I recently bought a wireless printer for our home.

Without the swelling music and creepy shadow lighting that Hollywood gives us in the movies, you might miss that my first sentence is the opening for a horror movie.

But like a good Hitchcock flick, this story opens in an ominous fashion that has you gripping the arms of your chair.  Something bad is about to happen.

‘It is easy, piece of cake,’ said the nerdy dude at the computer store.  Just take this home, fire it up, follow the instructions on screen, and you’ll be printing from anywhere in the house in minutes.

I don’t know how big my pupils can dilate, but I am sure the look of terror on my face would have scared small children.  I carried my box out of the store as if I had a big cobra in a cage.

During dinner with the family, I was a little distracted, worried about what was waiting on me in the trunk of my car.  You’d have thought I was working for John Gotti and had a body to bury.

When our little one asked if we could play a board game after dinner, I said they would have to start without me, but that I’d be there right away.  ‘Since our printer died, I got a new one today.  It should just take a few minutes for me to set it up for our home computer and Dad’s laptop.’

‘It is easy, piece of cake,’ he said from behind the big glasses and yes, the pocket protector.

Now you should know that just because our company provides deep and complex technical solutions for our clients does not mean that I have a clue.  In fact, our CIO jokes that our help desk team has developed an entire list of special ‘Coan’ problems.  At least I tend to find my way into unique and interesting technical messes.  More than once, one of our IT guys has tilted his head, looked at my screen, looked at me, looked back at the screen, and the muttered, ‘Never seen that before.’

Let’s say I am gifted.

The good news is that when I put the CD in the home computer it fired up as it should.  Then I began to get involved and things started to slide.

I believe I am a reasonably intelligent chap.  Got through school with a couple of degrees, have managed to stay gainfully employed for two and a half decades, and even read The Economist. 

But as I sat and stared at the onscreen instructions, reading them for the third time and trying to decide which button to check for the IP configuration with my wireless router, I started to doubt myself.

Forty-five minutes later, it said we were installed.  I stopped just short of doing one of the NFL end zone dances, maybe because I knew I was not quite done.  And because I knew all the really scary movies make the audience think everything is fine and then suddenly the dead guy’s hand comes shooting out of the grave.  It felt like that type of set-up.

The laptop, evil as it is, further added to the false notion that I had crested the challenge and was now master of my technological universe.  The software loaded automatically and instantly found the new printer all on its own since I had previously connected the printer to the router. 

The strains of a pleasant orchestra piece wafted across the theater and the audience began to relax, relishing in the fact that the hero had slain the zombie.

Then one of my kids went to print something from the home computer.

‘Dad, how come it only will print about four lines and then stops?’

Cue the monster music.

The fact that I am the tech support guy at home tells you that this ineptitude must be genetic.

After I tried about twenty things, most of which had no logical shot at solving the problem, I had about twenty pages that had only partially printed.  The laptop was fine, but the home computer was having some problem that I was now describing in psychological terms because the possible technical cause escaped me.

At this point, I abused my executive privilege and called one of our tech guys at home.  He was pretty new, so I knew he’d be very conscientious and take a late night call from the CEO.  The other folks on the team had not warned him yet.  We logged on to a remote session and I gave him control of my computer.  I watched in fascination for an hour (yes, the board game was long gone and the family had retreated to a movie…thankfully a romantic comedy) as he opened menus and clicked buttons and typed in codes.

After about an hour, he found the problem.  Of course, it was one he had never seen before.  It seems the printer had a proprietary wireless communication protocol that caused the home computer, but not the laptop, to shut down the communication with the router every time it tried to send a file to the printer.  Turns out that is also why I also lost him from the remote connection every time he tried to print.

Who knew?  That was not on the little set-up instructions.

