Guerra On Healthcare: Gathering Support For Your EMR

I thought it was the rest of the C-suite and board you had to convince when trying to get approval for large, capital-intensive projects like an electronic medical record (EMR) system. I thought you could construct a short list of those who had to be brought on board, and then go lobby them for support.

While it's true that board members and top executives must buy in for you to get any buying power, an interview I did with David Kempson -- VP & CIO at Maricopa Integrated Health System in Phoenix -- made me realize your list of necessary supporters is far larger than I had previously understood, and your efforts to garner sufficient backing far more complex.

Kempson said CIOs looking to win approval for enterprise-type projects, such as those involving EMRs and associated advanced clinical IT systems, must cast a wide net when building support, more akin to a political election than a system selection. That's because for every fiscal year, there's a finite amount of discretionary dollars to be spent, a clearly defined and delimited pie. If IT wants $10 million or so this year -- perhaps even for the next few years -- that money has to come from somewhere. IT's increased piece means someone else goes malnourished.

"May I have more, sir?" they ask with Dickensian sadness when confronted with the bad budgetary news. You, of course, are the reason they are told, "No!"

Kempson's point is that you had better convince these nascent Oliver Twists that, not only is accepting decreased rations good for the organization, but also somehow directly good for them. You had better demonstrate to those individuals how the system will help them do a better job. Neglecting this step, he said, will likely erode support among those you had considered key backers.

"I'm sorry, it's just going to cause too much pain throughout the rest of the organization. We had no idea but, in the last few weeks, I've had at least 10 clinical and administrative executives tell me they cannot live with the cuts we've got to make to buy your EMR," the CEO tells you. "And let's not talk about incentive dollars, because we ran the numbers, and it's not even going to cover . . ."

"But it's not my EMR . . .", you retort.

I think you know how the rest of the conversation goes. But it doesn't have to go this way, not with Kempson's advice. Rather than focusing only on higher-ups, think of your project's approval as a Senate vote. If you were a Senator, you would need to convince a whole lot of people to jump on board -- possibly doing some horse trading along the way -- to get your bill passed. So the first step is to expand your list of those whose support you need for ultimate project approval, probably tripling or quadrupling it. Put a check box next to each name to record their likely vote and add some notes describing your efforts to bring them around. When you're comfortable with the level of support, make your pitch to the other C-suiters.

This will give you two advantages. First off, you'll be able to cite existing support among the staff, rather than having the CEO suggest you ascertain it. Secondly, you'll have laid much of the groundwork needed for proper system selection because key participants have already been engaged. Since they've already supported your funding by accepting their own reduction, why wouldn't they want to help you pick the system they'll eventually be using?

It's been said over and over that you need to include clinicians in system selection, but what Kempson made clear is you need to engage them (and many more individuals) before you even attempt to win budgetary approval for the systems you'll eventually ask them to help you select. This is truly Step 1 in the long process that could result in your organization becoming a meaningful user of health IT. Do it right, and you'll be on solid ground for the rest of the journey.

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Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].