My First Year as a Consultant – What I have Learned

It has now been over a year since I became a consultant. I have learned many, many things and met some amazing people. I thought I would share some of the things that I have learned.

What was the hardest part of becoming a Consultant?

In past roles, I had direct reports and responsibilities of deliverables and operations. I had authority to make decisions, within my defined scope of control. So, I would make decisions, and instruct people to act. As a consultant, you provide recommendations. You use words like “I have observed…” and “According to my evaluation…” and “It is my recommendation…”. It was not really all that hard to make the shift, but changing any habit takes work.

To be honest, becoming a consultant was never a dream of mine. What attracted me to it was the variety of interactions and the opportunity to work on interesting projects. And getting to choose who I worked with. I have been really lucky to work with some great people at my clients, so I am enjoying it quite a bit.

Why Hire a Consultant?

I have found three main reasons people engage a consultant.

Capability

They lack some important skill set in their organization for some short term project. An example is preparing and managing an effective RFP process.

Capacity

Staff is too busy with the day-to-day operations to take on the work of an additional project.

Neutrality

There is a perception of bias among some stakeholders and they need an independent analysis and recommendation.

My Advice

Clients come to me with a wide variety of problems, but my overarching advice is usually the same. You need 3 things: To know (honestly and accurately) where you are; To know where you want/need to be, and; The right amount of talent to get there.

The first item can often be the hardest as our perceptions can skew our reality. The second requires some vision and input and collaboration from lots of viewpoints. The last sounds hard, but it is actually the easiest of the three. You just need the will to seek the talent and to commit the resources to getting it. If the first two steps are done right, the necessity of investing the resources is usually pretty obvious.

The first step to change is admitting that you can’t stay where you are.

Imaging Informatics Knowledge

I have found that there are a number of people that are skilled in HL7 integration (though still not enough to complete all the interfaces needed fast enough), but the level of knowledge in DICOM and IHE is less than I expected. A lot of problems can be solved if one understands the purpose of the information models and transactions that DICOM and IHE have built. The importance of ongoing learning in this area, such as by being a SIIM member and getting involved in that community, is more important than ever.

What is the best PACS (or VNA, or Enterprise Viewer, or other product)?

I get asked this all the time. The answer is always “it depends”. And, I am not trying to use consultant-speak, but it really depends on what you are try to achieve. If there was a one “best” vehicle for everyone, we would all be driving (or flying) it. Different products have their strengths and weaknesses. If you know your business goals, you can define requirements, and then assess the product (and vendor) as to the fit to your needs. Coming up with methods to verify vendor claims, and validate that the value claimed will be realized in your environment, is another important step in the process. The key is designing the right level of “test” (which will have a cost) for the level of risk that the capability represents.

In Closing

I actually learned a lot more than what I listed here, and am happy to share everything I ever learn …with my clients. 🙂 I will post a similar summary after Year Two and see what wisdom another year brings.

Imaging 3.0 at ACR Annual Imaging Informatics Summit

Quote: “If you don’t like change, you are going to like irrelevance even less.”

Dr. Bibb Allen talking about the importance of accepting change to the practice of Radiology, explained the rationale behind the American College of Radiology’s Imaging 3.0 framework.

Imaging 3.0 - Dr. Bibb Allen

Articles: EHR Stress

The benefits will come, but we must get through the change and this will be painful. Think of the shift from film to filmless, and paper to paperless (with coded, structured records) is this, times a thousand.

SIIM Blog: Part 2 – Organizing Concepts to Focus Learning Efforts

Part 2 of 2 of a SIIM blog post. Enjoy.

I have been discussing what it would take to create a “check list” of sorts (a scorecard?) to assess ones facility’s capabilities and strategies along the proposed themes listed. Would be fun to work on, but would need lots of help from people with bigger brains than mine. Stay tuned for a bonus Part 3, maybe? 🙂

P.S. Part 1 is here.

Survey: Doc dissatisfaction with EHRs grows

I enjoy articles like this because so much focus is on the expected benefits of healthcare IT, but as the old marketing tale goes, sometimes ‘the dogs just don’t like the dogfood’. If users won’t use the tools, the outcomes won’t be realized. As is often the case with products, the specialist is not well understood or served. The same applies for imaging consumers–the average imaging consumer using an EHR is quite different than the specialist that needs advanced visualization, navigation and measurement tools. Niche vendors will attempt to fill the gaps.

Most EHR user interfaces resemble an electronic filing cabinet, organizing information by type or service / organizational unit that created the data. Vendors could learn a lot from the design of social networking platforms, which are quite adept at coordinating activities in complex interactions among disparate users.

Article: How Not to Engage Patients in Stage 2

Some interesting observations in this article. We always need to consider the right moment to get users (patients, in this case) to engage when rolling out a new program and trying to get adoption. It can be the right application with the right value to the right people, but presented to them at the wrong time.