When he explained what it would take to fix it, I thanked him, went to the garage and got the box and started repacking.  I took it back the next day, bought the more expensive printer that he said used the standard protocol.  I wanted to tell the nerdy guy that he said nothing about the potential for configuration conflicts, but he would have told me I would not have understood it even if he had told me, and I would have had to lower my head and shame.  I paid the difference for the new printer and trudged to the car, fully assuming that I would again miss a game of killer Parcheesi.

Fortunately, God answers prayers and industry standards are there for a reason.  In 15 minutes, I had beautiful test print pages, the whole page no less, from both devices and I showed them to my family like a four year old shows off their crayon art.  We did stop short of hanging them on the fridge, but the family was so happy that Dad no longer had that face and furrowed ‘I am dealing with technology’ brow that we did have a group hug.

I am sure that at about this point my marketing manager is reading this and wondering why in the world I thought it would be a good idea to share such a horrific story about technology since we provide technology solutions for our clients.  ‘Note to self – maybe the CEO blog is not such a good idea.’

But there are some lessons from this story that are relevant as physician practices and hospitals rapidly rollout new technology.  And no, not once during the process of trying to get a simple page to print was my frustration soothed with the thought, ‘Well, at least I can use this in a blog posting.’

Obviously, what you buy matters. There are standards for a reason and you ignore them at your peril.  Or in my case, I had no clue they even existed.  But accept this reality in your IT decision making:  Increasingly, everything has to talk to everything else.  Hardware and software have to work together.  Data has to move from one to another.  Deep in the weeds technical stuff like the protocols for exchanging data may make your eyes glaze over, but it matters a lot.

And obviously, cheap isn’t always cheap.  There are three ways you can pay for your technology. 

• You will write checks to third parties. 
• You will spend your own time and the time of your staff. 
• And you will impact your revenue, either positively or negatively. 

I saved $50 on the first printer but more than gave it back with about four hours of my time and an hour interrupting someone else’s evening.  Not so cheap.

That gets to the point that I really want to unpack.  Your decision making, be it for your EHR or the upgrade to you PM so you can submit HIPAA 5010 compliant claims or, Lord help us, ICD-10, needs to be a lot more focused on implementation.

Let’s call it ‘the big I word’ and let’s start talking about it more.

Software matters.  Of course it matters.  That is why we won’t work with anyone but the big boy vendors who have real products that can swim in the deep end of the pool.  And you should not either.  Your business is at stake and that software that is $50 cheaper is more than likely to have its version of my little wireless communication protocol problem.  It just is not worth it.  Besides, the competition in the market has driven prices down to a point where it doesn't matter as much.  You are getting an amazingly robust and sophisticated piece of software for a really good price.  In industry, software as complex as an integrated EHR/PM package from one of the top vendors would cost 10x where it is priced now. 

So yes, buy only good software.  If not, be prepared to give up a lot of Parcheesi time.

But that should be a given by now, and fortunately is increasingly the case.

What matters is implementation and far too often it gets short shrift in the discussion.  Part of the problem is that most of the time the decision making discussion is between the practice and the software vendor.  The practice is generally new to this entire process, and like me, has no idea even what questions to ask.  The software vendor is like my nerdy sales guy, no offense intended to all of my friends who are selling software to docs and hospitals, who is just trying to sell me a printer.  He can’t take the time to ask about my wireless router, the layout of my house, which operating systems are running on all of my devices, and just how well I can translate set-up instructions written by a brainiac engineer.  His boss wants him to move boxes.

Here is the practice, looking at the price of the software and looking at their flat revenue and they start to have heart palpitations.  And then they get to the implementation discussion and immediately the ‘cheaper is better’ alarms go off because the software dude just took all of their money.

Now, the conversation takes a dysfunctional turn, something that psychologists call ‘group think.’  The practice says, ‘Well, we need to keep the implementation costs down.’  And the software seller says, ‘Well sure.  That is why we built these cools videos.  Your staff can just watch online and sort of do this yourself.’  And the practice says, ‘Well sure. We are smart people.  How hard can it be?  You have cool videos.’  And the software seller says, ‘Well sure.  Of course you are smart.  You are buying my software, aren’t you?’  And both nod and agree that the $4.12 that will be spent on implementation will of course result in roaring success, with physicians and staff alike singing the praises of the software vendor for making such a great product and the administrator for making such a brilliant choice.

