by Paul Roemer

Can being an 'early adopter' save your hospital millions of dollars? We both know the answer depends on what you're adopting. Suppose we are discussing the adoption of an idea. Can that be analogous to not adopting another idea? I think it can. Allow me to explain.

Many providers are in the process of making a very expensive, highly complex, and wide-ranging decision regarding their healthcare information technology strategy (HIT) for their electronic healthcare records system (EHR) -- a non-trivial moment, to say the least.

Careers will be made and lost as a result--I'm betting more will be lost. Why? By making a bad choice on the EHR, on how to implement it, and on how to modify your organization.

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I think the choices will be bad not due to a lack of effort, but from lack of understanding the complete issue. Problem is, the part that's lacking is the part that requires clairvoyance. Whew, that was easy!

Defining your requirements does not pass the test of necessity and sufficiency. It's like playing darts while blindfolded. The plan to select, implement, and deploy an EHR must account for a number of risky unknowns, including:

>> How healthcare reform will impact your organization:
>> What constraints will it produce?
>> What demand will it create for new HIT systems?
>> What new major operating processes will result?

When will reform actually be implemented?
>> How will reform be reformed?
>> How will payors, suppliers, and people react to reform?
>> How will you offset a resource shortage of, say, 50 percent?

What will change as a result of:
>> Interoperability
>> Certification
>> Meaningful Use
>> Mergers and acquisitions

We don't know what we don't know. That is not a throw-away line. By definition, we never know what we don't know. However, the downstream success of your EHR will be highly dependent on these unknowns.

So, where does your need to be clairvoyant come into play? One word--flexibility. Every part of your plan must be built with flexibility in mind. What will the system need to do in three years? How will the landscape have changed?

If you aren't convinced your EHR is either flexible or disposable, you'd benefit by rethinking your plan.

Paul Roemer 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.