Physicians love a CIO who lets them focus on patients, not technology

by Donald Burt, MD

Many hospital CIOs face an uphill battle winning the hearts, minds and fingers of physicians. It’s not because doctors are technology phobic. Quite the opposite: physicians are some of the most ravenous consumers of new information technology.  Smartphones and tablets are becoming as ubiquitous as stethoscopes at many hospitals.

The truth is doctors are happy to make screen touches, mouse clicks and keyboard strokes if the application is right.  But all too often it’s not – at least not for them; and that gets to the heart of the issue.

The software that CIOs often try to “sell” doctors on using typically wasn’t designed with physician users in mind. Some of these applications end up taking more of the physician’s time than the good old paper way of doing things.  And the CIO, who is not an MD, can’t fully appreciate how cumbersome, distracting and unproductive a traditional hospital information system (HIS) can be for a physician. Indeed, physicians love a CIO who enables them to focus on their patients, not technology.

The hard truth is computerized systems that don’t fit into the physician’s workflow don’t stand a chance of being readily adopted by physicians – and that includes systems like CPOE, which are part of the ARRA-HITECH “meaningful use” requirements.  Reluctant or grudging physician adoption is therefore a big problem not only for CIOs, but for the entire executive leadership team at hospitals, because now it impacts regulatory compliance and revenue.

The title of a recent study by the Economist Intelligence Unit (sponsored by NEC) accurately sums up the current situation in hospital IT: “Under pressure: The changing role of the healthcare CIO”.  The study, based on a survey of 100 senior IT executives at U.S. healthcare providers, reports several top-line findings that struck me as spot-on:

“CIOs also need to secure the buy-in of clinical staff when planning and rolling out new IT.”

“Changing the behavior of those who use the technology — doctors, nurses and other staff — may be a greater challenge than managing board-level expectations.”

Bingo! And that is precisely why CIOs increasingly are not being left to operate alone.  A growing number of institutions are “teaming” the CIO with a Chief Medical Information Officer (CMIO), an MD who offers exactly what the CIO needs: a physician deeply enmeshed in the hospital’s clinical systems who can be a credible and effective liaison and technology advocate with physicians. The CIO never studied medicine, and the CMO never studied IT, so employing a CMIO gets hospitals a blend of complementary skills, and an invaluable partner for the CIO.  As a team, they are sitting at the “big table,” making strategic, $20+ million purchase decisions for their hospitals related to IT projects that will extend out over four years or more.

Many hospitals have come a long way in a few short years.  No longer is the CIO merely a tool of the CFO, trying to force physicians to use a multi-million dollar HIS that the board of directors was persuaded to purchase. When I ran a health network in Western Massachusetts, I suggested that the role of the CMIO should be “the defender of physician workflow.” The key for hospitals is to make physicians want to use their HIS systems, rather than be forced to use the systems. Beating affiliated doctors over the head with a stick hasn’t worked – witness the single-digit adoption rates of commercial CPOE systems over the past 40 years – and it isn’t going to work now.

As hospitals look ahead to Stage 2 and Stage 3 “Meaningful Use” requirements, it will become even more essential that doctors willingly use the HIS. CMIOs will play a greater role in ensuring this happens by keeping IT focused on what matters most: providing productivity tools to physicians that streamline their workflow and that deliver more useful and timely clinical information, which can be applied to improve patient outcomes and let doctors focus more of their time on patient care.

Using this kind of physician-centric approach, I predict hospital IT groups won’t have any trouble winning physicians’ hearts, minds and fingers.

Donald Burt is Chief Medical Officer of PatientKeeper Inc.

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  • JF Sucher, MD FACS

    From my experience, the CMIO is a gelding who’s job is to accept the beatings from the staff instead of the CIO (if one even exists). For that matter, the CIO is rarely a “C” in the org chart and therefore lacks much of the power necessary to move the mission forward.

    This “power” couple not only lacks much power, but they lack good tools. The industry has not innovated significantly in the last 25 years. We are being sold technology that was created at least that long ago. It’s only advancement lay in the improvement in operating systems, networks and databases. The workflow remains poor and it’s ability to help automate processes and augment provider care continues to remain in the realm of experimental clinical domains.

    So… great chearleading post… I’m sure the CMIOs and CIOs out there now feel the warm fuzzies. But honestly.. there’s work to be done and innovation that awaits. The EMRs, EHRs, PHRs, etc can change the face of medicine. But not with the tools that we’re bogged down with today.

  • Med Nerd

    True statement, but it’s amazing how back-asswards the overwhelming majority of hospital software it. The simple fact is that technology should simplify and streamline workflow, the moment it ceases to do that it becomes a hassle, frustrates doctors, and ultimately compromises patient care.

    Forward thinking hospitals need to realize that investing in a solid IT infrastructure vetted by a DOCTOR is the best thing they can do.

    It reduces medical errors and lessens liability when there is an easy system that can document every aspect of patient care.

    I’m a medical student and I know tech better than half of the jokers we call IT staff around here, but you could never pay me enough to take a “CMIO” job because it would inevitably become emasculated by short sighted hospital administrators who are still stuck in the 80′s. :-P

  • jsmith

    I was at the medical staff meeting at our hospital this past Tuesday evening. The administrator and his doctor henchman are trying to force a computerized physician order entry (CPOE) down our throats. It is based on Meditech, the system our hospital uses. Beloved by hospital administrators, loathed by doctors and nurses. The new system left us shaking our heads–it is simply horrible. One of the local internists leaned over and said that the new system is like the Commodore 64 he used in the 80s.
    It will be interesting to see how this plays out. Only a few of the docs are employees, most are like me, on staff. We’ll see about the pushback later.

  • ninguem

    Some of the earlier EMR vendors gave me these lovely presentations. They demonstrate the generation of a typical chart note. It took longer to write the note than it would take for the office visit itself. And the price of the EMR for a solo practice, absolutely staggering. I think I’d sell my practice for some of the prices asked for a EMR for a solo practice.

    The insulting part, I have a (non-lawyer) relative who runs the office for a 6-lawyer law firm. He computerized their practice. An electronic LEGAL record did more, the firm offered direct hands-on training of the lawyers, paralegals, secretaries, and for all that, cost less than most of the EMR’s I was offered.

    Then there were the contracts that allowed the firms to hold your data hostage if you switched systems. Pay through the nose to transfer the data. I narrowly missed getting hurt by that early

    And then the self-styled “experts”, claim the docs are technophobes for resisting EMR’s.

  • horseshrink

    I believe the best catalyst for EHR evolution and cost reduction is standardization of data constructs.

    If docs can change products at will, without the pain of database migration, EHR developers that want to remain in the market will become very interested in what docs actually want.

    As it is, right now, buying an EHR marries vendor and client via the proprietary database.

    Data migration cost + new product cost = very painful divorce

  • Molly Ciliberti, RN

    Ditto for nurses, most nursing documentation and input for EMR’s sucks. You have to learn to work around it and it increases your overall work load.

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