"When I think of myself," Spain explains, "I think of myself as being like all other physicians in terms of thought processes. We're all trained to think a certain way: it's like the Navy SEALs with their training. Conceptually, I know I'm different, but don't really understand how."
Just being different, however, wasn't enough. "As I became increasingly responsible in terms of the leadership involved in my job, I came to be aware that my 'Navy SEALs' training wasn't adequate," says Spain. "I realized I needed another language. So they sent me to business school, and I got an MBA. On the first day, they asked us all, in a special course for physicians, to describe ourselves in one word. And I'm the only one who said 'visionary.â€™â€
When the opportunity arose to create a heart hospital in Tulsa, Spain led the charge, bringing his colleagues together to embrace the all-digital concept and to build the new hospital, which opened in April 2004. What makes this story different even from the numerous specialist-led specialty hospital openings of the past 10 years is that Spain, seeing the need for IT innovation, partnered with Chalfont St. Giles, U.K.-based GE Healthcare.
Paperless in Tulsa
The union turned St. Francis Heart Hospital into a showcase for clinical IT progress, as the facility was paperless from day one. The physicians practicing there and at the paperless Cardiology of Tulsa work in a totally automated environment, but Spain, who has been in practice since 1988 (with a three-year break from 1997-2000, when he was a hospital administrator), says acceptance of technology has only come over time.
Asked why resistance to IT advancement has historically been so strong in the medical community, Spain says that the very qualities that make good clinicians tend to work against their embracing information technology.
The fact is, he says, "Doctors don't play well together, and they don't make good team members. They're trained and bred so that if you walk into the room and someone says, 'Doctor, you have 30 seconds to make a decision or somebody dies,' no one calls for a committee meeting."
But that same fierce autonomy, as well as the scientific skepticism, inhibits the embracing of innovative information technologies, Spain reflects. This is especially true, he says, when such an embrace requires accepting some degree of group-think and of openness to untried solutions.
This brings up a line of questioning to which he is frequently subjected, Spain says. "People say to me all the time, with regard to the progress we've made, 'Well, your guys like computers!' And I say, 'What are you talking about? They're just like everyone else.â€™â€
In fact, when he first pushed to automate Cardiology of Tulsa, Spain says, he faced the same kind of opposition every IT leader faces in healthcare.
In the fall of 2000, shortly after he had taken the helm of the group practice, Spain recalls, "I was having a discussion with the docs, and I said, 'For the amount of money you're willing to spend, I can achieve 1 percent downtime for you. For billions of dollars, I can achieve 0 percent downtime.' And one of the doctors challenged me. He said, 'I cannot live in a world where I can't see the patient record.' So I challenged him with regard to downtime in the paper world. It turned out that 60 percent of the time, the paper records he needed were locked up in another building down the street."
Doctors simply have an unrealistic attitude toward electronic patient records in comparison with the actual performance of paper records, he says. At that point, he recalls, "The light bulb came on" over that doctor's head. The good news is that, "access to data, for doctors, is like heroin. Once you get them hooked, you can never get them off it."
The secret to his success
But if there is a single key to the IT success that Cardiology of Tulsa and St. Francis Heart Hospital have enjoyed, Spain says it lies in the experience of failure.
Before his time-out as a hospital administrator, Spain tried to help Cardiology of Tulsa automate during the 1995-1997 time period, but the solutions available at that time were "very primitive," he recalls, and the group practice had put no organizational preparation in place for automation. "We failed miserably; there was no planning involved."
But after his return from hospital administration in the summer of 2000, he says, "I came back, and my colleagues said, gee, now that you're back, would you like to dust this thing off?"
Spain himself had also learned some operational lessons from IT-related initiatives on the hospital side, including a "terrible" experience with a system-wide implementation.
"Having been involved," he now recalls, "I said, I can do this now. And I had enough leadership capital to get over the hump" of initial implementation challenges. "And we laid out a plan with very detailed costs, and performed on schedule, to the day."
As a result, when Spain and his colleagues decided to build their own hospital, there was a natural consensus that the new facility would have to be paperless from the outset.The Second Time Around
Spain says that three years after first trying to go digital at Cardiology of Tulsa, some advances in technology made the second time a charm in 2000.
Memory and storage costs had become affordable.
Network systems had become more robust.
High-speed scanning had arrived on the scene.
Core ambulatory care products were simply better.
Things are going well, Spain says, and in fact, Cardiology of Tulsa has become "the knowledge base developer for cardiology" for Horsham, Pa.-based NextGen Healthcare Information Systems. "We just evolved into that," he explains.
But, advantageously, "It's really letting us have an impact now on some national data standards, because whatever we develop, a lot of people will be using. Between that and community health portals and RHIOs (regional health information organizations), we're trying to get to the next level of influence. We just recognize that there's an opportunity nationally to have an impact."Mark Hagland is a contributing writer based in Chicago.