Guerra On Healthcare: Respect The Clinical Specialists

Every successful business must clearly differentiate itself from competitors. To do this, it must select one or two areas it will "own" and continually strive to make them the standard against which everyone else is measured. At healthsystemCIO.com, for example, we pride ourselves on strong interviews.

Solid interviews are the result of both preparation (doing research and having appropriate questions ready) and flexibility (willingness to let the interviewee veer from the assumed path). To ensure that the questions don't limit the scope of discussion, we often ask the simple questions: What are some of the other main projects you're working on? Is there anything else you'd like to discuss today? Sometimes, however, this still doesn't do the trick.

I realized this a few days ago during an interview with Steven Riney, VP and CIO at Methodist Medical Center of Illinois. Only because I had lunched with Evan Steele, CEO of specialty EMR-producer SRSsoft, earlier in the week, I asked Riney whether he had experienced any pushback when rolling out his enterprise primary-care-centric electronic medical records to the organization's specialty practices. Such pushback, I told Steele during our lunch, had not been mentioned by CIOs during my many interviews. As far as I knew, I said, it either didn't exist, had yet to surface, or CIOs just didn't want to talk about it.

But when specifically asked about it, Riney said that yes, there was pushback--especially from the cardiologists. At first, it sounded like the incumbent EMR would be customized as much as possible to satisfy them, then the cardiologists would have to make do. But I was wrong again. Such was not the necessary outcome, said Riney, and the possibility of going the specialty-EMR route for those docs was not necessarily off the table.

Perhaps it's been obvious to many for some time, but Riney's comments were eye opening for me, constituting a testament that all is not well with the enterprise EMR rollouts we see dotting the U.S. hospital landscape. The specialists, methinks, are about to roar.

And who could blame them? At a previous job, I balked at having to write my copy directly in a new content management system that would facilitate information sharing across the publishing enterprise. "I write in Microsoft Word," I proclaimed, sounding like a real prima donna. While I was happy to cut and paste my copy into the CMS, I just could not write directly in it. Why? It was not comfortable. It was obviously designed for content layout, not creation.

Likewise, primary-care EMRs have not been designed to handle the work of specialists--they often ask for information the specialist finds irrelevant and fail to ask for that which is critical. So when a specialty practice either says, "We're staying on the EMR we bought before you acquired us," or, "I'm sorry, we can't use this system; but we happen to know of one created just for us," what's a CIO to do?

The reality is enterprise-wide EMR buys that run into the tens of millions are like freight trains running through the enterprise--very hard to stop. And just like freight trains, they can cause a lot of damage if warning signs aren't observed. Forcing a primary-care-designed EMR down a specialty practice's throat may sound necessary for purposes of integration and data sharing, but, if disruption is major, the economics warranting it break down. I once interviewed a CIO who admitted that sparking a revolt in, or even significantly slowing down, his specialty practice--which handled millions of dollars in billable care--would be financially ruinous.

Navigating these waters will require you to keep two things in mind. The first is that communication and outreach are essential. Bring the specialists into the enterprise-wide EMR selection process, give their views proper consideration, and let them know the reasons if alternate paths are chosen. The second is to remember that the fundamental dynamics of healthcare under the current fee-for-service model haven't changed. Physicians still run healthcare, with most hospitals existing simply as one of many workshops where they may ply their craft.

To put a finer point on it, healthcare is run by the best-paid physicians--the specialists and surgeons. You may think you've got an open door to the CEO and board, but these doctors can probably summon those folks to their offices. In your enterprise-wide EMR rollout, when the freight train is running fast, keep in mind that you run these specialists over at your own peril.

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 [email protected].

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