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EPtalk by Dr. Jayne 10/12/17

October 12, 2017 Dr. Jayne No Comments

My travel schedule has been very busy with organizations that are taking advantage of the relative relaxation of requirements in some of the regulatory programs. They’re using the time to tackle workflow issues and work towards standardized best practices in preparation for the next round of regulatory hurdles. A fair number of my clients are non-profit organizations, but there are significant variations in their ability to fund these initiatives depending on how non-profit they are and how they run. We all know of non-profit organizations that have millions (if not billions) in the bank and those that run on a shoestring. At least half of my non-profit clients fall into the latter category, including community health organizations and other programs which are largely grant-funded.

Working with these organizations is a challenge and I was pulled into one of those situations last week. The practice is experiencing severe performance impairment in not only its EHR and practice management system, but in other applications. They brought their IT services in-house a couple of years ago to save money and have been trying to diagnose the issues without success.

I had recommended an IT vendor to do an assessment and it took several months to get them to agree to the cost. When he finally had the opportunity to look at the system, there are multiple potential root causes. The first is that their servers are well beyond their service life and everything is running on versions of software that are no longer supported. They haven’t taken maintenance releases or patches in more than a year on some of the applications and system resource use is off the charts. If their IT systems were a patient, I’d have to diagnose multi-system organ failure.

Now that we had data defining the problem, it was time to sit down and talk about a timeline for solutions. We discussed the fact that any attempts to enhance the EHR or the other applications would likely not have demonstrable results due to the overall performance issues. Not to mention that their situation leaves them vulnerable to total system failure, hackers, and more. Their cash-strapped state is why they gave up their white-glove IT support in the past and they’ve been holding things together with the proverbial bubble gum and duct tape since then. When you’re working with an organization that has prohibited overtime and reduced clinical shift coverage due to lack of funding, asking them to spend tens of thousands of dollars on servers and software is a non-starter. We discussed moving their system to a hosted environment to reduce some of the issues, but they don’t think they even have the cash flow to handle the monthly charges.

It’s difficult knowing that their users are experiencing the pain of using a system that often just doesn’t run properly, but that there isn’t a ready answer. Their patients are experiencing less-than-optimal care because the practice can’t implement some of the newer bells and whistles of the system because it will barely handle the basics. I spent several hours with the CEO and CFO, with the ultimate outcome being that they simply can’t afford upgrades and will have to just “make do.” They’re a safety net care provider, so it’s not like they can raise their fees or start offering lucrative cosmetic procedures to boost the bottom line. We’re now looking into additional grant programs and funding sources, but there isn’t going to be a quick fix if we can find one at all. I hate to see an organization like this flounder, but unless someone wins the lottery and throws some cash their way, they’re a bit stuck.

In addition to their IT woes, I was also asked to assist with some staffing issues. They’ve having trouble with physician retention and have had to start filling in with some locum tenens providers, which usually isn’t great for continuity or morale. To make matters worse, on one of the days I was there, the locum physician had the license plates stolen from her rental car. Apparently, the practice has provided special anti-theft screws to employees to secure their plates, but didn’t think about the locum. It made me think twice since I was in a rental car as well, although I didn’t think my plates from across the country would be as much of a temptation since they’re memorable and obvious, which might be a theft deterrent.

The practice is also struggling with hiring new staff, with some applicants being afraid to work at one of the organization’s locations. They don’t have the payroll to add security guards, and apparently there have been some incidents with angry drug-seekers threatening staff. This has introduced friction because the organization decided that requiring at least one male to be present on every shift was the solution and the men don’t want to work there, either. Although I can help with things like standardizing workflows to make the day flow better and people to be more efficient, I doubt the employee satisfaction that brings will do much to fix some of the deeper problems.

For people who work in other parts of the healthcare IT industry who might not always see this side of the equation, I offer it as food for thought. Whether you’re in development, marketing, public relations, finance, investing, etc. you may not always be exposed to the different situations that practices are living up to. It’s important to remember that ultimately the patients are the customers, and the teams that have to use our systems and solutions to care for them. A practice that is worried about keeping the lights on or worried about keeping its employees safe may not care very much whether your corporate logo is in one font or another or whether you’re using the most agile development methods. If they’re less than interested in what you’re trying to get them to buy, it may be because they’re farther down on the hierarchy of need than you can imagine.

This week, I’m working with a practice that is the polar opposite, one in an affluent suburb that is looking to maximize patient engagement and specialized offerings while delivering enough wow factor to lure patients from the competition. It makes me feel like I’ve gone through the looking glass into another world after last week.

Have any tips for helping practices on a shoestring budget? Email me.

Email Dr. Jayne.

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