Zombie ECM

ECM: not alive and not dead, walking towards sounds and smells. On autopilot to get to the next big event. What do you have with information management that does not have adequate quality? You have zombie ECM systems marching toward something.

We like to think this something is for the greater good. A place where healthcare can find their data and get paid, where financial institutions can store their signatures, where pharma can follow the regulations. Without more information quality checks and balances, this greater good looks more like zombie land where we only do what the standards and regulations say, nothing more. We trudge along and wait for the next upgrade, for the next event, the next big thing.

Does everyone feel that they are doing the best quality work on implementing their systems? What would be a better way of designing ECM? How can you improve on how your process works, how solutions get implemented? Why doesn't Gartner have an info quality quadrant their ECM leaders?

“One Patient, One Record”

This healthcare IT tagline has been around for a while. Software vendors and healthcare provider IT groups, touting this slogan, are definitely aware that it over simplifies a patient’s information trail. There are many unknowns that could splinter that “one record” goal. For example, what if a patient goes to a different hospital? What if the patient’s insurance changes, what if any number of issues could happen to the many systems used to keep track of a patient’s registration, appointments, orders, results, ED visits, discharges, etc.

Patient is a person not a chip

Patients being human can inadvertently cause havoc on their own information. It could be as easy as changing your baby’s name or moving to a different healthcare provider. The information that follows the patient me get split into two separate buckets, orphaned by glitches in the systems. Regional information exchanges can help, but typically do not house all of a patient’s record, only the current, actionable data. What happens when patients move and then return to the same hospital years later? I can tell you that merging patient information can be very tricky.

Release of Information—can you be specific?

When a patient requests all of their health record data, do you really think all of it is collected? If so, how is this verified? Are there any regulations that state this type of request has to be complied with fully? Essentially, the patient has to fill out a form and select which information he/she wants, with an “other” line for her to fill out. This could leave many documents behind because the patient has no idea how many types of documents are in a healthcare ECM system: hundreds, if not thousands.

Every Visit to the Doctor’s Office

Every visit to a provider generates thousands of records. There is the registration which gathers insurance information, signatures for consent, appointments. There’s the nurse who enters current information about allergies, weight, body temperature, blood pressure, etc. He may or may not have paper forms as well for the doctor. The doctor opens another form on the computer, shows test results maybe, enters in clinical notes, writes a script, enters in a diagnosis code, and so on. Many of these entries are split up and branch to other systems for further processing.

From One Record to Many

A patient’s healthcare record will never be “one” record, it will always be a tree of information, or many trees of information, connected by one or many medical record numbers. A regional exchange will hopefully help to cull a patient’s information trees together. Maybe a national register would help as well, but this is way in the future. Sharing health information transparently would lower healthcare costs, however it would lower profits, so there will be lots of feet dragging before “One” record is achieved…

Hallway Chat Projects

With all of our productivity tools we use to communicate and make decisions on projects, hallway conversions can still drive the everyday decisions and information sharing. The problem is that there’s no way to forward a decision or share information beyond the folks that have the conversation.

Sometimes the conversation is summarized, but usually it turns into action and surprises other team members. It’s the surprise that is a sign that the vehicles of communication of a large company are still not being used. The small company mentality is still there.

Small businesses that grow to large ones slowly have this issue more than ones that grow quickly. The slow growth makes it possible for the relationships and behaviors to stay the way they were without too much change. Fast growth usually brings in MBAs who have learned the structure and designs of past organizations that have “worked”. The case study of fast growth breaks up the old patterns of hallway communications.

So, applying this to IT projects and large project communication, you can experience the symptoms of this hallway phenomenon as the tasks progress beyond the planning stage. When the doers are engaged in the discussions, the scope of the project is usually torn apart. The hallway decisions are fast and furious. The project starts with members shaking their heads. The more experienced team members follow along, but secretly see the gaps. If they speak up, the project manager, who by this time has had a hallway agreement on the deadline, overrides their concerns and pledges to consider them.

The final result of hallway projects is that the project manager moves onto to a new position. The implementation of the project is done, but the fixes and stabilization are painful and disruptive.