Written by Stevie Davidson Sunday, 22 August 2010 08:14

My blogs are always novels, because I get so passionate about the issues.  Recently, due to certain events here in NJ, I am very concerned about how organizations are structuring programs that directly impact the success of providers. I have had to make some hard business decision of not aligning with them, because I feel their plans, motives, and style of execution are not in the best interest of my clients or health care professionals as a whole.  So with that, I need to bust out my advocacy soapbox...here I go.

This subject, in particular, is near and dear to my heart.  For almost six years now, I have personally dedicated myself to advocating and assisting health care providers and professionals on a whole with improving business health, implementing best administrative and clinical practices, and most importantly for HIC, successfully selecting, contracting, and implementing EHR technology.

Since Meaningful Use has been thrown into the mix, the push for EHR adoption is on.  It is by far not an organized, planned, or carefully executed initiative.  The Rule itself was developed in a very ad-hoc manner, where it took how long for it to get finalized?  We still do not have a full set of Certification Bodies in place on a temporary basis, and no real view of what products are deemed "Certified" either.  For a consultant that is paid to protect their clients, and to assist with the choice of an EHR product that is a best fit and partner for the future, this is an arduous task.  The chosen one, should reap providers the "supposed" benefits of financial incentives, assist with efficient workflow, ROI, and provide a longitudinal view of a patient's PHI through data exchange to improve the quality of care and decrease costs. How can we push adoption when we have no idea what products are truly qualified?  The clock is ticking ONC!

Once again the government is working from a top-down approach of pushing providers to adopt without being completely upfront about the magnitude of change that they need to plan for, and more importantly, what type of education, tools, and resources are needed to plan for it.  EHR is a tool, and a magic wand is not included, period.  It will not change your workflows for you, it will not improve the performance of a provider and the staff without transformation, increase your revenue overnight, or provide a quick fix to anything.  In fact, if it is not built and implemented well and with an expert by your side, it can bring a practice or organization to its knees.  We are already seeing it.

Your vendor will help you to a certain extent, but not nearly enough and it isn't their job to. They are limited with time and resources in their implementation and training offerings, and the rest is on you.  RAC is coming and they are going to come with a vengeance.  Bad implementations are causing a problem with the level and quality of a provider's documentation.  They are not documenting enough to justify their coding because they are scrambling to get through their day, and don't want to be up every night till 2:00 am completing charts either.  So guess what this is a product of?  Lack of up-front planning, little to no workflow transformation, not purchasing enough training remotely and on-site, and not having an expert hold your hand and guide you.  RAC is real ladies and gentlemen, and they are not messing around.  We do chart reviews and my goodness it is ugly.  Please don't give your money back to the government so you can pay yourself back your MU payments!  It is all related and intertwined. If you rush to fail and don't invest properly to get the right return, business health, safety, and sustainability is at major risk, so then what is the point? Unfortunately today, if you fail it is in many areas not just risking MU payments, but it also risks your financial future and the safety of your patients.

What you put into it is what you will get out of it.  Lack of up front education, commitment, planning, reduced schedules, proper roll-out plans, interface and conversion planning, system build, sand box time, training, training, training, and more training - guess what? I don't have to even say it.  I can assure you, EHR implementation is a real challenge.  Stage 1 is really not that complicated for those already on EHR, but just getting to a go-live point successfully and then obtaining MU Stage 1 is not so easy.  To do it right it can take 12 - 18 months for a mid-sized multi-physician practice. Stage 2 and Stage 3 MU will really put the pressure on for workflow transformation without compromising the quality and accuracy of documentation, patient satisfaction, safety, revenue, and much more.  This is where the rubber hits the road. 

Vendors are now outsourcing implementation and training because they are so backed up.  More and more are relying on their on-line training modules because they can't afford to hire the resources to be on-site to perform the quality of training and hand holding that is needed.  Some EHR vendors have really good certification programs that they put outside resources through to ensure the job is being done somewhat well, others are just throwing people out there.  This is what scares me for you.  Millions and millions are being awarded to Community Colleges, Universities, and even private insitutions to develop curriculum and certification programs to get people trained too quickly in order to have enough resources in the industry to implement EHRs.  I don't want to sound like the doomsayer here, but unless you know how a practice runs, experienced the pain and challenges it holds, understand clinical practices, billing, and have workflow and overall best practice business experience you can forget it. 

Bev Jenkin and I, have been speaking to Colleges and learning institutions and asking how they are bridging the gap of on-the-job experience versus just learning in a classroom and playing with a donated EHR system.  Touring a hospital and then going into a practice is not cutting it.  So yes, we will offer to have students shadow us and partner with some colleges just to do our part in getting quality people out there. So why does this scare me for you?

This is a clinical implementation, NOT an IT implementation.  I cannot say this enough, if you let someone green into your office, or someone that does not have the practice management, billing, clinical, or past experience doing ambulatory EHR implementations, do I need to say guess what again?  You are opening yourself up to patient safety, liability, and risk issues like crazy!  Don't believe me? Please start reading the web and listen to what others are saying.  Do not compromise your business health, your revenue, or the safety of your patients by doing this on your own, counting just on your vendor, or have an inexperienced resource that you hire or is provided from an entity for "free", and it is not "free", that will compromise your success.  Free isn't worth it when it may cost you a bundle at the back-end to fix the problem. 

i would never compromise the quality of a provider I would use for myself or my family based on what the needs were.  From a PCP to a specialist, if our health, safety, and well being was on the line, would we choose a provider that was not an expert in a particular area? Was new on the block with no experience for the sake of convenience or cost and risk everything?  I don't think so!

Please do not get trapped into the hype of you must hurry up so you can fail mode that is going on.  Do NOT let people sell you the Brooklyn Bridge either.  Everyone has an agenda, and the agenda is most likely not in line with yours.  You have the power to choose, so please take your time and empower yourself to choose wisely.  Find your advocate and expert, get educated as this is the one area that the ONC and CMS is not investing in correctly.  How can entities educate you when they have inadequate real-life experience to share?  You need to speak to professionals who have done this and understand it as a whole. Physicians who have implemented can speak to the physician part, but that is only a piece of what you have to worry about.  You need to know up front what you need to do COMPLETELY for success. I speak with a physician all the time, he is phenomenal. He speaks to certain issues, and I cover the rest.  It is a balance of knowledge, and unfortunately the Federal Government isn't getting it.  Find out who you can trust and stick with them. I am the biggest advocate of EHRs, and of course, health care professionals.  My job is to tell you the risks and guide you on how to do this right.  Remember, to achieve business health and success it is Ready, Aim, Fire!  Fire, Ready, Aim seems to be the standard right now, and you want to hit the target of success, not shoot yourself in the foot.

Until next time,

Stevie