Note to physicians: Figuring out the technology needs of your hospital or practice isn't just for propeller heads anymore.
As healthcare systems lean more on technology as a clinical tool, they are counting on physicians not only to contribute to the choice of a technology system, but also to lead the way.
The demand is steadily growing for physician chief information officers, a position -- once the sole province of computer engineers -- that requires the knowledge necessary to maintain computer information systems. And physicians also are being sought to head up healthcare "informatics," which requires the ability to identify ways computer hardware and software can be integrated to best enhance clinical care.
At the least, doctors are being asked to think about ways technology can improve the care they provide. Answering "I don't know" is no longer enough.
The growing involvement of physicians in choosing and fine-tuning hospital technology is fast becoming a necessity. With hospitals spending $20 million or more on information systems that will take years to install and need continuous upgrading, the failure to get the right system -- and the failure of physicians to use it effectively -- can be a disaster.
"The complexity of medicine and delivery of healthcare today is such that the knowledge of technology alone isn't an adequate background for selecting, designing and evaluating healthcare information systems," says William Bria II, M.D., director for medical information services at University of Michigan Hospitals. "It's like saying I can be an (information technology) person for launching the space shuttle without knowing anything about aerospace."
According to CIOs at hospital systems, group practices, managed-care organizations and insurance companies who were surveyed in the fall, the average budget controlled by a CIO in 1997 was $9 million, up 25% since 1995. The respondents said they expect that figure to increase another 17% in 1998 to $10.5 million. The survey was conducted by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives.
The survey also confirmed that physician-CIOs are a relatively new phenomenon; only 1% of the 512 CIO respondents had a medical degree. And although the survey did not specify, it appears anecdotally there is a larger preponderance of doctor-CIOs at major academic medical centers. However, as Bria notes, if you're a physician who makes technology decisions in the absence of a designated CIO, you're the CIO.
There are a number of clinical and practical healthcare tools that computerization allows. Among them: The trend toward disease management has healthcare systems looking for better ways to track treatment. Managed care is demanding not only detailed financial records but data relating to quality-of-care compared with that of other practices. And, not least of all, HHS' inspector general's office's increasing aggressiveness in rooting out Medicare and Medicaid billing fraud has health systems more invested than ever in ensuring their billing and coding systems are accurate.
The relatively new availability of computers on doctors' desks hasn't led automatically to their willingness to put everything they used to put on paper onto a computer hard-drive.
"You need a local champion," says Greg Schorr, M.D., an adjunct associate professor of medical informatics at the University of Utah and a medical informatics consultant.
With physicians in technology leadership roles, rather than computer engineers, high-tech clinical care should be an easier sell to M.D.s who aren't computer-savvy Schorr says.
Experts agree that information systems won't work without doctors' direct involvement, and some large systems, including the University of Michigan, are counting on doctors managing electronic clinical records to make up for cutbacks in administrative personnel.
One of the more difficult tasks for physician technology leaders is determining what the doctors who use technology need it to accomplish. And because many doctors don't know enough about computers to know what is possible, asking them what they need isn't always useful. "If you ask six physicians what they need, you get seven different answers," says Frank Cavanaugh, a healthcare technology consultant at the accounting firm of Coopers & Lybrand.
Most of the current crop of physician technologists came by their dual skills almost by accident. Some started working with computers before they decided to study medicine; others had less formal training.
"Most of the physician-CIOs I know got in through the back door and learned through the school of hard knocks," Schorr says. "There's nothing wrong with that, but (computer skills are) not something you're born with. You have to make a lot of mistakes along the way."
In that spirit, more colleges, including Stanford and Columbia universities, are offering computer courses geared specifically toward physicians. In the fall, the University of Missouri-Columbia will offer what it is calling the first-ever master's program in health management and informatics housed within a medical school. The program will combine business and technology skills and be aimed directly at preparing physicians for CIO jobs.
"Consulting firms have already said, 'We'll hire all of your graduates,' " says Gordon Brown, the department's chairman. "We don't even have any students yet."
Given the current focus on physician technologists, it's not surprising to learn about the organization of a new group created especially for physician technology leaders, the Association of Medical Directors of Information Systems.
Bria is one of its founders. Based in Keene, N.H., the group plans to have its first meeting Feb. 24 in Orlando, Fla., during the annual Healthcare Information and Management Systems Society conference. Bria says about 90 physician technology leaders, representing hospitals, healthcare systems, managed-care organizations and clinics, have joined the group since its formation last August.
One purpose of the new association, Bria says, is to provide a forum in which members can share information about their experiences. Bria, for one, wishes such a forum had been available earlier. Two years ago, the University of Michigan "de-installed" a multimillion-dollar clinical-technology project because the CIO and medical director left. Bria won't reveal how much it cost to scuttle the plan.
"We're starting again," Bria says, "but it's back to square one" -- the same place many hospitals and health systems haven't yet moved from when it comes to using technology as an integral part of medical care.
The following stories profile four physician technology leaders, pioneers in their field. Their stories explain how they became physician technology leaders, what tasks they are responsible for and how the lessons they've learned can apply to all physician organizations.