Implementation gets thrown in at the end of the deal sort of like my nerdy guy sold me a $30 service warranty on my printer that wouldn’t print.

There are about 100 problems with this scenario.

Installing a wireless printer at home is harder than making toast, but even that is not quite on the scale of installing an EHR.

This has nothing to do with being smart.  It has to do with being knowledgeable in a specific domain.  I mean, just because I can explain Maslow’s Hierarchy of Motivation, which I can, does not mean that I can pick the right button in the configuration of my printer.  Clueless is the right term, I believe.  Practices are good at running a medical practice.  That does not mean that by osmosis they magically know how to implement a system of this scale and scope.

Cool videos, which are important by the way and make the training part of implementation more efficient, are only about 0.05% of the implementation.  Knowing what buttons to click to complete a prescription refill request is important, but that is about as close to fully implementing your technology as was my step of plugging in my printer.  Yes, a little light came on when I plugged it in.  Yes, I was delighted.  No, I could not print.

This technology is going to change your practice in every way imaginable.  At least it better.  Otherwise, you’re going to land in that group that says this new technology harmed your productivity.  And once you spend your $44,000 (coming over several years, by the way, so don’t rush out and buy that boat just yet), you’ll have one more thing eroding the financial side of your practice.  You don’t need that.

Please know that it does not have to be this way.  There are real, practicing physicians who are not shilling for anyone who will tell you that their new technology is producing tangible, material, sustainable financial benefits for their practice.  They are billing and collecting more effectively.  They are more productive in seeing patients and thus generating more revenue.  They spend less time after hours charting. But they will all tell you that it is because they took the time and spent the money to do their implementation the right way.  They did think about how to change and improve their workflow.  They did invest to make sure their physicians and staff could really use the system in a productive way.  They did think about implementation as a change process, not a software task.  And they think about implementation as an ongoing, continuous improvement journey.

Of course, we are an implementation firm so this sounds like a big ad for our services.  Sure, we’re glad to help and would love to talk, but I can also point you to practices that successfully did it themselves and accomplished everything described above without the help of someone like us.  But they really committed and really invested.  They did not think that because the software was running and that people could log on that their implementation was over.  It was just starting.

As mentioned above, you can pay for your implementation with cash or time.  Actually, it is a combination of both and some people have more of one or the other, so the approach can vary.  But if you don’t pay with one of those ways, you’ll pay with the third – a negative hit to your income.  I promise you, that is the most expensive form of currency you have.

Here is what is starting to show up across the industry.  Hospitals and physicians are buying software at the speed of heat.  Adoption is finally taking off.  That is good.  But a whole slew of factors are converging to breed implementation disasters.  Certain vendors are now taking reputational hits for their really bad implementations.  Practices are abandoning perfectly good software that was so poorly implemented.  People are really hacked off at their vendor because the software with the cool videos is killing their practice.

This will be a running theme that gets more and more press in the coming months.  But your practice does not have to go down this road. Accept that implementation is at least as important, if not more so, than the software.  Plan and spend, with whichever form of currency you prefer, as if you actually want this technology to positively change your business.  I promise, it will pay off.

Do this little experiment.  Go talk to physicians and hospitals that have been on their technology for a while.  Ask them how they like it. Your sample will break into two groups, one positive and one negative.  You’ll be puzzled because you’ll see the same software vendors represented in both camps.  Then ask about how they approached implementation.  There you will find the variable that separates the good from the bad.

I did not just want my printer to look spiffy on the shelf and have a few flashing lights.  I actually wanted it to be able to print.  Anything else was just a bad horror movie.