EHR & The Ghost of Technologies Past

November 30, 2009

“It’s like déjà-vu all over again” Yogi Berra famously once said, and yes, it is. We’ve been here before.  The promise of a new technology the will create so many efficiencies – too many to count.  It will make everyone’s life so much ‘easier’ and allow the organization to make unprecedented gains.

Enterprise Resource Planning (ERP) systems, and the consultants that sold them, promised us the moon.  While a few (and very few) made their mark, most would fall into the ‘failure to launch’ category.  If they did get off the launch pad, they didn’t make it very far.

While everyone generally accepts the definition of insanity as ‘doing the same thing over and over again and expecting a different result,’ organizations and leaders of organizations continue to repeat mistakes from the past despite warnings from many.  They rationalize it to themselves by saying, “our industry is different.”  The only thing to say to that is, “Yes, you’re different – just like everyone else.”

They then make the same mistakes done by those in different industries, but implementing the same concept, and wonder why the new technology failed to meet expectations.

So now, we have Electronic Health Records (EHR) [Electronic Medical Records (EMR)].  We’ve been told that this will help solve some of the issues that create so many problems in healthcare, and improve patient care, efficiencies, eliminate medical errors, etc.  Sounds a lot like the ‘moon,’ and if any industry feels they are ‘different’, it’s healthcare.

But the question is – what are you going to do different?

The traditional approach to implementing new technologies (like EHR) has been to focus on the Technology, glance at the Process, and be blind to the People.  We have traditionally centered everything we do around the new technology, treating it as a panacea; all we need to do is install it, and our problems will be solved.  To this end, we may take a brief look at how the process will be with the new system (rarely ever at how we currently perform it), and typically ignore the people who actually perform the process (we interview and train them, but do we listen to them?).  This approach has produced less than stellar results, with some pundits claiming up to 75% of technology project fail to meet expectations (this approach being only part of the many reasons for failure).

To approach an EHR in this manner would be doing the same thing over and expecting a different result.  A different approach (which I continue preach) would be to focus on the Process, while involving and engaging the People to prepare for the Technology.

By focusing on the process, we can get a true understanding of the way things really get done – how the people actually perform the tasks that move the organization each day.

With the people engaged, involved, and focused on the process, the organization will get a solid understanding of what needs to be improved, and have created the buy-in and ownership of the people who perform it each day to improve the process.

By cleaning up the current process, the organization will be prepared for the new process the EHR will bring and fully understand how to effectively integrate the technology and the process into a new way of operating.

So, are you going to repeat the mistakes others have made in the past when implementing technology, or are you going to try a new approach?

Let me know your thoughts!

Glenn

Note: This is cross-posted here

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Understand the Outcomes, then Focus on the Inputs

July 13, 2009

 

The recent and ongoing debate on Healthcare highlights a problem that is prevalent throughout organizations, governments, and society in general.  The problem is with the thinking process, or should I say, lack of a thinking process, and an almost myopic and emotional focus on addressing only the outcomes of a process.

In Healthcare, we are constantly told that the “system” is broken, it doesn’t meet the needs of patients, and there are too many people who can’t afford healthcare.  People not being able to afford healthcare is a problem, so, as some are presenting, the solution is to provide those people with health insurance (the mechanism which they receive it doesn’t matter), then we will have solved the problem of people not being able to afford healthcare.  But what does this solution really solve?  What is being done to drive the costs of healthcare down?  What is being done to improve the quality of the delivery of healthcare to better meet the needs of the patient?  What is being done to fix the broken “system”? And it is broken.

The issue is the solution proposed does not address the reasons as to why people can’t afford healthcare.  Lack of insurance may be one of the reasons, but it’s certainly not the only reason, just maybe the easiest reason to address to a frustrated public that wants to see “results.”  The problem is that to truly address the reasons healthcare is unaffordable means we need to dive into the system and determine what is driving costs from the moment a patient enters a physician office (or earlier) until they settle their bill (which may be covered by insurance).  If the output is unaffordable care, we need to focus on the inputs that are driving these outputs.  Healthcare is a very complex model, with physicians, providers, insurers, pharmaceutical companies, and medical device suppliers all functioning as independent groups (often times, required by law to do so).  To fix the outcome of our current system, we need to focus on the inputs these entities provide and the interrelations that exist.

Years ago in manufacturing, when an organization had quality problems, the solution was to simply put more quality inspectors in to monitor the product.  Well as anyone who’s been involved in manufacturing knows, “you can’t inspect quality into a product.”  Organizations that tried this quickly found it was unaffordable and not sustainable – they had to go fix the inputs of the process to truly improve and sustain quality.  The logic has nearly universal application, whether it’s manufacturing, healthcare, technology, etc. : to fix the outcome, focus on (control) the input.

The outcomes of a process are very important, and measure how effective the process is performing, but if one wants to improve the process, it is the inputs that must be addressed.

Let me know your thoughts!

Glenn Whtifield