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6/22/2010
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Guerra On Healthcare: Father's Day Lessons On CPOE

Understand physicians and you understand the abysmal computerized physician order entry adoption rates.

At first blush, you might not see a connection between Father's Day and the industry's abysmal computerized physician order entry adoption rates, highlighted in a recent KLAS report. You might be tempted to focus on the vendor involved in each instance to see what's so user-unfriendly about their applications, or the hospital to see what's so clinician-unfriendly about their rollout strategies. But in both cases, you'd be wrong.

Father's Day, you see, holds the key to the low CPOE adoption rates, more specifically, the look I'm sure some physician dads got from their kids last Sunday, or perhaps more importantly the look they didn't get. Very young kids are funny -- they don't understand how their actions can hurt someone's feelings. I remember back when I wasn't visiting my sister's house very often. One day when I managed to stop by, my three-year-old nephew looked up at me and said, "Who are you?"

What I realized at that point was I hadn't been coming around enough, and I didn't like the way my nephew's question made me feel. On Father's Day, I wonder how many doc-dads got that feeling from the children they only see a few hours per week. Looking at the typical physician in this light -- not to mention the stress they suffer during Congresses' regular "let's cut their pay" exercise -- is it any wonder they resist things which keep them away from home longer?

"To hell with them," say the Washingtonians. "If they want to keep practicing medicine, they better get out of the Stone Age and start acting responsibly, because writing orders on paper is a joke."

Well, maybe. I certainly do agree that removing handwriting from the ordering process is an absolute win, but I do not agree that clinical-decision support is ready for primetime. Too many alerts cause physicians to tune out, and dozens of interfaces between core clinical applications mean translation errors abound.

But HITECH has silenced the "is CPOE ready" debate and replaced it with "CPOE now!" So with software orders piling up, vendors have little reason to devote any cash to R&D, very little incentive to get the applications ready for a primetime they have been granted but not earned. It's unfortunate that now these technologies have been frozen in place, at least for the foreseeable future.

So academic medical centers will leverage their hospitalists to quickly surmount the Stage 1 10% CPOE bar, but what about the small community hospitals that make up the majority of the nation's acute care facilities? Without employed physicians, and no money for a single-vendor big bang approach, they will have to hoe the toughest of all roads. They will not only have to convince those doc dads to spend less time with their families (at least during the training phase) but glue the whole thing together with interfaces and duct tape.

Since the Regional Extension Centers are only mandated to help small physician practices, small community hospitals fall through the cracks once again. And though some big vendors are starting to customize offerings for this segment, that process seems just now to be gaining steam.

I recently interviewed Greg Walton, CIO at El Camino Hospital in California, who said he learned something very important about working in this sector long ago -- all healthcare is physician-led.

If that's the case, it's critical that hospitals, payers, and the government understand the physician. It's not so hard, because they're just like the rest of us. They want to do quality work, but they also want to work just a little bit less, make just a little more money, and spend a little more time with their kids, because the saddest thing in the world is celebrating Father's Day with a child who doesn't recognize you.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at aguerra@healthsystemCIO.com.

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