by Paul Roemer

I built a deck one day simply because I wanted to build it. I called Home Depot, told them what I thought I needed, and the next day they delivered the necessary supplies to my house. Twelve hours later, I had an 800 foot multi-level deck with a railing and benches. Prior to that day, I'd never built anything. I had no plan, just and idea. I got lucky.

Several years later, my friends and I climbed two 19,000 ft. volcanoes in Mexico. We had a detailed plan, talked to people who'd climbed them, read about the climbs, practiced climbing on glaciers, and practiced using crampons, ice axes, and ropes. We even spoke with a doctor about how to deal with some of the health dangers we might encounter. Good thing: We almost died from pulmonary edema. Had we not planned, we would have died.

I've been thinking a lot about why projects fail. My most demonstrable failures can be traced back to two things: a lack of leadership and a lack of planning. Planning doesn't guarantee success, but I like my odds a whole lot better with it than without it.

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When it comes to planning your EHR strategy, your best bet is to take it slow. You don't need to be in a hurry. ARRA will not dry up and blow away. No matter when you start, you will be done well before there are a single set of standards and before anybody can even spell 'interoperability.'

How long can you plan? At least as long as it'll take you to redo the project--plan on at least six months. What's in the plan? By the way, this is a deliverable, it will be written, evaluated, rewritten. Build your requirements for your team. Build a PMO. Define the business problem you hope to solve with an EHR system. Define your unique business requirements. Put handcuffs on any renegade part of the organization thinking about implementing their own system.

Develop a request for proposal (RFP)-plan on making this part of your agreement with your vendor. Tell vendors that to win the bid they must state that their solution will pass any test of Meaningful Use. Create a list of possible vendors. Issue and score the RFP. Check vendor references. Make site visits. Use the services of a brilliant healthcare software attorney--you will need what they can do for you.

Create an implementation plan. And to run concurrent to that, create a change management plan, as well as one for work flow improvement and one for training.

And if there are any crayons left in your box, you may want to figure out what it would take to get rid of all the duplicative departments like IT, HR, payroll, and registration.

If you take all of these steps, can I guarantee you will succeed? Of course not. But if you don't take these steps, you will likely fail.

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.