eWeek.com has a slide presentation on The Best IT Advice I Ever Got. I thought it was excellent.
What would you add? Some thoughts (I hope to add more later):
We have just received the responses to our Electronic Health Record RFP. As I had mentioned before, I don’t find a lot of value in the boilerplate RFPs that you would typically get from a consulting organization. Ours only had 56 questions in the functional section (there was a technical section too).
It appears that providing minimal answers to a response is a common vendor tactic. Most of the responses really lacked the depth that I desired. For example, we had some open ended questions regarding disease and health management capabilites. Some vendors had two sentence responses. That should be 8 paragraphs.
I think this is a tactic. I think vendors know that there is a human tendency to fill in the blanks with the answers that the reader wants.
We did try to keep the vendors entertained. In the middle of the RFP we asked: What is the air-speed velocity of an unladen swallow? All of the vendors had a witty response and seemed to appreciate the spirit in which it was asked.
We also asked: Please demonstate how your HER (don’t you just hate it when Microsoft Spell Checker changes EHR to HER) will help us to achieve…
Only one vendor acknowledged our parenthetical observation. They wrote: Our solucion too the Microsoft Word EHR/HER conflikt is to turn off spellcheque.
I would love to reveal that witty responder, but they were the only ones that made us sign a non-disclosre agreement.
One quick sidebar…I took Amicas to task a while back regarding their lack of a web-based tool for tracking service issues. they now have one, and it works very well.
After a project has been budgeted, we ask the business champion to develop a charter. There are a lot of elements in a good charter and the larger the project the more complex the charter requirements.
All project charters must address a few key elements in order to be approved for launch:
This first bullet is important. Luckily Ministry Health Care as a world class project management office that are experts at creating business plans. But most organizations aren’t good at developing plans. They just right down a series of phases with a start date and a stop date. Whenever I see one of those plans (they usually come in an Excel file) I send the user back to develop a real project plan, with a little help. The real plan is always 50% longer (in duration) than the original attempt.
I have seen a lot of project heartache that could have been avoided with better testing. However, testing is an art form and very few organizations do it well. Most people believe the extent of testing is to make sure that the system behaves as expected. But that is the easy part.
There are many aspects of testing, including unit testing (just testing the particular aspect of functionality), integration testing (making sure all of the components work end-to-end), interface testing, conversion testing, stress testing (simulating real world volumes), and exception testing (because users don’t always do what you expect). This is far from complete. The type and amount of testing will vary by project.
Most project plans that I see need to triple the amount of testing that they plan. The development of a comprehensive test plan is a key component of any IT project.
Also, testing should be auditable and signed off by the business. When I worked for SMS in the 80s we created folders for screen prints. The outside of the folder had the scenario stapled and the expected results were checked off as they were validated. Today we typically document the testing in a QuickBase application.
I feel so strongly about testing we have created a new position in our organization for a testing guru. This person will be the consultant to the various projects helping the project teams to develop effective test plans. This person will also develop our internal methodologies which we will improve over time.
In general Microsoft makes some great software. I think the office suite may be the exception. I really find Word difficult to use and needlessly complex. It is a classic example of “bloatware.”
The other thing that drives me crazy about Microsoft is their pricing strategies. They typically price their products below market at the beginning of their life cycle. Then, once we are dependent on them, they raise their prices well above market. What really makes their software expensive is their client pricing. When we install a new server with Microsoft software we pay for the software on that server AND an additional fee for a all of the PCs that connect to that server.
At my organizations, we pay more for Microsoft software than GE/IDX and MEDITECH combined.
Well, we are going to start to bring some sanity to our Microsoft spending. Recently a Ministry/Affinity team completed a project to develop Ministry and Affinity’s strategy for managing Microsoft costs, and I think they have come up with an outstanding plan. Not all PCs will have Microsoft Office. In clinical areas we will only install the free viewers. So, people can read Word and Excel documents, but won’t have the expensive software needed to create those documents. This requires extra work on our behalf, but the money we will save justifies the added effort 10 times over.
Also, we have made a decision to NOT deploy Microsoft SharePoint servers. we are using an ASP collaboration tool called QuickBase, which is much more intuitive and will be significantly less expensive.
Recently Microsoft rolled out their Reporting Services tool. We will not use that product unless a full analysis of the options supports that direction.
In general, I only use Word or Excel in rare situations. I never type a message in Word and attach it to an email. That only perpetuates Word usage, and it wastes the user time sine they have to open the email, then open the Word attachment.
We will not be installing Microsoft Access on any PCs unless there is a specific justification accepted by an IT manager. Usually QuickBase is a much better choice than Access since it is natively multi-user, easier to use, and much less expensive.
There is a new web service called bidrx.com. They aspire to be a website that links consumers with pharmacies, manufacturers, prescribers and payers so all can make better decisions when purchasing prescription drugs. I am familiar with them because they are based in my part of Northeast Wisconsin.
I have long thought that we could really provide our patients with a service by providing them information regarding what local pharmacies are charging for the medications that we are about to prescribe for them. Because electronic prescribing systems fax/transmit the prescriptions directly to the pharmacy, we are forcing patients to choose a pharmacy without having the information they need to make a good buying decision.
Wouldn’t it be cool if we could imbed bidrx.com’s technology/information in an electronic prescribing system? So instead of choosing that pharmacy based upon convenience, the patient could also consider price (which could vary by $100 for something like a dose of lamisil).
