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:

• A detailed project plan (each task must have a duration, successors, predecessors and a description of the deliverable)
• An eloquent description of the expected benefits
• Success metrics with actual baselines and targets

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.

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.

Here is a quick video of a doctor unlocking his workstation using a fingerprint reader imbedded in the keyboard. These keyboards are from Cherry. The single signon software is from Healthcast. Affinity uses this setup in physician offices and exam rooms.

Whenever someone is discussing a RHIO I can’t help but daydream about Duran Duran videos. Anyone else?

It is very common for a new software selection to be determined by a scoring system. I am sure most of you have seen this. The selection team identifies the various considerations and assigns them a weight. Then, usually through demonstrations, the team assingns a ranking to each of the considerations It might look something like this:

This was actually an RFI scoring matrix we used to whittle down vendors. An actual PACS scoring matrix should be much more complex. But, you get the idea. Yes, we did choose Amicas and we are very happy with the decision.

The best thing about this approach is that it makes the selection more objective. Approving bodies like executive teams and boards love that.

But, I often find that this kind of scoring system can fail a selection team. I frequently see these scores end up to be within a couple of percent of each other. Because the process of weighting is based upon gut, they really present subjective results in an objective looking way.

In my mind the ideal selection chooses the least expensive option that meets all of the critical capabilities. That is, I think price should be balanced against the feature function scores.

It is common in ERP selections to see vendors chosen based upon bells and whistles that will never be implemented. Remember, we use less than half of the features of the software that we buy. Be sure not to make your purchase decision based upon those unused features. Especially if you are paying good money.