What Can Your EHR Do for Me?

(This is a guest column submitted by Paul Roemer, who blogs at HealthcareITStrategy.com)

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A recent piece in iHealthBeat wrote, “Report Says Hospitals Could Save Billions by Implementing Health IT.” Indeed they could. Continuing to quote, U.S. hospitals could reap a total of $40 billion in annual savings if facilities effectively set up health IT strategies—a phrase curiously resonant with the name of my consulting firm—according to a recent McKinsey reportFierce Health IT).

I agree with the statements in that paragraph, but permit me to split a few hairs. Could and should have nothing to do with whether healthcare IT (HIT) will do anything other than drain the purses of providers. The ‘will HIT help save millions’ comes down to the strategy—as a sidebar, I encourage you to read Dr. Alberto Borges’ post, "A day in the life of a Physician EHR Meaningful User" (HCPlive, 8/24/2010).

HIT Strategy; without one, do not take out your checkbook. Buying what your neighbor bought, and assuming they did their homework, is not a strategy. Buying something because the sales-rep told you they had an amazing list of client references is not a strategy. These are shortcuts. Have you noticed none of the EHR providers were not wearing “I love my EHR” T-shirts at the last HFMA meeting?

My rule of thumb about Google is that if I cannot find something, it is because it does not exist. There are no good EHR RFPs available on Google. Here are a few thoughts on RFPs in case you want to use one—by the way, a good RFP makes a great addition to a vendor contract as it provides a written audit trail of what they contracted to do.

• The RFP should have an exhaustive list of requirements. It is designed to separate one vendor from another, not make them all appear to be equally capable.
• The requirements should be addressed in a way to help a provider know what business capabilities the vendor offers, not to show how pretty their screens are.
• The RFP should not mirror your current business. Your goal is not to simply automate what you do, but to do it better. That means change. Without change your EHR will simply be an expensive scanner.
• Along that same thinking, I have yet to see an RFP that mentions a single requirement about making the provider’s business more efficient or more effective. Here’s why. If each provider tells you their system can perform the same tasks as the other systems, you have not learned anything to cause you to pick one vendor over another. If they say their system is efficient, make them supply you with details about the number of clicks, screen navigations, and times needed to do the ten tasks you do most often. If they say they are twice as fast as Vendor A, make them prove it, make them prove it in your office. Contact vendor A and find out who is telling the truth. If they each have the same functionality, and one vendor takes half the time to perform a task, that fact should be included in your decision. How important is 30 seconds? How many 30-second improvements are there with each patient? If there are four, and you see 30 patients a day, and your practice has eight doctors, you’ve either just saved a total of eight hours a day to spend more time talking to your patients, or to add patients.
• The other important part of the RFP that is often either overlooked or under assessed is the specialization of the EHR. Warning: A large vendor has probably has at least one implementation covering each specialty; cardiology, orthopedics, urology. Having one or a few clients in a specialty does not mean their product was designed to serve that market. It may mean their clients did not do a very good job selecting tem as their vendor.
• That brings us to references. A large vendor may have a thousand or more providers installed. When you ask to check their references, which ones are they likely to parade in front of you—the ones who like their product. The other 990 are kept in their lock-box. Whoever they give you to talk to will be those who they feel are least likely to say something negative.
• How should you check references? Most vendors will give you as a contact either a top administrator or someone in IT. That will tell you very little. Once you learn the name of the organization, call them. “This is doctor so-and-so, and I am calling to speak with one of your physicians.” Whatever this person tells you will be of much more value than having someone who not use the system tell you how much they like it.

Anyway, those are my thoughts. There are a range of savings available if you have a good EHR strategy, pick a good system, and implement it correctly. If you pick the wrong one, you do not need to worry about calculating your ROI—there won’t be one.

Paul Roemer is a healthcare strategist with more than 25 years of experience in executive management. He is managing partner of Healthcare IT Strategy in Downingtown, PA, and is also Chief Imaginist of the Healthcare Idea Lab.