That was the idea that I floated past an e-prescribing developer. But he pointed out that their SureScripts agreement from steering patients to a particular pharmacy. The road to remaking healthcare is filled with obstacles like this. The pharma industry is especially good at putting up roadblocks. Health plans don’t even know the unit cost of the medications that the pay for. They just get one big bill from the Pharmacy Benefits Manager (PBM). There is a lot of trust and little transparency.
It’s official (because I am writing it here). The Leapfrog Group is no longer relevant. Perhaps they never were. We can stop talking about them now.
I just finished reading through their 2006 press releases. Almost all of those press releases are the Leapfrog Group commenting on other organization’s quality initiatives.
The only accomplishment that the Leapfrog Group claims is receiving more surveys than ever before. Like usual, there is no comment on the pace at which the submitters of those surveys are embracing the leaps. It seems like they could have counted up those surveys by now (they were due on June 30). I suspect they know the numbers, but there isn’t anything to brag about.
Where are the corporate sponsors? I thought they were big into accountability?
I believe the Leapfrog Group made a mistake in choosing CPOE as their first leap. There are so many other safety initiatives that produce excellent safety results and are significantly more achievable.
The fact is that the number of hospitals that have implemented CPOE is insignificant. Last year that number was less than 80 (out of nearly 1,000 surveys received). That is pretty dismal for the 4th year. I don’t expect a great increase this year. Ironically, one of my hospitals will be one of the few additions.
And, what has ever happened to the Leapfrog Group/FCG tool to test the clinical alerts in a CPOE system? This was announced in 2001? Is it out there and I just missed it? Or, is the Leapfrog Group 4 years behind schedule?
It really doesn’t matter. Because there are far more important patient safety initiatives (IHI’s 100K lives). And, because nobody is listening. CPOE mania is dying as executives realize that they have better patient safety opportunities that are more proven and don’t disrupt their admitters.
Since Leapfrog launched 5 years ago they have never steered a single patient to a hospital with CPOE (I could only hope). I would bet they never will.
Fin.
I am always frustrated how some often used terms in Healthcare IT are used in very different ways by different people. A simple example is Electronic Health Record (EHR) and Electronic Medical Record (EMR).
For a period of time the term Computer-based Patient Record was hot, but that seems to have been a short-lived fad.
So, what is the difference between and EHR and an EMR? As we are in the midst of developing a new EHR strategy for our 400-physician group this is a debate that is near and dear to my heart.
I think CCHIT and HL7 EHR-S do a nice job of describing core EHR capabilities. Those would include medication management, allergy list, problem lists, immunization, etc.
However, we are looking for a phrase that captures what we are trying to do. For our purposes we are saying that the EHR promotes the practice of medicine. Whereas an EMR is simply an electronic version of the traditional medical record. That is, the information is in there and it is retrievable, but it is generally organized around the hospital departments.
We have great doctors at Affinity and Ministry. Our goal is to continue to provide better tools that allow physicians to focus on the practice medicine, not search for data. By giving them IT systems that present the most clinically relevant information to care for each patient we can make these doctors even more efficient and effective.
What is your definition of an EHR?
I just got back from spending the better part of two days at MEDITECH. Even though I have been a MEDITECH CIO for 11 years I had only been to Boston 1 other time. I just don’t feel like I need to talk strategy very often. I also feel guilty tying up executive time for a little 15 hospital chain in Wisconsin.
The MEDITECH campuses are beautiful. I suppose that is in part because founder Neal Pappalardo’s daughter is an interior decorator. There is tasteful art everywhere. My understanding is that MEDITECH has unintentionally done very well with real estate appreciation.
Anyone that states that MEDITECH is a closed system that is difficult to interface to/from is stuck in the 90’s, presumably listening the Spice Girls and using CompuServe on their 486. I have always been able to get the MEDITECH interfaces I need. But, the interoperability efforts they have underway really made me say “wow.” They are clearly adopted emerging standards in a way that they never have before.
We were supposed to go to dinner with the MEDITECH folks last night, but we decided to cancel out in order spend some time working (rarely are our clinical IT leaders in the same place). I felt bad about canceling, but I assumed the MEDITECH execs would appreciate their unexpected free time. Today I asked Howard Messing (President and COO) how he spent his free night instead of schmoozing customers. He told us that he installed a new distribution of Linux on one of his computers. I love that dude.
I asked Howard if I should read a business strategy into that. He told me that they are already running some Linux applications internally and have been playing with it. I don’t suspect there is a Linux option forthcoming for MEDITECH’s HIS customers. But Howard, feel free to take Microsoft out of the equation. We can split the savings 50/50.
You don’t hear folks talk a lot about population management when they are discussing EHRs. To me this is a key capability and should be central to the decision making process. Sure it great to have all of the clinical information at your physician’s fingertips during the exam room visit. But success in a pay-for-performance world (P4P) requires the care team to be more proactive.
A good EHR should have a worklisting system (or tools to create one) that allows schedulers to see which patients most need to get into the doctor’s office so they can call (or automatically email) them. Patients need to be hounded to get the care they need.
Mr Weider, it is time to get your prostate checked. It isn’t pleasant – but it is a lot better than late stage prostate cancer. This is the kind of care that procrastinators like me really need.
Candid CIO 