Alternatives - Bleeding-Edge, Low-Performance Practices

Characteristics of Bleeding-Edge Low-Performance Practices

• Table of Contents

  1. 1. Characteristics of Bleeding-Edge Low-Performance Practices
  2. 2. What approach are you choosing today?
  3. 3. Talk is cheap!
  Continue the anachronism of clinicians creating most of the documentation via dictation and/or hand writing.
• Delegate practice decisions (such as EMR implementation), and don’t delegate documentation tasks.
• Have administration or the information system persons be the primary decision makers rather than the clinicians.
• Spend years trying to find the perfect vendor-product. Allow a search for perfection to prevent incorporation of the great.
• Spend months and thousands of dollars having an administrator, technical person or consultant develop an Request For Proposal. Better yet, pay thousands to a consultant so they can take off your watch and tell you the time (**1).
• Travel thousands of miles and spend many days out of the clinic doing site visits. Make site visit to practices that are the exception rather than the norm. Don't ask for full disclosure regarding the rewards the visited site is receiving from the vendor.
• Remain stuck in the fallacy of “I can’t afford it.” it does not need to be expensive. In fact, with higher EMR costs, you usually get what you pay for… EMR advertising, promotion and payola.
• Make decisions based on expecting someone with shiny shoes to come in to stroke egos of  the decision makers.
• Purchase systems that have limited numbers of installs and lots of venture capital.
• Only consider systems offered by "Big Name" vendors thinking this is safer. Buy into the notion that the more employees the EMR vendor has, the less the risk. (**2)
• Plan for “Big Bang” Revolutions instead of Non-Disruptive Evolutions.
• Buy a system that requires intensive and expensive training.
• Acquire systems that include few customizations, and require you to invest large amounts of time and/or money to have the customizations you need incorporated.
• Buy systems that lack connectivity or charge exorbitant fees for interfaces. This is the norm and can only be negotiated at the time of initial purchase. Get specific in writing. The current, minimal, average cost for a simple, one-way interface is $14,000.
• Buy systems that store (i.e. trap) your data in a proprietary database so that you can only get to it through the single vendor’s proprietary software. This is the norm, and an average cost to be able to get your patient's data out of the system averages $10,000.
• Focus on having a big list of bells and whistles rather than focusing on improving basic practice efficiencies and workflows.
• Choose products that either force structured entry or don’t support structured entry. With few exceptions, you should have both options in all areas.
• Plan transitional approaches that creates more, rather than less work for clinicians.
• Implement a stand-alone electronic prescribing product as a "transition tool" thinking this will make it easier to get to a full EMR. This a completely false assumption leading to more work for clinicians and secondarily leads to delayed or failed EMR implementations.

What approach are you choosing today?

What are your actions, not what you intend or say?

Are you choosing to mostly grumble and turn the hamster wheel a little faster?

Are you choosing to partner with technology vendors that are reluctant to give straight information regarding pricing, interfaces, etc?

Are your actions making you more vulnerable to entities that do not have your (and your patients) well-being as the top priority?

Talk is cheap!

And, the answer to questions from most EMR vendors is usually yes we can. However, the answer should be yes we can with enough money and time. Get it writing, and get it in advance!

A majority of entities promoting Health Information Technology and most health care policy initiatives in the U.S., to date, are misguided and counter to the evidence.

• Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System:  PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1506-1512 (doi:10.1542/peds.2005-1287)
• Are Electronic Medical Records Trustworthy? Observations on Copying, Pasting and Duplication; AMIA Annu Symp Proc. 2003; 2003: 269–273
• Electronic Health Record Use and the Quality of Ambulatory Care in the United States;  Arch Intern Med. 2007;167(13):1400-1405.
• Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors:  JAMA. 2005;293:1197-1203.
• Bad Health Informatics Can Kill - summaries of a number of reported incidents in healthcare where ICT was the cause or a significant factor.
• High Rates of Adverse Drug Events in a Highly Computerized Hospital; Arch Intern Med. 2007
• E-prescribing errors raise worries;  Healthcare IT News, March 13, 2008
• IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans’ Medical Centers; JAMA. 2009;301(9):919-920.
• NHS boss attacks e-records system; BBC News, Friday, 13 February 2009
• Electronic medical record use and physician–patient communication: An observational study of Israeli primary care encounters

The following links offer a satirical glance into the business side of the EHR industry. Sadly, the exaggerations are not very far from the reality.

• Extormity
• Seedie
• Being Ricky Roma, or Tales from the Dark Side, Episode V – The Empire Strikes Gold

**1 Much more to come regarding effective use of consultants. The EMR consultant business is a particularly toxic environment at the moment. Few consultants are truly objective and above the influence of payola, vendor tactics. Hopefully, we can facilitate the identification of the exceptions. It is just one of the dirty little secrets that has impaired EMR adoption. The number of consultants effective for small practices is exceedingly small.

Does Your EHR Consultant Have Your Best Interests in Mind?  

 **2  If anything, the size of the EMR vendor company has had an inverse relationship on success and survivability. There are thousands of orphaned EMR users that bought from such names as Microsoft, Pfizer, Glaxo, Wang, Mysis, GE, and dozens more. A far more valid assessment is to take the number of installs and divide this by the number of EMR vendor employees. The lower the number, the greater the ultimate risk.

Path - Success Culture