Clinical computerization for physician offices is in large part a financial challenge, as the federal government is recognizing through its hints that it will promote broad adoption of IT through economic incentives. However, doctors are going to need a large dose of practical knowledge to go with the software and hardware they will eventually acquire, experts emphasize.
Once the technology is implemented, the healthcare industry will have to supply physicians with the education and training to fully optimize the benefits of their capital expenses, says Blackford Middleton, a physician and director of the clinical informatics department of Partners HealthCare System, Boston.
"We can't leave doctors on first base," Middleton said during a fact-finding hearing in February at the Healthcare Information and Management Systems Society conference.
Some help may be forthcoming as part of the emerging HHS battle plan to promote rapid adoption of healthcare IT, to be unveiled July 21 by David Brailer, national healthcare IT coordinator. At a June 25 news conference, Brailer said the government would offer research into effective implementation strategies to ease the fears of physicians in solo and small-group practices about investing in an IT system.
"How can we help them implement these tools?" he asked. "We can make physicians more comfortable with their buying decisions."
Until that happens, a growing group of physician IT experts are trying to raise the level of proficiency among their colleagues. Through higher education, publications and an association devoted to the advancement of physician involvement, physicians are helping to lead the transition, if for no other reason than because they have to be involved for the systems to be implemented successfully, experts say.
The Association of Medical Directors of Information Systems, or AMDIS, a trade group for physicians involved in healthcare IT, has about 1,200 physician informaticist members today, up from 300 four years ago. Among them are a growing number of pioneers who have reached significant milestones in their own IT treks. Most are willing to warn the next wave of physician IT champions of the pitfalls ahead and want to point out the surest paths to successful IT deployment.
Physician leaders ready to hit the IT trail might start with a new explorer's guidebook written by veteran medical informaticists William Bria and Richard Rydell. Bria is chairman of AMDIS and Rydell is the organization's president and executive director. Their book, The Physician-Computer Conundrum: Get Over It!, was published by HIMSS in June.
Rydell says the book is aimed at a broad audience: "everybody who is thinking about or has rejected the notion of getting into IT." Adds Bria: "We tried to get rid of the fear factor. And as God knows, when you get into this, you wonder if this is a career-ending decision."
The high-profile failure and abandonment of a homegrown computerized physician order-entry system at Cedars-Sinai Medical Center in Los Angeles in 2003 left many physician leaders gun-shy, Rydell says, and that fiasco influenced the authors.
"I don't know how many people are sitting on the sidelines because of Cedars," Rydell says. "They didn't know what happened, but they saw it as a bad thing. We're trying to get to some of these people."
Bria and Rydell say any physician who is thinking about extending his or her career into leadership in medical informatics should go back to school, get meaningful clinical experience and network with other like-minded doctors.
"There are now many excellent degree-granting programs actually tailored for physicians interested in approaching healthcare IT careers," they say.
The good news is some of them are short introductory courses that don't require a physician to quit his or her day job. Other programs are beginning to incorporate Internet-based classes in the curriculum and require limited on-campus participation.
Oregon Health & Science University in Portland has offered courses in healthcare informatics since 1992 when it launched a fellowship program under a National Library of Medicine grant. It opened its doors to a full, on-campus Master of Science degree program in medical informatics in 1996.
"We've probably had about 40 or 50 graduates, about two-thirds are physicians," says William Hersh, a professor and chairman of the school's department of medical informatics and clinical epidemiology.
In the late 1990s, OHSU offered its first distance-learning courses in informatics over the Internet. In 2000, the university first offered a certificate program in medical informatics on a quarterly schedule consisting of eight core courses, each 11 weeks long. All credits from the certificate program are transferable to a full, online master's degree program that was added a year later.
"That program has attracted a lot of physicians who have a day job and can't pick up and go study informatics for two years," Hersh says. "The distance students are the most dedicated students we have. They're not only spending their hard-earned money, they're spending their time. They're very motivated."
Typically, enrollees take only one course per quarter. Hersh estimates 250 students have enrolled in at least one Web-based medical informatics course, including those who start with no intention of completing a degree or certificate program.
For physicians interested in exploring the field of informatics, Hersh recommends the introductory online course. The three-credit course costs $1,500.
"We offer the introductory course every quarter so people can dip their toes in and see if this is something they might be interested in," he says. "We've had a lot of nonclinicians take that course. We cover the crucial points. I don't think it would blow away anyone."
Physicians taking the online courses have the added benefit of joining a peer group of project leaders at their own knowledge and experience levels, Hersh says.
"I've always heard this phrase, `virtual community,' but that's what we've formed. A lot of students across the country participate. We have asynchronous bulletin-board types of discussions and we get people to talk and engage in discussions with each other. So people get to know each other. And we like to have social events at some of the big meetings, like HIMSS, so people get to meet one another, too."
Other informatics programs offer various accommodations for physicians who cannot drop out for long periods of study. Stanford University, for example, offers a four-day, on-campus introductory course as well as a short course online.
In the Midwest, the University of Missouri offers a master's degree under its executive health informatics program that is taken mostly online, though eight on-campus weekends are required during the two years needed to complete the degree.
On the East Coast, the National Library of Medicine, part of the National Institutes of Health, has a weeklong informatics fellowship at Woods Hole, Mass. "That's probably an excellent place to start for physicians who are interested and want to get into IT," says recent Woods Hole fellow Frank Davis, a trauma and critical-care surgeon and informatics leader at Memorial Health University Medical Center in Savannah, Ga.
The program starts on a Saturday evening and runs through the following Saturday afternoon, with six, 12-hour course days crammed in between.
"I found it to be a real eye-opener," Davis says. "I would highly recommend it."
Davis remains active as a surgeon but spends a little less than half his time in informatics. Memorial Health is a winner of this year's AMDIS award in applied informatics for its Web portal and the more recent rollout of a complete clinical and financial healthcare information system.
Rydell and Bria recommend physicians right out of residency get seasoned in their practices before jumping into clinical IT.
"In the past, on-the-job training may have been a reasonable place to start because there were few models of physician IT careers and most traditional (master's of public health) and MBA programs were not geared to preparing physician leaders in healthcare IT," they wrote. "Times have changed."
The advent of IT training programs tailored for physicians eliminates the need to risk failure and frustration by a seat-of-the-pants learning approach that pioneers in the field were obliged to endure, they say.
-with John Morrissey
What docs are prescribing
The Medical Group Management Association offers physicians two collections of surveys-called Information Exchanges-on electronic medical records, or EMRs.
* One, a 33-page report, Electronic Health Records (Item 4741), is based on a survey of 95 groups and lists the EMR software they're using and its functions, whether it is leased or purchased and whether the software resides on their own computers or is supplied via the Internet.
* A second, 140-page report, Information Systems Selection: RFIs and RFPs (Item 4879), offers the results from 170 groups surveyed on how they made their selection, whether they used competitive bidding and requests for proposals, and who made the decision.
To obtain a copy of either report, go to the "store" section of the MGMA Web site, mgma.org, and type in the title or item number in the search field.