the tool would accompany the next survey. I believe that is due in April 2006. This is over THREE years after it was initially promised. Even my worst projects are not delivered this far off schedule.

Why does Leapfrog expect 100-bed community hospitals to implement technologies that it can’t seem to master, even with all of the financial backing of its members / funders and the intellectual capital of the country’s largest healthcare IT consulting group (FCG)?

Was Leapfrog premature in suggesting that CPOE was an immediate opportunity to improve patient safety? Sure CPOE is great in theory, but then again, so are flying cars.

I do appreciate that Leapfrog has provided a definition of true CPOE, which they say includes three elements:

1. Assure that physicians enter at least 75% of inpatient medication orders via a computer system that includes prescribing-error prevention software;
2. Demonstrate that their inpatient CPOE system can alert physicians of at least 50% of common, serious prescribing errors, using a testing protocol now under development by First Consulting Group and the Institute for Safe Medication Practices [this is the missing evaluation tool]; and,
3. Require that physicians electronically document a reason for overriding an interception prior to doing so.

Despite this clear definition health systems continue to claim that all kinds of things are CPOE, like clinic e-prescribing systems. Ambulatory CPOE is an oxymoron.

Most CPOE implementations that I see don’t even try to tackle 2 and 3. For that matter they can’t meet the threshold of the first criterion. What is the value in that?

And even though the Leapfrog survey instructions are clear there are many instances where hospitals submit CPOE claims that are, at best, overly ambitious. It will be interesting to see how many hospitals report true CPOE success in their 2005 survey after reporting that they were a year away from full CPOE in the 2004 survey.

Update: a few hours after posting this I was heading to the bathroom (I know, TMI) and I grabbed whatever was on top of my mail pile. That turned out to be the HIMSS 2006 materials. As I was flipping through it I saw that FCG and University of Pennsylvania Health System will present the benefits of the CPOE Evaluation Tool (Education Session Number: 58). Perhaps Penn is the beta site.

It appears, by the title of the seminar, that the intent is for the tool to be available before HIMSS. So, Leapfrog and FCG may be making some headway. Then again, since the HIMSS submission deadline is in May this may have been wishful thinking.