Why Cats (and EMR Consultants) Don't Bark

In a previous post (link here), I discussed EMR consultants, emphasizing the following quote from Mr. HIStalk (link here):

Name the consultant and I'll tell you with 80% accuracy which product they'll recommend even before they bill the first phone call, although that's offset by the 50% of hospitals that ignore the advice they're paying for anyway.

I have been asked why healthcare executives pay very high prices to name-brand EMR consultants for such little value and why, in turn, the consultants do not feel compelled to provide a higher level of services to the hospital executives that engage them. In other words, why pay good money when the recommendations are totally predictable or ignored. The answer to this question is similar to the question of why cats don't bark. It is not in their nature to do so and it is not in the nature of EMR consultants to behave otherwise.

HIT consultants do, in fact, deliver substantial value to health system executive but it has little to do with recommending the most suitable EMR for the health system. It is the "nature" of EMR consultants to seek two goals: (1) to reproduce themselves; and (2) to generate new consulting contracts and more revenue. EMR consulting firms have an informal working relationship with a particular vendor and will pick that vendor perhaps 80% of the time, as observed by Mr. HIStalk. This avoids the nuisance of having to learn the details about a new system. The vendor, in turn, will steer potential clients to their favored consulting firm, knowing the positive bias of the firm.

All EMR consultants and hospital executive know that at least three-quarters of all installed EMRs will underperform or fail. The "value" delivered by the consulting firm for the hospital executives is an insurance policy -- the health system executives will have someone to blame when the installed systems perform poorly. It is then imperative for the consulting firm, when singled out as the cause of the problem, to deflect blame from themselves to some other person or group. Here is the list of the four prime candidates to blame:

1. Hospital physicians and nurses who have proven to be untrainable on what is obviously an excellent EMR that has been road-tested in multiple other hospitals. This excuse can backfire and should be used with caution because physicians and nurses can bite back. Here is the appropriate statement that can be whispered to the hospital board members: "Our physicians and nurses dropped the ball on this one because they were so busy delivering quality care."
2. The healthcare system CIO or one of his/her major lieutenants, but only if that person is known to be incompetent and/or deeply wounded politically. In this case, the CEO needs an excuse to fire the CIO and owes some later favor to the consulting firm. If the CIO is fired, the consulting firm will immediately hire him or her in order to have someone on the team who has actually worked in a healthcare setting.
3. The EMR vendor, but only if the failure is one in a series that have received major publicity and another favored vendor has already been lined up. This is clearly not a favored option because the new system needs to be learned and this takes time.
4. The healthcare system technical personnel. Having floated this excuse, the consultant then launches into a highly technical critique about hardware and arcane system architecture until told to sit down. This discussion frequently leads to a proposal from the consulting firm to manage the hospital IT department on an outsourced basis.

Comments

[Johnson Clift]

The best emr and medical billing software in my opinion is from AllegianceMD. We love it. We haven't had any problems, we have been using it for years.

[Shelley Sturgis]

When physicians have "informal working relationships" with outside consultants and vendors it's considered unethical or in some cases, illegal. But it's okay for consultants and vendors to work together? Yet another example of how doctors and hospitals are victims of a double standard.