Baylor Health Care System's $119 million initiative to transform clinical care using information technology, unveiled last week, is a high-profile example of an emerging strategy to win physician acceptance of computers gradually, patiently and permanently.
The Dallas-based provider network plans to redesign how it responds to patient needs and delivers care at its 11 hospitals, 69 clinics and numerous physician practices in north Texas. Fundamental to that goal is a clinical IT network to link all facilities and share timely medical information.
But less than half the expense of the project, which will take up to seven years to deploy, represents information technology investment, said Peter Dysert, chief medical information officer of the health system and chief of pathology at flagship Baylor University Medical Center.
The majority of the estimated expense is "to buy professionals' time to achieve the vision" of a complete internal reorganization emphasizing efficiency, evidence-based medicine and patient safety, Dysert said.
Much has been made of the capacity for innovative clinical IT to alert physicians to safety concerns and advise certain actions based on sound evidence. In its most complex form, physicians enter their own orders on a computer that sorts through clinical rules, patient history and test results for possible problems with the order and suggestions for alternatives.
But some health systems have been hit with fierce opposition from physicians when trying to implement computerized physician order entry, and others are thinking twice about treading the same path (Feb. 10, 2003, p. 6). In many cases, organizations that seized on the physician order priority as their first project "led with their chin," Dysert said.
Baylor instead has spent years working behind the scenes to overcome resistance to the use of computers and also get across that the issues of safety, efficiency and use of best available medical knowledge are top-drawer priorities-independent of the computers that introduce those priorities to the practice of medicine.
The health system's vision comes to grips with the reality that healthcare processes are designed mainly around facilities rather than their patients, said John Anderson, the health system's senior vice president of clinical integration.
To reverse that emphasis and build safety into the routine of care, healthcare professionals will be charged with breaking up processes and putting them back together to diagnose and treat medical problems using the best available evidence of what works and what could be harmful, said Anderson, who also is Baylor University Medical Center's chief medical officer.
The hope is that doctors will recognize IT for its value in helping achieve these clinical objectives, instead of resenting it as an imposition.
That approach is becoming the mainstream strategy in healthcare for clinical IT, said David Classen, a consultant with First Consulting Group and a pioneer in the use of IT in clinical care. Instead of trying to skip a step by making computers move physicians to change, provider organizations "have to be willing to do the upfront work to reinvent the process first," Classen said.
One of the worst moves is to automate overly complex and poorly organized care processes, he said. In addition, computer projects have to get the basics of information organization and clinical acceptance accomplished first. Once providers build the necessary information-retrieval networks and doctors recognize their value, high-end projects such as physician order entry can be phased in, Classen said.
To build support, Baylor started four years ago to make computers an easy and attractive component of daily practice for physicians and their office staffs (Aug. 9, 1999, p. 52). After surveys disclosed that administrative information was high on physicians' lists of needed data, office support staff was given access to basic billing and demographic data on patients kept by the hospital facilities in the Baylor network, affording up-to-date details on payers and their policies.
Then the same secure Web site that provided the business data started making clinical information available on patients, giving doctors immediate access to lab results as well as other information such as discharge summaries.
With about 40% of physicians now on the information portal daily, and their office workers using it "quite regularly," Baylor has a degree of acceptance that will serve the next step of greatly increasing the amount of information available and the ability of doctors to interact with the clinical system and get what they want, Dysert said.
Upon completion of the project, each patient will have a single electronic record accessible from a handheld or desktop computer. Records that follow the patient will substantially decrease the potential for medical error and ultimately pave the way for systematic deployment of evidence-based best practices, said David Ballard, senior vice president of a Baylor unit called the Institute for Health Care Research and Improvement.
Physician order entry will not be introduced until the latter stages of the project, Dysert said.
Another big project to give doctors value through the computer network-comprehensive information from payers to speed up reimbursement and reduce administrative overhead-was aborted in May 2003 after a year of unsuccessful collaboration with Electronic Data Systems Corp., a vendor of information technology outsourcing services.
The 10-year, $200 million contract for billing, collections and revenue management was supposed to gather together all payers doing business with Baylor doctors and create a common Web-based platform for determining eligibility for care and other information necessary to be paid for healthcare services. Physicians in 1999 had identified relief from managed-care overhead as their No. 1 problem and expeditious payment as the biggest attraction for using a computer system. But because of problems getting payers to participate and performance issues with EDS, "we weren't able to get it off the ground," Dysert said.