For Effective I.T. Governance, Focus on Patients

Lutheran Health Network is a nine-hospital delivery system centered in Fort Wayne, Indiana. And its member hospitals are at various EHR adoption levels. But two of the hospitals have virtually eliminated paper orders, and the others are on their way up the ladder. Getting physicians and other clinicians to embrace order entry and other clinical I.T., says Matthew Sprunger, M.D., chief medical information officer, is largely a matter of maintaining the right perspective. "The front line nurses don't care about meaningful use," Sprunger told attendees at a HIMSS educational session on effective I.T. governance. "They are focused on patient care."

Lutheran Health Network has abandoned some common I.T. nomenclature to reinforce that message. It refers to CPOE, for example, as "computerized patient order entry," substituting the word "patient" for the more commonly used "physician." To gain adoption of clinical I.T., organizations need to focus on benefits in safety, quality and efficiency, Sprunger emphasized. "I'm a technophobe in the CMIO role," he said.

To manage its I.T. efforts, Lutheran created a clinical informatics committee, which is led by physicians and reports to various medical executive committees, Sprunger said. Members include physician, nursing and pharmacy leaders. As the deployment has unfolded, Lutheran also added representatives from patient registration. It proved to be a smart move to improve the overall quality of the information food chain, he said. "Without registration, nothing gets done," Sprunger said.

Understanding physician temperament is another key to their acceptance of clinical I.T., added Mrunai Shah, M.D., who serves as vice president, physician technology services, at OhioHealth, a 10-hospital delivery system in central Ohio. Shah formed a "physician I.T. special interest group" to help the provider organization facilitate adoption. "You will experience many uncomfortable moments asking physicians to serve on a team," he said.

For one thing, physicians see themselves as captains of the clinical ship, said Shah, himself trained as a family physician. But in a group, not all physicians can be the leader. Shah's early efforts with the physician group proved contentious, so he regrouped and drafted a new charter for the committee. As part of the package, Shah clarified the roles physicians would play and stated they would need to work within realistic timeframes. Otherwise, many physicians have unrealistic expectations about the time it takes to develop clinical applications. "Ninety days is a really long time for physicians," he said. "They want everything within the hour."

OhioHealth also pays physicians for their I.T. committee time, he said. That underscores the importance. Word-of-mouth marketing about the value of I.T. has helped OhioHealth expand its use of order entry and other applications. A handful of smaller hospitals within the provider organization have retired paper charts, he said. "As physicians realize that other physicians have been involved in system design, buy-in becomes considerably easier," he said.


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