Guerra On Healthcare: How Do You Engage Physicians?
When trying to win support for your hospital's EHR and CPOE from doctors, be sensitive to how training will impact their personal and professional lives.
While every CIO I've interviewed has challenges fostering physician adoption of technologies like CPOE, clinical decision support, and electronic documentation, they differ in their estimation of what really makes docs tick.
In one camp lie CIOs who view physicians as noble servants of the public welfare, who--somehow endowed with truer a moral compass--merely want to provide the best possible care, regardless of the personal sacrifice that might entail. "Talk the patient-safety language of healthcare IT," they say, "and all will come right." I've often heard statements like, "Most doctors I know went into this business to give great care and, if you can show them these systems will help them fulfill that mission, they'll be on board."
In another camp lie those with a more cynical view of human nature, who see no reason to believe that physicians are exempt from the more unseemly characteristics of our species. One of those characteristics, they note, is the desire to make money. Implementing clinical information systems in their practices, and even learning how to use them at hospitals, slows them down, at first significantly and perhaps to a lesser degree permanently. While this may be tolerable to the employed physician whose paycheck doesn't fluctuate with the number of patients seen, to the independent, it is anathema. And let's remember that while the pendulum may be swinging, the vast majority of doctors in this country are still independent businessmen and women.
If I had only one description to choose, I'd pick the latter, as it more conforms to my perception of human nature. But in being forced to pick, my efforts would be far less effective than if I'd been given the freedom to take both into account when crafting my strategies to increase adoption and deepen use of advanced clinical systems.
No independent physician wants to make less money, and few want to work more than they currently are, even if that would mean greater income. Most want to earn more by either working the same amount (becoming more efficient) or, in the Holy Grail scenario, by working less. All would say yes to the abstract question, "Would you like to give better care?" if achieving that improvement was fairly painless.
As a hospital CIO, independent physicians come into your world both when they exercise their admitting privileges and, if you're going down the Stark road, when leveraging that exemption to underwrite systems in their practices. For our purposes here, we'll focus on the former, as an engagement of the latter type would mean you'd been invited in and, thus, the dynamic would be far different.
In promoting use of your inpatient systems among the independent physician community, acceptance of the aforementioned character profiles means you should offer some type of compensation for time invested in systems training, as well as for the slowdown they'll suffer during initial use (perhaps the first three months).
Apart from the slight financial cushioning such payments might provide, these doctors will appreciate its symbolism. They will see you value their time, that you would not fritter it away on extended coffee breaks in training or instructors who show up late. They will know that you have skin in the game to ensure their investment in the process is well spent.
But to leverage both physician types, you must also communicate that at the heart of your clinical systems strategy is a desire not to obtain Meaningful Use funds, nor to expand your IT fiefdom by garnering more of the hospital budget or expanding staff, but rather to simply provide the best patient care possible.
While there are both noble and base doctors, the majority are people just like you and I--trying to do good work while maintaining a balanced lifestyle. When you impact that lifestyle, as you must when rolling out advanced clinical systems, be sensitive to the ripple effects in both their professional and personal lives. Do your best to acknowledge and mitigate that impact and you'll be well on your way to attaining whatever thresholds ONC and CMS come up with.
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