A new group has been formed that has taken a novel approach in the campaign to accelerate adoption of health information technology. It will focus its efforts on guiding the people who are not currently using health IT in large numbers but are perhaps the most-needed in making an interoperable electronic medical-record system work: physicians in solo and small-group practices.
The Chicago-based National Alliance for Health Information Technology has convened the Clinical Advisory Group, whose roster includes mostly physicians, many of whom are the chief information officers for healthcare organizations or the chief medical officers for IT-related enterprises. In contrast to many other advisory groups, members of the new panel are still deeply involved in patient care or have championed IT implementation within their own organizations.
"We wanted people who had gone through this and knew how painful it could be, but persisted and were successful in getting IT implemented," said NAHIT Senior Fellow Clair Callan, M.D., who will chair the group along with Narendra Kini, M.D., the executive vice president, clinical and physician services for Novi, Mich.-based Trinity Health, and Diane Bradley, M.D., the chief medical officer for Boca Raton, Fla.-based Eclipsys Corp.
"It's frustrating to read articles about how only 17% of physicians have implemented some aspect of an electronic medical record system," said Callan, who previously served as the American Medical Association's interim vice president of professional standards and helped steer the AMA-convened Physician Consortium for Performance Improvement in the development of evidence-based performance measures. "We're hoping to move that number up and we have a goal of getting it up to 50% within five years."
Callan said she's also frustrated when she meets with organizations that are deep into the planning stages of IT implementations and she asks them "What do your physicians think?" and they answer by saying they haven't talked to them yet.
She said that a strength of the new group is that it "understands the nuances" of a medical practice because, sometimes, when people who don't practice try to impose an IT system on clinicians "they are way off the mark."
Callan added that the group intends to be move rapidly so to stay ahead of any developments out of Washington. That way they can maintain a proactive focus rather than just be reactive to whatever mandates get imposed on physicians.
Although everything is still very much in the preliminary stages, Callan suggested that the group may produce something that could be roughly described as an IT-implementation "playbook" by the end of this year.
According to Clinical Advisory Group implementation committee member Arnold Wagner, M.D., this playbook would contain information physicians need to know about EMR systems, what questions they need to ask vendors and warnings about potential pitfalls.
"The idea is to shorten the learning curve, so they don't have to learn by making mistakes but can learn from the mistakes of others," said Wagner, who led the IT integration effort for Evanston (Ill.) Northwestern Healthcare, where he serves as medical director of clinical informatics. "Physicians want to do the right thing and they understand that this is the wave of the future, but many have been or know someone who has been the victim of snake-oil salesmen who put a word processor on a desktop and said: 'You have an EMR system, doctor.' "
Although the committee includes representatives from "big gorilla" IT vendors such as Eclipsys, Cerner Corp., IBM, Siemens and others, Wagner said the panel will not endorse any particular company's product.
"We want to get the target practices to at least ask the right questions -- but they don't even speak the right language right now," he said. "We're just another voice providing some reasoned thought that people can use to make their decision."
Wagner said Northwestern's implementation was helped by a unified commitment from all aspects of the system's leadership, technological advances and societal pressures from the Institute of Medicine and the Leapfrog Group all coming together at the same time.
"It was also a single focus and it was the corporate goal for three years and we had a take-no-prisoners approach," he said. "There was no using of the words 'pilot,' 'test,' or 'trial.' One day we flipped the switch and paper went away. It wasn't always popular, but it got the job done.
"It was a difficult journey," Wagner added. "But last year I was able to leave my Kevlar jacket in the closet."
But while implementation is difficult, Callan and Wagner also want to raise awareness of the benefits of IT adoption, particularly: better outcomes for patients, eventual financial rewards and a more efficient practice that results in a better quality of life for physicians. Part of the effort will be a focus on changing the attitudes small-group physicians have regarding IT and the attitudes IT vendors have toward small-group practices.
"As physicians, we've all gotten used to living in the paper world and have gotten used to the inefficiencies and flying blind when we didn't have the needed information," Wagner said. "So part of our challenge is to get out to the world the message that gunslinger medicine is not entirely in step with what society, the government and the payers are looking for. If we demonstrate that, then maybe we've done something good."
Wagner added that vendors "don't want to be hand-holding a three-physician practice through this difficult transition," but Callan -- who acknowledged that physicians can be a hard market space to sell to -- said economic pressures may force IT companies to be more helpful to small practices.
"It's probably a fair criticism of physicians, but some vendors are responsive and some are not -- and the market will take care of those who are not," she said. "I think the important thing is that we're focusing on physicians and trying to help them do whatever it is that needs to be done so they can help their patients -- which is at the core of everything we do."
For a list of CAG members, read: http://nahit.org/cms/index.php?option=com_content&task=view&id=50&Itemid=28.
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