It's well known that clinicians are not unanimously in support of information technology, for a variety of reasons, one of which is that the medical community is not entirely convinced that electronic records and ancillary systems actually improve patient care; and another being that capital poured into I.T. infrastructures is money not spent on other areas of clinical improvement.
But, supportive or not, clinicians can see which way the winds are blowing, and they're all blowing in the direction of adding layers upon layers of I.T. But if you read through the mission statements of health care provider organizations, you don't see I.T. mentioned. And while I.T. might be an underlying topic of virtually all conversations at the executive level, C-level leaders say that all those technology endeavors still have to run through the gauntlet of the true clinical mission.
Uphill battles
At Lower Bucks Hospital in Bristol, Pa., information technology used to face an uphill battle when competing for capital dollars, recalls John McHale, executive vice president and CIO. If the radiology department wanted to purchase new imaging machines, it could show a clear-cut return on investment and impact on patient care. By comparison, the ROI on clinical software was much harder to pin down, as were the concrete benefits to patient care.
But that was then, this is now. "We're going after meaningful use dollars, and everyone, from the board of directors to the radiologists, can see those dollars are available now, and in a few years you're going to see your Medicare reimbursements cut if you don't have an EHR. So the C-suite is a lot more incentivized to support I.T., but that doesn't necessarily make your job any easier. Information is just a tool in the toolbox that you use to improve your patient services."
Even with all that momentum behind I.T., aligning HIT initiatives with clinical care is not necessarily easier to do. In fact, the laser focus on becoming a meaningful EHR user and grabbing those federal dollars sometimes makes it a challenge to see the forest through trees.
Even with all that momentum, C-level executives have to tread carefully to ensure information technology supports the overall, and overriding, mission of patient care. Meaningful use has been a double-edged sword for executives in terms of aligning their I.T. efforts-and capital expenditures-with their primary mission.
Razor's edge
Ted Matthews, CEO at Eastland (Texas) Memorial Hospital, has been on that razor's edge at two different hospitals. Until December, he led 25-bed Anson (Texas) General Hospital through a project to create a regional health information exchange, using a common electronic health record, with some of its local competitors.
Matthews' mission for the last two-plus years has been to garner meaningful use dollars. His aggressiveness stems from the fact that he, as a long-time hospital exec, can see the fundamental improvements electronic health records can make, he says.
Meaningful use has created a window wherein rural hospitals like Eastland and Anson can basically cover the costs of their automation, moving them into a new realm of patient care and, if successful, receiving meaningful use dollars.
"The reality is that we have a pie, and everyone, from physicians to nurses, want a slice of that pie for what they see are necessary expenditures for patient care," Matthews says. "But right now, I.T. is getting a bigger slice of the pie, and that requires some hard choices and some tough conversations with clinicians.
"It's 104 degrees out here today, and we have some aging HVAC units on the roof that need to be replaced. Salary increases are going to be chipped away at, and other capital expenditures are being put on hold. We plan to attest very soon, and when we get the $1.4 million we anticipate we'll receive, then we can retire the debt on the EHR project and have something left over to address our needs. But behind patient care, this is our second biggest priority right now."
The conversations about I.T. aligning with the corporate missions have different tenors. For small, rural facilities, leaders are pushing I.T. because without it, there may be no mission-care facilities that can't "play" in terms of I.T. have to shutter their doors if they can't provide the evolving evidence-based standards of care and support analytics and quality reporting the federal government is requiring.
But leaders at larger organizations still struggle with ensuring their technology is taking them to the next level. I.T. still has to compete with myriad other demands for capital dollars and face scrutiny from multiple stakeholders before it gets a green light.
At Marshfield Clinic, this mission is straightforward, according to the organization's mission statement: "to serve patients through accessible, high quality health care, research and education."
Asked if Marshfield Clinic executives take that mission seriously, Karl Ulrich, M.D., president and CEO at the clinic, notes that those words hang on the wall of the boardroom. "When we're not sure which direction to go, we use those words as a guiding philosophy for what we're trying to accomplish. Does that mission statement come up during the executive conversations we're having? Yes, it does, all the time."
Marshfield CIO Ken Letkeman, for his part, says that his staff reviews that mission constantly.
Why are those words so important? "Because those words turn into real things," he says. For example, "accessible" was inserted a few years ago, and that single word has been the impetus behind millions of capital dollars being spent on patient services such as a comprehensive patient portal, as well as online services that connect patients directly to their clinicians.
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