Physicians Aggressively Pursuing I.T.

Bill Briggs, Senior Editor
Health Data Management Magazine, September 2006

When Triangle Orthopaedic Associates started looking at electronic medical records systems in 1999 there were many new vendors offering tools to manage patient records via computers. William Mallon, M.D., was so enthralled by the idea he helped his practice's fledgling vendor design its EMR.

Many startup vendors vanished into the ether in the dot-com bust, however, and Triangle Orthopaedic's vendor was absorbed by another. But the I.T. bug had bitten Mallon, and he's still an active player in the Durham, N.C.-based practice's technology initiatives.

Since 2000, Triangle has installed three different practice management systems and Mallon is assisting a company in designing an EMR. "I'm kind of into computers and I.T. stuff," he understates.

His comment and efforts reflect a common commitment among physicians who have chosen to take on a leadership role in the use of I.T. Many of them, especially outside the hospital setting, do not have a technology title or formal I.T. duties. But they have taken on equivalent responsibilities just the same, on top of their clinical roles.

"Physicians are getting a sense of the importance of the I.T. task," says William F. Bria, M.D., chief medical information officer at Shriners Hospitals for Children, a 22-hospital delivery system based in Tampa, Fla.

"It's one of the most important 'aha' revelation points as they move from being casually involved in I.T. to physician champion to the longer term and more risky step of pursuing permanent information technology positions."

Whatever the setting, physicians who push for new information technology tools are developing skills-often on their own-and doing so in greater numbers.

"More physicians have gone from viewing I.T. as 'Oh, isn't that interesting,'-like a singing pig-to sitting in the executive board room," says Bria, who also is chairman of the Association of Medical Directors of Information Systems, Lake Almanor, Calif.

Many physicians who spearhead I.T. initiatives say necessity breeds their interest and curiosity brings out the scientist in their nature. Some of these innovators go looking for specific new technology, but others encounter them by chance.

At the 20-physician Triangle Orthopaedic Associates, EMR and practice management technology was in use, but there was room for improvement, Mallon says. There also were more products on the market from which to choose as vendors in the space continued to enhance their products.

Four years ago when visiting a friend practicing in Texas, Mallon came across an application from Watertown, Mass.-based athenahealth Inc.

"We liked it, but had just bought another practice management system," Mallon explains. "Then we got a new CFO and in 2005 he talked about looking at athenahealth again."

Athenahealth offers Web-based practice management software and business services for a percentage of a practice's revenue. Triangle Orthopaedics went live on the practice management application in May.

The practice also is exploring options for a new EMR, an area of strength for Mallon. He has written program code for EMR systems and has seen enough applications to know what works and what doesn't. He also has designed computerized operating notes software, which athenahealth licenses.

Mallon majored in math in college, which helped him quickly pick up programming skills.

"I would have majored in computer science, but it wasn't offered when I went to Duke," he says. His theory on tweaking applications is process-driven. "I never want to do anything on a computer three times. Twice is OK, but no more." His solution is to write codes or macros to shorten steps and streamline repetitive tasks.

Administrative and clinical factors driven by practice growth led physicians at St. Luke's Family Health LLC in Boise, Idaho, to deploy new technology.

Five of the practice's 14 physicians joined the group this past summer, says Bill Crump, M.D. The sunsetting of the group's practice management system was seen as an opportunity to replace it with technology that would enable the practice to keep up with the increased volume of data. The only way to expand the practice would be to go with an EMR, he says.

Crump had been interested in EMR technology for 10 years, since his residency days. He volunteered to do some legwork to examine available products that began with a trip to the 2003 American Academy of Family Physicians meeting.

What he saw was a mind-boggling range of functionality and pricing.

"Per-provider fees ranged from $5,000 to $50,000," he notes. "The average family physician with $325,000 in annual revenue is not going to be able to pay $50,000 for an EMR."

St. Luke's Family Health was using a rudimentary charting application, but it was too basic for the practice's needs. "We wanted something sophisticated, but affordable," Crump says.

Crump and members of a technology search committee investigated a half-dozen systems and then asked for demonstrations. He and the practice manager then attended the Towards the Electronic Patient Record Conference & Exhibition in the spring of 2004.

Meetings and displays

"We went to all the meetings and saw all the displays," Crump says. "By the end of TEPR we had an idea of where people were, and the practice was committed to doing something."

After extensive demos and reports from the search committee, the group selected practice management and EMR technology from eClinicalWorks LLC, Westborough, Mass. Both systems rolled out in October 2004.

Crump and practice leaders liked the applications' programming ease. Early connectivity issues to its four sites were resolved by using a shared data server maintained by St. Luke's Regional Medical Center, also in Boise.

The price also was attractive. Licensing was $10,000 for the first physician and $5,000 for each additional doctor. The practice's two nurse practitioners were included at no charge, Crump adds.

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