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Dining With Cannibals

Medical IT instillations challenges and techniques.

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Dining With Cannibals

  1. 1. Dining With Cannibals An Anthropological Analysis of Medical IT Implementations Frank W Meissner, MD, CPHIMS
  2. 2. 1st Law of Reality: Life Is A ContinuouslyBlended Sequence of Rashomon Mo ments
  3. 3. Idealized Medical IT System: The Engineering Perspective Health IT System Patient+ Dis-Ease State Transition (∼)Patient (+ Coin of Transformation∫the Realm) Input High Level FFBD Output
  4. 4. Idealized Medical IT System: A Matter Of Perspective
  5. 5. Process Structures & Characteristics Job Batch Assembly Project Continuous Shop Process Line Flow None Continuous Flexibility High Low # Products High Low Investment Low HighVariable Cost High LowLabor Content High Low Labor Skill High Low Volume Low High
  6. 6. Taxonomy OfImplementation Barrier’s Mneumonic TEARS Time Expertise Access Resources Support
  7. 7. Taxonomy OfImplementation Barrier’s Mneumonic TEARS Time Expertise Access Resources Support
  8. 8. Greatest Equations of All Time 1+1=2 C=2πra2=b2+C2a/b=c/d eiπ+1=0F=maδ iγ⋅δΨ=mΨ S=0 E=hνPV=nRT ν=Η0δ I=V/R S = k(logW) C=Blog2(1+S/N) E=mc2
  9. 9. Principle Impediment - Hospital Based Systems Some CPOE Implementations Have Initially Decreased Provider Efficiency 20-40%Last Yr Avg Decrease in Cardiology Medicare Revenues approx 20-25% Without CPOE
  10. 10. Solutions To ImpedimentsTotal Commitment From Hospital Management TeamPre-deployment Buy-In From ‘Principle Hitter(s)’Pre-deployment Process Analysis and Re-engineeringEngineering ‘No-Way Back’Effective and Persuasive (Local) Physician ChampionIntensive/Responsive Pre- & Post-deployment Help DeskDetailed Daily Visibility - Sr Managements ‘Dashboard’Defeat ‘Success Has a Thousand Fathers, Failure Dies AnOrphan’ - Accountability
  11. 11. SolutionsCommitment (Sr Management)Buy-In (‘Big-Hitters’)Process Re-engineeringNo Way Back (Succeed or Die)Champion (Local Leader Is Best)Responsive (Help Desk)Visibility (Sr Management Dashboard)Accountability (Somebodies Head on the Block)