When it comes to designing clinical technology for physicians, one size certainly does not fit all, says Martin Harris, M.D., Cleveland Clinic's first chief information officer.
"If you force (a system), you've assumed all practices are the same," Harris says. "You will find people have appropriate reasons for why it does not work. The second thing is that putting it down on the desk in a gross mandate also doesn't make any sense because of the timing that's required to do good training. It takes as much time (to integrate the system) as it does to learn a new clinical procedure."
Harris, who started in Cleveland in June 1996, is keeping that idea in mind as he rolls out a patient records system for the 900-physician clinic's ambulatory-care operations. Though the system can be tailored to each doctor as needed, the underlying technology will still allow the clinic to collect and analyze overall data. So far, the system, which HBO & Co. is producing, has been implemented in Cleveland Clinic's main hospital and three satellite clinics.
When Harris arrived at Cleveland Clinic, it already had the beginnings of a strong clinical integration operation, he says, using only one chart per patient, which was circulated online to different facilities. Plus, the clinic had a small-scale results-reporting system and order-entry system.
However, in the past three years the Cleveland-based multispecialty group has expanded rapidly: It has affiliated with four hospitals and health systems, purchased one hospital, and constructed four satellite centers, with two more on the way. Going high-tech "all the way" seemed like the only way to keep up, Harris says.
"Those satellite centers see 30% of our patients," he says. "It's impossible to circulate the charts (on paper)." The clinic overall sees about 220,000 patients annually, about 66,000 of those at the satellite centers.
Harris, 41, studied the use of technology for clinical systems as a graduate student at the University of Pennsylvania's Wharton School of Business in the late 1970s, during a break in his medical school studies at Penn.
A Philadelphia native, Harris started down the road to medical technology when he was selected for an exclusive scholars' program as a Penn undergraduate. It was during the program that he developed the idea of researching health services and alternative models of delivery.
After graduating from Penn's medical school in 1982 (he already had graduated from Wharton in 1980) and spending three years in residency in general internal medicine, Harris was selected by the Robert Wood Johnson Foundation for its scholars program. From 1985 to 1987, he studied science and engineering, learning computer programming skills and becoming friends with fellow student Michael McCoy, now well-known among physician technology leaders as an M.D. and CIO at the UCLA Medical Center.
"We spent a lot of time talking," Harris says. "At that time, even results reporting, which I think of as commonplace now, was really a paper-based process in most institutions. We spent a lot of time thinking about how to improve the basic processes of care; processing, receiving, distributing information, but in a consistent and uniform fashion. In the typical academic medical center, a patient might have (separate registration) numbers they used with the doctor, hospital and radiology. It was impossible to think of doing analysis of data."
As it happened, Penn hired Harris to come back and set up a uniform patient registration system. While that was good for administrators, it didn't require much physician involvement.
"The role of the physician at that time was understanding how the system was going to work and what effect it had, primarily on their administrative operations," he says. "Clearly over the last few years, my focus is on the true integration of information technology into the practice of medicine. That requires substantially greater physician participation."
At Cleveland Clinic, Harris employs two physicians to work full-time as liaisons between the technology department and the other doctors. He has continued to practice internal medicine because "if you're not practicing, you can very quickly lose sight of where the opportunities are" for clinical technology, he says.
The combination of physician meetings and Harris' experience helped to develop the idea of building template- and individual-based patient-records systems, which for now are limited to doctors employed by the clinic.
A template-based system is one in which physicians fill in information on a stock form. It is designed for physicians who see mostly similar conditions that are treated in similar ways. The individual approach relies on "free text" and dictation entry, helping physicians who see more complicated disease processes.
Harris plans to hire two more physicians for his department in the next year.
He can envision that someday clinical technology will fall into the realm of subspecialty training. After all, he says, it's not like you can train someone to be a gastroenterologist just by putting an endoscope on his desk.