Healthcare CIOs Need To Understand Physicians' Pain
Clinicians are frustrated by immature clinical information systems and questionable pay-for-performance rules. Understanding their angst can bring about cost-effective patient care.
The ability to sympathize with another person's suffering is one of the admirable traits that separate humans from the rest of the animal kingdom. It's a trait that can certainly help health IT executives work more effectively with their clinical counterparts.
That realization hit home the other day while reading the comments of "Dr. A," whose complaints about computerized medicine and pay-for-performance metrics were recently chronicled in the Journal of the American Medical Association under the headline "Use of Quality Indicators in Patient Care."
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Dr. A, a senior primary care internist, recently left a small private practice that relied on paper records, and joined a large group affiliated with a very big electronic health record (EHR)-equipped hospital network. He's convinced that the care he offered patients in the smaller practice was of higher quality than what he's providing now.
[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs.]
"I really think the electronic record and electronic counting of things will be helpful, but I think we're at an embryonic stage where it isn't good yet."
One of his chief concerns is the lack of actionable clinical data. He was hoping for practical, real-time information on what shortfalls needed to be immediately addressed patient by patient. Instead, he's getting financial report cards and requests to follow quality standards for heart disease, peripheral artery disease, and diabetes that he considers questionable.
Dr. A isn't alone in his misery. While some academic medical centers have published reports showing dramatic financial and clinical benefits from implementing EHRs, several studies have failed to duplicate such improvements. According to a recent analysis by HIMSS and the Advisory Board Company, "EMR Benefits and Benefit Realization Methods of Stage 6 and 7 Hospitals," a likely explanation for these conflicting reports is that most hospitals with EMRs are still implementing clinical decision support (CDS) systems.
CDS is one of the keys to success in medical informatics, and I suspect that the lack of such a system is at the root of Dr. A's angst. And it's not just the system that's needed, informatics experts are also key.
According to a recent survey from PricewaterhouseCoopers, "Needles in a Haystack: Seeking Knowledge with Clinical Informatics," healthcare providers are starting to realize that EHRs by themselves have limited potential. "In the clinical space, there was a belief that if you put in an EHR, all your problems of interoperability would go away," said John Edwards, a director at PwC. "There is evidence in the survey that providers were realizing that the 'silver bullet' of EHRs needed to be enhanced with clinical informatics people."
Put another way, without clinical analytics experts on staff to put all the EHR data and pay-for-performance metrics into perspective, there's no way EHRs are going to reduce the cost of care while still improving quality of care.
In practical terms, establishing a robust CDS system requires, at the very least, having a chief medical information officer (CMIO) in every healthcare system to help create and direct the organization's CDS system. If the size of the organization can't sustain the cost of a full-time CMIO, look for a physician on staff who can split his or her time between patient care and clinical informatics. As the PwC report puts it: "We need [CMIOs] who understand how data mining and computation can be used to make sense of massive clinical data sets."
And to address Dr. A's concern about questionable pay-for-performance rules, CIOs and CMIOs need to join forces and take a hard look at the practice guidelines upon which those rules are based. Are they truly based on solid, controlled medical research, or do they rely too heavily on insurer-generated statistics that put more emphasis on cost savings than patient welfare? Equally important, do the guidelines allow for individual judgment on the part of experienced clinicians who don't see the wisdom of practicing "cookbook" medicine?
Compassion and empathy aren't popular words in business. But a modest dose of each will help health IT execs see what their colleagues on the other end of the stethoscope are going through right now. Such insights can remove the roadblocks to cost-effective patient care.
Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)