William Bria, the chairman of the Association of Medical Directors of Information Systems, told a record number of attendees at his groups 17th annual Physician-Computer Connection Symposium in beautiful Ojai, Calif., this week that the turnout is testimony to the level of activity in the field and the amount of work still to be done.
Boy, if there were any more going on right now, most of us would be lying face down on the floor instead of sitting up in chairs, Bria, a founder of AMDIS, told the 170 physician informaticists convened about 15 miles inland from Santa Barbara, Calif., at the base of the Topatopa mountains.
The pulmonologist and chief medical information officer for Shriners Hospitals for Children system in Tampa, Fla., said the current push to implement electronic-prescribing systems is the most important final driver to a more effectively automated state.
The team-based approach to providing medical care is now widely referenced as the modern model, which is being equated with health IT and the interoperability that IT affords. But, Bria said, anyone who has done anything in this knows that doesnt always happen.
Now that clinical IT systems have been or are being installed in many AMDIS members facilities, the next big, ongoing challenge for physician leaders in medical informatics, Bria said, is in designing and building computerized clinical decision support systems that bring an ever-changing body of clinical knowledge to the bedside.
CDS is on everyones lips just as CPOE was before, Bria said. All of us have guidelines, but putting it on the front line, not so much. What if you could make that available inside our systems? As you implement it in a system and you look at the category of care sets, you say, how do you get going? He encouraged members to join their respective medical societies in helping to develop these computerized-care systems.
Bria said one noted academic medical center took three years to come up with a few hundred order sets for the computerized healthcare IT system.
If we dont do this translation well, if theyre going to be sitting there at 3 a.m. and saying, Where is my information? Then were not doing what we want to accomplish. Encourage informaticists to get involved in standards electrification for clinical decision support projects within their medical societies. This is the beginning, he said of work that has been going on for more than a decade.
Robert Kolodner, the head of the Office of the National Coordinator for Health Information Technology, told attendees an OHCHIT-developed privacy and security framework will be released later this year. For many people, but not all, a driving force towards the proliferation of healthcare IT will be patients use of personal health-record systems, a force that HHS cant do much to change or affect, he said. Its very hard from a government level to drive that sort of thing.
Employers and voters can, however. Employers are pressed against the wall now. The cost of healthcare has really affected their global effectiveness. That may be one source of action that affects the politics in Washington. If tomorrow, the public gets itthat will drive it, he said. That would mean transforming care from a face-to-face model with a physician and a patient to a telecommunications-based model with the patients and the clinician at a distance, he said.
Kolodner predicted the adoption of electronic health-record systems will double in 2008 from the rather anemic levels of 2007, where a recently released, HHS funded survey indicated just 4% of ambulatory-care physicians use a fully functional EHR.
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The meeting, it turned out, generated some hard news for this reporter. A physician informaticist told attendees that a major snafu has been averted in a Medicaid requirement that tamper-proof paper must be used in printing prescriptions that had been sent electronically.
The mandate, which was slated to go into effect Oct. 1, would have required physicians using e-prescribing tools to print paper prescriptions on expensive, tamper-resistant paper at a cost many times that of ordinary printer paper costs. The irony is that the mandate was designed to save money.
The CMS has accepted the recommendations that soon should be released by the National Council for Prescription Drug Programs, or NCPDP, to create anti-fraud measures using computerized printing technology deployable in electronic health-record systems and stand-alone e-prescribing tools as a substitute for the costly tamper-proof paper.
The Scottsdale, Ariz.-based NCPDP is a standards-development organization for pharmaceutical claims-data interchange. An NCPDP task force has been working on the problem since January.
Peter Basch, medical director of ambulatory clinical systems at MedStar Health, Columbia, Md., worked to overturn the CMS regulation, which interpreted a 2007 federal law that required tighter security on Medicaid prescriptions, a law Congress passed with the aim of saving taxpayers an estimated $100 million a year on fraudulent prescriptions.
That mandate now has an alternative, Basch said. The NCPDP will issue a guideline to state Medicaid officials saying that the CMS will soon clarify its prior policy and unequivocally state that compliance for handwritten or printed prescriptions for fee-for-service Medicaid patients can be achieved without special paper.
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Physician informaticists are, by and large, a happy lot, in what is still a very new position, according to research results presented at the meeting.
Violet Shaffer is a research vice president and the industry services director for healthcare at Gartner, a consulting firm that advises healthcare managers on future trends.
For the fourth year, Gartner has worked with AMDIS on a survey of its members and other physician practitioners of applied medical informatics. Physicians were invited to participate via the AMDIS listserv, and chief information officers participating in a separate survey through the College of Healthcare Information Management Executives were asked to encourage their physician IT leaders to participate.
In total, 97 physicians responded this year. More than half, 55%, reported they go by the title of chief medical informatics officer, another 20% go by chief medical information officer. A solid majority of respondents were from larger hospitals and multiple-hospital healthcare organizations, with 39% from organizations of 201 to 600 beds and 21% from organizations of 601 to 1,000 beds.
Despite the relatively large size of their organizations, 58% of CMIOs and their peers who took the survey reported their informatics duties were part-time while 42% indicated medical informatics was their full-time job. An even larger percentage, 79% of respondents, reported that they still see patients.
A major industry trend, Shaffer said, is that large and growing healthcare organizationsabout half of U.S. hospitals are now part of the top 200 healthcare systemswill be leveraging their size not only for purchasing power, but also in the search for what Shaffer describes as systemness and the organizational agility to adroitly change. Physician informaticists will be key leaders of that change.
Job satisfaction is high among CMIOs and other informatics leaders surveyed. An increasing number have survived initial system installations and can see light at the end of the tunnel and no longer worry its an oncoming train, Shaffer said.
In 2008, the CMIOs can see a path through automation, Shaffer said. Some of them have done it, and others are working their way through. They are optimistic this year. This can be done. Were moving ahead. We can get physician order-entry. We can get an electronic medical record. These people and the organizations, many of them are organizing for and changing their procedures for the future state. The future state looks at computer-based patient records as the end point of one phase and the beginning of another.
More CMIOs (and their peers) surveyed, 42%, report to their organizations chief information officer than directly to its chief executive or chief operating officers, 20%, or the chief medical officer, 15%. But 47% of survey participants would rather report to their CEO/COO, with another 29% wishing to report to their CMO and just 13% to their CIO.
They want to report to power, Shaffer said, with those reporting to the CIO or CMO saying that they need to go around them. They wont take up the big issues for me, she said. Still, we have predicted the CMO will win out as the natural reporting authority for CMIOs and their peers over time, Shaffer said.
About 87% of respondents are in their first job as a CMIO or an equivalent title, with 16% having been at the job for a year or less, 28% for one to two years and 30% for three to five years. Only 40% of survey respondents have team members reporting to them, while 60% did not.
More than half either wanted to stay in their current CMIO position, 49%, or wanted another CMIO post, 16%, elsewhere. Another 8% have higher ambitions and are aiming to be a CEO or COO. No respondents indicated they want to return to medical practice exclusively, a result consistent over the four years of surveys, Shaffer said.
Reporter Joseph Conn, based in Chicago, covers information technology.