Talking lean management and EMRs with Simpler's Mike Chamberlain

Mike Chamberlain is the General Manager of Simpler Healthcare and President of Simple North America, which services 75 health care provider networks. He has had hands on involvement with the executives of a number of organizations--including Denver Health, Christus St. Vincent Regional Medical Center, Joint Commission Resources, and ThedaCare--all of which have seen meaningful improvements across their enterprise since working with his "lean" transformation team. FierceHealthcare talked to Chamberlain about how the "lean" concept has been applied to healthcare, specifically with electronic medical records, and the future of EMRs as a whole.

FH: Please briefly describe what your company does and the "lean" concept again.

MC: [To give you a little background on Simpler] we started back in 1996, and the idea was how to apply the Simpler business system--which was modeled after the Toyota production system [1]--and we started out in manufacturing....In 2003, we started to get some pull and we identified the need to help healthcare. And so we launched our service line of Simpler Healthcare under the premise that Simpler business system could transform the way in which patients receive care. The premise...is that you can apply tools, techniques and principles to generate breakthrough improvement to enable the true potential of business processes to be realized. So, in essence, it's a way to streamline the way in which patients, information [and] materials move through a healthcare system.

FH: How has that methodology been specifically applied in terms of electronic medical records in the last few years?

MC: Obviously there's been a lot more emphasis on [EMRs] over the last few years, but the challenging part of those is that they overlap on top of bad processes. So in essence, what ends up happening is, if you spend a tremendous amount of money to move information through a system, but the information is broken, it's very redundant [and] it's layered with waste. All the EMR system is doing is, first of all, adding another layer of waste to that, and it's not enabling improved patient flow, improved quality [or] improved outcomes.

So what Simpler has done is, we've worked with these EMR vendors and the hospital systems and said "OK, before we overlay this, and just create another layer of waste, what processes do we need to simplify so that when we lay it over, it becomes more of an enabler and a tool to ensure that we can follow the new processes and it becomes a positive, as opposed to just another additional burden." So our time, whether it be Denver Health, or New York Health and Hospitals--the various clients that we've helped with EMR--it's all been about identifying the proper information and patient and material flows up front, so that once significant waste is removed from the system, then a much less expensive and easier rolled-out EMR system can be applied.

FH: What sorts of waste have you encountered in your work?

MC: Well, in terms of healthcare, none of the departments are linked. So if I'm in the ED, and perhaps I get admitted and then later I go to surgery, those systems don't talk to each other and they're not very well integrated. So the patient sees a tremendous amount of moves, they don't see something that benefits, necessarily, their needs, but each department is set up to function on it's own, as opposed to for the long-term care of getting the patient out as quickly as possible for the lowest cost and the highest quality. So that's the biggest gap that is within healthcare: It's not centered around the patient, it's by department.

The other issue is obviously the tremendous amount of waste associated with the infrastructure within the organization and maybe some additional waste that's been layered on them in terms of what they're allowed to do to improve. They've not used a lot of their people to help transform healthcare. It's been maybe some other projects or initiatives, as opposed to using the people, and their human capital to improve the business. That's an altruistic statement, but now healthcare is just starting to use those professionals to help transform and change the processes.

FH: How tough is it for you to go into a situation that doesn't have any sort of EMR system at all, as opposed to a situation that already has at least some sort of process in place?

MC: Honestly, in some cases it's easier. In some cases it's easier because they don't have a system in place that's impeding them from improving [2]. For example, during admin, sometimes an electronic system is so cumbersome and it takes so long, then it itself is redundant. Then, that's no better than a paper system. I would say that's one of the fallacies that healthcare has made, is assuming that if you put an EMR system in place--if there's one within a healthcare organization--that it will deliver better patient safety and quality than one without it.

FH: In a commentary in FierceEMR entitled "Another reminder: EMRs alone are no cure [3]," Neil Versel uses a quote by Dr. Peter Gabriel from the University of Pennsylvania Health System in which Gabriel states: "The focus on IT in healthcare is a good thing, but there's way too much hype about it and misunderstanding about what the benefits will be and how quickly they will come." Based on that, what else do you think needs to be done in terms of EMRs?

MC: Well first of all, I agree with him. I think if you have a tremendous amount of money say, from the stimulus package, clearly where I would like to see that money spent is helping organizations improve the way they deliver healthcare. That can be done with a portion of that. And then, organizations that truly start to deliver better outcomes--you know, their mortality rates are going way down, their timeliness and their access is greatly improving--when they start to see the indicators move in a positive way, and then they realize that EMR will take them to the next level, that's where money on IT should be spent.

But, it has been proven that to suggest that EMR is the magic bullet for improve healthcare is false. Because again, it assumes that it'll do one of two things: It'll either just sit there and it will continue to let bad processes feed bad information and you won't see improved outcomes; or it will make it worse. It will become so structured that it will force the processes around the system, and then when it's time to make true improvement, we will use the EMR as an excuse for why we can't change things...I see that all the time where, everybody puts the system in for what we believe will create standardization, and in fact it does the opposite. What it does is, it exacerbates all of the broken processes; and then we spend so much of our time getting people wired around the EMR system, that we forget on the larger outcomes and patient safety goals.

Just a little bit more context, as a manufacturing example, EMR today is what [Enterprise Resource Planning] systems and [Manufacturing Resource Planning] systems were in manufacturing, where those people thought [ERP] was the silver bullet. And they put them in place, and all it did was force all these additional transaction steps in these things. But they wanted to improve the processes and streamline them, but they were unable to do so because, for that IT system to work effectively, it needed all these additional transactions that were put in place. So the implementers, they were saying, "Well, your people just aren't disciplined," and the people were saying, "There's no reason for me to have to do this five times; I've already told you one time that it's right." So, there is that clash, and you're going to see the same thing if you fast forward the EMR discussions; in two or three years you're going to see a tremendous amount of money spent, and you're not going to see a delta in cost quality or delivery.

FH: In that same commentary, Neil Versel concludes by saying: "The popular $19.2 billion figure associated with the health IT stimulus actually is a net figure, based on expected efficiency gains from closer to $32 billion in gross federal outlays. Only if everything works as expected will the lower amount appear on the federal balance sheet. Otherwise, taxpayers will be on the hook for so much more money. The message is simple: Don't screw it up." Would you agree with that statement?

MC: All I know is, most EMRs, they run so far over budget because the money is not on the implementation, it's on the maintenance. And when you're trying to maintain something in a fluid, dynamic changing organization, the maintenance goes up. If they were just to table some of that funding until they'd improve some of the processes, I think you'd see the total costs go way down. Or [if they were to] shove some of the funding toward improvement, I think you'd see a tremendous net gain. I can't even speak to what the numbers are; I just don't buy the fact that if we spend $19 billion or $20 billion or $30 billion that we're going to see the changes that we want across healthcare when that's not the root cause of why we have problems in healthcare.