Many CIOs say that making the case for I.T. requires involving a cross-section of clinicians from day one in assessing the need, selecting the technology, designing the features and overseeing the implementation. In some cases, hospitals and clinics are taking the extra step of paying physicians to get involved in these projects (see sidebar, page 40).
“I.T. people are the mechanics,” Lukens says. “We keep the car running. We don’t decide where it’s going and we don’t drive it. The groups of users heading the project drive it and then push it out to the rest of the clinical staff.”
When working with physicians, CIOs must keep in mind that each specialty has its own data needs, advises Frank Cavanaugh, principal at The CCI Group, a Homer Glen, Ill.-based consulting firm. “Physicians are above-average users of technology, so it’s not fear of technology that’s the issue,” he notes. “It’s trying to fit technology into what they do and not slowing them down.”
Many CIOs say it’s much easier to involve physicians and nurses in I.T. decisions now than it was a decade ago.
“Doctors see the benefits of technology now,” Lukens says. “Plus these kids coming out of medical school have grown up with technology, and they’re not afraid of it. The paradox is that physicians are much busier today and seeing more patients than ever, and yet they are willing to take the time to help with I.T. And it’s the same with nurses.”
Most hospitals now involve physicians and nurses in the important process of defining the functions of a new application, says Becky Quammen, CEO of Quammen Group, a Winter Park, Fla.-based consulting firm. For example, clinicians are designing templates for electronic health records “and they are determining how they will interact with the product based on their individual workflows,” she says.
A New Role for Physicians
Many larger hospitals are creating the position of chief medical information officer or a similar title, designating a physician to take a lead management role in I.T. (see November 2007 issue, page 42).
“CMIOs are involved in identifying how to use technology to support changes in processes,” says Cavanaugh, the consultant.
Mike Gorczynski, D.O., director of medical informatics at Aurora Healthcare, a 13-hospital system based in Milwaukee, has seen his role evolve in the last 13 years.
“In the early days, I was serving as a change manager, addressing such issues as vision, benefits and training,” he says. Now, far more physicians are getting involved in various I.T. committees, he explains.
“Today, instead of being the major voice for articulating various questions and needs on behalf of physicians, I facilitate the meetings of groups of stakeholders.”
Legacy Health System in Portland, Ore., recently hired a new medical director of information services who spends 70% of his time on I.T., spearheading an advisory council’s work on an ongoing electronic records project. In addition to that hire, the organization selected a physician, Dick Gibson, M.D., as its new CIO. “I can go to committees where doctors get together and speak authoritatively knowing what their budgetary and political complexities are,” he says.
Mark Nolte, a senior consultant at Beacon Partners, Norwell, Mass., is in the unusual position of serving as a contracted CMIO for a three-hospital delivery system in the Midwest that’s implementing clinical software from Eclipsys Corp., Atlanta.
An often overlooked way to help ensure the success of a software launch, Nolte says, is to make sure that physicians and nurses on the implementation committee receive at least a full day of training on how the software works very early in the deployment. “That way, they can make informed decisions when they design the workflow,” he adds.
Steering the Ship
The three-hospital LeHigh Valley network sets up steering committees for every major I.T. project. After using a committee of clinicians and others to oversee the rollout of hospital clinical systems from GE Healthcare, Waukesha, Wis., the organization formed another committee to oversee an ambulatory electronic records project, also using GE software. That effort involves a group practice of 400 employed physicians as well as a number of independent doctors.
LeHigh Valley is implementing EHRs at its clinics using the application service provider computing model.
“You have to get physicians involved from the get-go and you have to listen to them,” says Lukens, the CIO. “You have to show them the small, quick wins that can be achieved.”
Lukens approaches medical department chairs to nominate physicians who they think would be the best contributors to committees. “We also go to clinicians who we know are technically savvy,” he adds. “Unfortunately, we often keep going back to the same group of doctors and nurses.”
But selecting the right participants makes all the difference, Lukens stresses. “For example, they took a vanilla CPOE system and turned it into what we needed here.”
At 247-bed Good Samaritan Hospital in Vincennes, Ind., a 13-physician health informatics committee is weighing whether to invest in CPOE.
“Some of these systems are finally maturing enough that they no longer will be viewed as a hindrance,” says Charles Christian, CIO. “But we’re taking a long-term, measured approach.”
Christian stresses that hospitals must introduce technologies that support the way physicians work. “Physicians are taught how to think in specific ways, and if you introduce something that causes them to think in a different way, it won’t work,” he says. “So we try not to throw too much technology at them at one time.”
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