Too Much, Too Fast? – Physicians and Healthcare IT Mandates For Change
My role and that of most CMOs, CMIOs, and CHIOs (Chief Health Information Officer) often positions us in one way or another as representatives of all practicing physicians. Of late, there has been a loud resurgence of the collective physician voice on the topic of healthcare IT mandates.
In effect it is saying, “too much, too fast, with insufficient regard to sustainability, incentives and penalties.” The recent CMS announcement to delay ICD-10 by one year adds credence to this position.
Further, the most succinct, coherent, and cogent message I have seen to date on this subject is contained in a March 28 letter to HHS. The signatories were 112 critical components of the physician voice including the AMA, many state associations and medical colleges. A copy of that letter is here.
Assembled forcibly, the arguments noted in the letter are deeply based on objective practical issues (time and available talent constraints), economic considerations (revenue, ROI and cash flow), and tech-related issues. Too often, such arguments are wrongfully discussed in an overly simplistic manner that focuses on orienting the user, customization, training, or attempts to standardize beyond what is effective.
The most simplistic of these relates to physicians’ temperament when they are stereotyped as resistant to change or otherwise inappropriately engaged. Understanding this is critical to driving adoption for meaningful use. Let me explain further.
• Community Physicians don’t experience a personal benefit from problem lists and other rigors of MU. The docs like to get things out of EMRs, but generally do not want or perceive a need to put anything into them.
• Hospitalists are a different story for a variety of reasons:
- They are shift workers
- They have different professional standards and workflow, with more patient hand-offs
- They have the higher cognitive burden of intensively ill patients, often with multiple active problems and safety risks
- They maintained problem lists before MU, albeit uncodified and in their progress notes, to facilitate making sure they track all the complexity and not forget anything
• Physicians in academic teaching institutions with attending, fellows, residents, interns, students, and often with multiple services involved in each patient’s care present a whole different set of challenges. The need for coordination and communication between a dozen or more physicians demands tools more akin to MS Outlook, with Inboxes, Tasks, Rules, Shared Calendar views, etc. Therefore, it is resonable to conclude that getting EHRs to work effectively, assuring quality and cost-effective care is, at best, a work in progress and likely will be for years to come.
In my experience, independent of the practice settings, physicians universally share a vision for better care. Only by focusing correctly on physician temperament, and therefore adoption, usability and satisfaction, can we make meaningful use of the systems available to improve the quality of patient care.
Your opinion?
P.S.: As supplemental reading, I suggest the IOM November 2011 report, Health IT and Patient Safety: Building Safer Systems for Better Care, which noted, “Safety is a characteristic of a sociotechnical system.” Click here for the link. And if you’re looking for an excellent interview with Erica Drazen of CSC on this topic, written by Mark Hagland in Healthcare Informatics, you’ll find it here.
Joseph I. Bormel, MD, MPH
Vice President & Chief Medical Officer
QuadraMed Corporation
