The article about Pediatric Associates in CA has a nugget with a potentially outsized impact: the implication that VFC vaccines…
Practice Wise 1/20/12
New Year’s Resolutions I Hope to Fulfill
I gave up making personal resolutions years ago, when I realized I never stuck to them past January 10. But I do try to set a few resolutions or personal business goals at the start of every year. These aren’t business plan type financial goals. Instead, they are usually relationship growth goals.
As the owner of a small consulting firm serving mostly small to medium practices (with a few bigger systems thrown in the mix,) I have the opportunity to have very personal, almost intimate relationships with our clients. We are part of their practice family. We know a lot about their personal lives, and they about ours. I’m constantly striving to improve those relationships. They are the lifeblood of my business; the reason we exist.
Resolution #1: help my clients to understand the importance of their vendor relationships and how to foster them into practice family relationships. In particular, as practices adopt EMR software, they need to incorporate their EMR vendor and their IT support vendors into their team. I want to help my clients understand the value of their technology, and more importantly, the value of their technology partners in their practice success. With standardization of the elements of certified EMR products and generally standardized hardware, the value of technology is not solely the technology itself, but the partners who make technology successful in the practice.
I had a third-party business associate comment to me the other day that in all his years in business, he’s never seen customers treat their vendors the way that some medical practices treat their IT support vendors. He didn’t mean that in a positive way. He observed interactions between practices and their technology support vendors and was shocked that the clients were making demands and laying down ultimatums. In his mind, the demands seemed unreasonable.
It got me thinking about out why perfectly intelligent and reasonable people can seem so unreasonable and difficult to please when it comes to their computer environment. Of course, there are many factors at play here. It’s no secret that the medical field is anywhere from 10-15 years behind corporate America in the adoption of business computer systems. Smaller practices are at the tail end of that curve. They are approaching all of these major business technology changes to their practice with the adoption of EMR from a bit of a disadvantage.
Many small to medium practices don’t even use corporate e-mail before they move into a complex EMR. They often don’t understand the difference between buying a computer with Windows 7 operating system and Office 2007. They have no frame of reference of how these things should work. Nobody has set expectations for them. Vendors recommend solutions, install them, tell them how they work, and expect that they will be effective users and grateful support customers at the end of an implementation. The customers think if it’s a complex technology, it should just work. They are frustrated and fearful. We’ve upended the way they practice medicine. They don’t know what to expect. We have failed them by not setting realistic expectations.
Resolution #2: set realistic and appropriate expectations. OK, I could use this one is all areas of my life, but that’s another story. In relation to my business, my goal is to help define appropriate support expectations with my clients. Not only for my firm, but with all the vendors that help my clients keep their practices running.
We know that end users become effective with ongoing support. Part of that support should be educational about the processes, not just the products. For instance, I had a provider complain that we do too many software updates to his EMR; he only wants one a year. He thinks updates are about new features and functionality only. I showed him the Microsoft Automatic Updates history on his computer. It was setup to download and install automatically at 3:00 am.
He wasn’t aware that this was happening weekly. It answered his question as to why on Wednesday mornings when he comes in, his computer is rebooted and all his applications from Tuesday are closed. He thought he had a computer problem and nobody believed him that some days his computer rebooted itself. Understanding what software upgrades entail and why they are necessary was not something he ever thought about, until he started using an EMR.
We can’t expect them to set expectations of how their products or vendors will perform if they’ve never experienced these in the past. I certainly would have appropriate expectations about a cardiothoracic surgical procedure outcome having had no experience with one.
This is not a new discussion. There was an excellent post on this site last year about having empathy and compassion for the customer, and likewise, the customer for the support team. It dealt primarily with internal hospital teams. Those of us who provide support services to private medical practices have the extra challenge that these are our paying customers. We don’t have control over their environment or unsolicited sway in their culture. If they don’t feel like their needs are being met, they’ll take their business elsewhere.
And let’s be clear: not all vendors are created equally. There are plenty of vendors who do not meet even the minimum expectations, set or not.
Someone will read this and state that it is elementary and pedantic. Nevertheless, I see hundreds of providers in small practices, and by and large, they are in the same boat. I have a handful that are really computer savvy and understand what to expect. I value my clients and the work I get to do with them. I want to make sure they are given the opportunity to play on an even playing field, knowing all the rules of the game, so that they can be successful in this part of their business.
We can all help them set appropriate expectations. Then, hold them and us — the vendor community — to those standards. We can only expect them to have reasonable expectations if we agree to them, and then meet them.
At least I won’t be fretting over another year of wasted gym membership fees after another failed resolution to start exercising and lose 15 pounds.
Julie McGovern is CEO of Practice Wise, LLC.
Again, we don’t like software because it is poorly designed, disruptive to workflow, and inadequate to the task. Why wouldn’t a vendor resolve to make better software? Or meet our expectations? Instead we get this: set more realistic expectations. This is just another way of saying you failed.
Brian – Your comment has a core of truth in that medicine, being one of the last industries for software (and hardware) to be designed for, is really still in it’s infancy and as such has a ways to go. But it’s not just the products, its medicine in general that is also evolving. Granted, with over 750 products on the market by definition there is bound to be variation in quality, functionality, etc. But your point also fully exemplifies the main challenge – success is subjective. You are looking for “better” and to meet your “expectations.” Subjective requests. If how providers practiced medicine were to any degree standardized, if the hardware and network environments were always solid, and if practices were always willing to spend the $$ and the time for what it actually takes to properly select, implement, train and support their systems then on average then “better” solutions that “meet expectations” would be the norm and not the exception. This is not the world we live in.
For practices that are brand new to EHR often the expectations are wildly unrealistic: The system reads minds, is totally customized to that particular physicians idiosyncracies, local environment, regional requirements – out of the box, and oh by the way all done in 3 days with no time commitment on the part of the physician needed and all done for next to free. And when all of that doesn’t come together the vendor is labeled as a failure. Unrealistic? Of course.
What I got out of Ms. McGovern’s blog was that just as patient compliance is a major variable to a successful medical or surgical outcome so is practice/physician compliance to a successful outcome for EHR. And that compliance starts with treating vendors with the respect their expertise warrants. Usually solutions can be found that might not be exactly what you initially envisioned but close enough to work well if the end user is flexible. But in order to get to the point cooperation built on mutual respect has to come into play. And when that does happen – surprise! effective users of EHR that wouldn’t go back to paper if you paid them. If you aren’t one of these then perhaps the issue is not with your vendor.