Comments on: Doing it Right

By: Ken O

Ken O — Mon, 23 Mar 2009 10:46:09 +0000

Well, Dr Rob has got my point; I meant talk to the whole staff (or at least representatives of all main functions that you, and not the practice you’re visiting or the sales rep, choose).
I’ve diagnosed a flakey, underspecified and overloaded server and network within 5 minutes of arriving in a hospital for an outpatient visit, simply by chatting with the clinic receptionist (and she was known as the “Dragon Lady”)! Ok, this is my specialty, but if I can do that that quick, a proper “due dilligence” visit should expose a bad system.

By: Healthcare IT Win-Win Now! » Blog Archive » EMR selection and visiting/surveying/querying current users

Sat, 21 Mar 2009 04:50:48 +0000

[...] Rob – board certified in Internal Medicine and Pediatrics – has a balanced post about EMR’s and his experiences on his blog “Musings of a Distractible [...]

By: S Silverstein MD

S Silverstein MD — Fri, 20 Mar 2009 18:51:31 +0000

I didn’t make the point before, but I consider site visits – in the plural – an essential due diligence before an investment of this magnitude. However, one must be diligent while exercising the due diligence.

I’ve given dog-and-pony shows myself as a key site for a vendor, and was under some subtle pressures not to show the warts.

Ask tough questions on the site visit, as if your patients’ lives and your career depended on it.

Because they do.

– SS

By: Rob

Rob — Fri, 20 Mar 2009 18:21:22 +0000

The answer is somewhere in between. Yes, there is abuse and you need to be suspicious, but a physician coming to another physician’s office and talking to the staff is unlikely to be duped. Watching the process and talking to the whole staff – you get a good picture of things. Be wary, but not going to site visits limits you to the opinions of salespeople. You know that salespeople aren’t going to tell you anything bad.

By: S Silverstein MD

S Silverstein MD — Fri, 20 Mar 2009 18:14:17 +0000

Mr Silverstein, I’m sure what you say is correct in some cases, but if a system does not work stablely and reliably, a site visit, and informal chat with someone like Medrecgal. will reveal the fact unless, not only the partners, but the entire staff of the site are being paid off. As a former CMIO of a 1000+ bed healthcare system, I only wish it were so easy. Sometimes it takes a bit more to assess and fix a system. link

By: Ken O

Ken O — Fri, 20 Mar 2009 15:18:44 +0000

Also I’d rather change my work practices a bit to use a reliable product, than buy an unreliable and unsupportable customisation.

By: S SIlverstein

S SIlverstein — Fri, 20 Mar 2009 12:32:00 +0000

You assume your efforts are completely portable in the real world in a short time frame.

By: Rob

Rob — Fri, 20 Mar 2009 12:24:53 +0000

Yes, Ken. The single best argument about those who nay-say about EMR is my office and others like it.

By: S SIlverstein

S SIlverstein — Fri, 20 Mar 2009 12:12:51 +0000

Just beware conflicts of interest when seeing someone else’s EMR.

Think this doesn’t happen? In pharma it happens. See for example yesterday’s NYT article “Drug Maker Told Studies Would Aid It, Papers Say” at http://www.nytimes.com/2009/03/20/us/20psych.html?_r=1

Regarding clinical IT, per Jonathan Bertman as I posted at http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=secrets

“Clearly—and reasonably—an EHR company would try to avoid giving you the contact information of an unhappy client. But might the doctor to whom you are referred be getting compensated? Surprisingly, a number of EHR companies actually pay referring physicians to “compensate them for their time” in speaking with you. This can take the form of a direct cash payment or free/discounted software and services. Again, this is not necessarily unreasonable so long as the relationship is disclosed. “

By: Ken O

Ken O — Fri, 20 Mar 2009 11:58:57 +0000

I’d agree Rob, and not just about EMR products. If I was wanting to buy any software that requires this degree of specialisation (so not ledger accounting but possibly cost accounting), say configuration control systems, I’d want to see the product in action. If nothing else, the mere fact that an existing customer is prepared to let other people see the product in action is positive.