Egg on My Beard: I Confess
In the Catholic Church it is the confessional booth. In the Twelve Step program it is the 9th step, “making amends”. I guess there are a lot of ways to apologize and ask for forgiveness. Maybe it is good for the soul to own up and accept responsibility when you have wronged someone. I call it egg on my beard.
In another lifetime I was a Project Manager for one of the largest pre-ARRA EHR vendors. It was my job to manage implementation projects for medical practices. The sales staff would make the sale, get the contract, and then it would be turned over to me to find the resources to implement the transition to an EHR. In the majority of the cases the medical practices were not qualified to negotiate a proper EHR contract and so they were at a distinct disadvantage. It was my job to deliver any bad news. I once had to tell a physician that the lab interface they were expecting would cost an additional $10,000. The corporate goal was to get a practice to “Go Live” as soon as possible, as that was when billing could begin. Did I mention that the corporation was looking to be bought out? That brought increased pressure to book as many sales as possible to drive the valuation of the company. Of course we all drank the Kool-Aid and repeated the mantra, “The customer always comes first”. In truth, although this was one of the better vendors, the upper management (with one notable exception) knew there was gold at the end of the rainbow. This would be the second cash out for many of them. They were licking their chops.
A full load for a Project Manager was considered 12 practices. Each practice was between 4 and 20 providers. That is a lot of projects to manage. Lots of change management and hardware/software issues and lab interfaces and training. Let’s not kid ourselves. Going from paper to electronic health records is probably the most difficult thing a practice will ever experience. I started with 12 projects and was soon managing 18. We didn’t have enough trainers so we were sending in people with no clinical or workflow background that only had 3 months of training on the software. Excuse me, we weren’t doing that. I was. As sales escalated I was managing 25 separate projects and starting to cut corners. I began making decisions not based on what I knew was best for the people who were buying our software or the patients they were taking care. I made a pact with the devil and told myself that I was just part of the process and it was bigger than me. I knew what I was doing was not justifiable by any means. I was just trying to keep my head above water.
The buyout took place and management made a phenomenal amount of money. I don’t remember if the physicians who bought our software got any of it. I doubt it, nobody thought too much about them. We were in business, not health care. Well, the company that swallowed us was a public corporation so they were focused on quarterly earnings. Immediately the memos started to filter down with phrases like “book as many billable training hours as possible before the end of the month”. That last memo was the final straw. There was no longer any pretext about what the real priorities were. I submitted my resignation the next day and vowed to never commit theses sins again.
OK, here comes the apology. I’m sorry for every time I took the company’s side against a “problem client” when I knew it was our fault. I’m sorry when I sent inexperienced trainers to teach a cardiology practice how to use our complicated software. I’m sorry for all the times I looked a client in the eye and pledged I would work to resolve a problem when I knew it would never be fixed. I’m sorry I didn’t stand up to management and in a loud and clear voice say that our sales team was misleading clients.
I still work on EHR implementations from time to time but not on any project where the provider does not come first. In the last 5 years I have worked closely with over 135 HIT vendors on their strategic initiatives. Many of these vendors have renewed my faith in the industry. It is possible to be a profitable business and deliver elegant documentation tools for health care delivery. My hat is off to those who everyday do what I was unable to during that dark part of my career, put the physician first. I promise I’ll never make this mistake again. Lessons learned? Well, I guess a few basic ones. Tell the truth even if it is hard. Don’t over promise. Stand up to the Big Boys, especially when they are wrong and Justice and the American Way are on your side.
One final quote from John Lennon, “Don’t do what I have done”. Amen.
Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.