by Ransom Parker

There were few surprises when on June 16, 2009 the HIT Policy Committee released its initial recommendations for the definition of “meaningful use” of EHRs. While the recommendations are far from final, the “holy grail” remains intact at the policy level. We are reminded once again of the dramatic changes that are coming.

Consider a short list of what lies ahead. Deployment and adoption of EHRs. ICD-10 conversion. Revenue cycle management re-engineering. Pay-for-Performance reimbursement based on outcomes and quality. Bundled payment into a single rate (if not single payer). Personal health records. Health Information Exchanges (HIEs).

Business as usual has become a faded memory. On all fronts – providers, payers, users, consumers and vendors – there are more unknowns than knowns.

While we may be unable to specify what we will do, we may be able to decide how we will do it. Sounds a bit anachronistic? Maybe not.

For those in the world of emerging growth companies, unsettled environments are the rule, not the exception. Those brave entrepreneurs, who live on the razor’s edge of the early stage precipice, immerse themselves daily in unknowns, imperfect information, limited resources, critical timelines, ill-defined requirements, and unproven technology solutions. Not all of us have been born with entrepreneurial DNA (if such nucleotide strings have ever been isolated in the first place), but we can learn from those who have. For our purposes, why entrepreneurs do what they do is less important than how they do it.

By the way, these lessons can be learned by all HIT stakeholders – providers, payers, users, consumers, and vendors.

So…how do entrepreneurs do what they do?

  1. Focus on the Customer – they know that new software applications and services will succeed only if these are designed with the end user as the focal point. They find an informed and articulate user and “live” with him/her before writing a line of code. They know the user’s environment as well as their own.
  2. Understand the Whole Picture – they understand the challenges and constraints within which the end user operates. They know the total situation. They recognize that external factors will shape user needs, but not necessarily define them. They allow the user to interpret external factors rather than defining them for him/her.
  3. Attend to the Details – they avoid any temptation to gravitate toward the big picture. They keep asking questions and listening for the micros. They know that a macro solution will only be as successful as the sum of its component parts. They design and build from the bottom up, not from the top down.
  4. Apply Passionate Persistence – they recognize at the outset that things will not go according to plan. While they define contingencies up front, they understand that no amount of planning will account for all of the variables. When the unforeseen occurs, they know that passionate persistence will be critical to overcoming the inevitable disappointments ahead.
  5. Work with Urgency – they focus on action with a need for speed. When all else fails they do something. They recognize that overcoming roadblocks requires analysis and understanding, but they never underestimate the role that action plays in diagnosing and treating a problem.
  6. Tolerate Risks – they know what they are getting into and are realistic about the degree of risk that they can take. They know that, regardless of their operating environment, they will be constrained by limited time and resources. They maximize their use of both, always have a viable Plan B, and never hesitate to convert to it.
  7. Exhibit Self-Confidence – they constantly remind themselves and their teams that they are well suited to act entrepreneurially. They control what they can control with enthusiasm and confidence. As they make incremental progress, their confidence is reinforced. They know that new solutions will not be built in a day. They act Obama-like in their self-confidence, but they remember points 1, 2 and 3.
  8. Remain Calm – they understand that their road ahead will produce failure and frustration. They forecast this and prepare for it. They avoid the temptation to allow their emotions to prevail. If they focus on their customer, understand the whole picture, attend to the details, work with passion, persistence and urgency, measure their risks and remain self-confident, then they do not have time or capacity for anger or frustration.

Information is imperfect. Resources are limited. Time is short. Requirements are not defined. Solutions are unproven. What a terrific opportunity to become ENTREPRENEURIAL!

About the Author

Ransom Parker has been a senior executive with leading health care information technology companies TDS (Eclipsys), SMS (Siemens AG) and Compucare (QuadraMed). He has also worked as a venture capital investor and director in emerging software, communications and microelectronics companies. He has extensive experience in strategic planning, sales and business development, software development and implementation, equity / debt transactions and exit planning / execution.

To  contact Ransom Parker, email  or call (703) 629-1460.


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