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Moving Forward with Clinical IT on Multiple Fronts

September 29, 2010
by Mark Hagland
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An Interview with Asif Ahmad and Kevin Schulman, M.D., Duke University Health System/Duke University

Many things are happening these days at Duke University Health System in Durham, N.C. Under the leadership of Asif Ahmad, vice president, diagnostic services and CIO at Duke University Health System, and Kevin Schulman, M.D., professor of medicine and business administration at Duke University, the Duke organization has been moving forward strategically along numerous dimensions. Ahmad and Schulman spoke recently with HCI Editor-in-Chief Mark Hagland regarding their organization's multi-pronged push forward.

Asif Ahmad
Asif Ahmad

Healthcare Informatics: At Duke, you've been moving forward on a number of fronts with regard to information technology.

Kevin Schulman
Kevin Schulman

Asif Ahmad: We're really approaching healthcare information technology more strategically now.

Kevin Schulman, M.D.: On the academic side, it's been interesting to focus on how to train a generation of leaders with regard to the application of information technology. And organizationally, are we trying to make organizations more efficient? To create more value? To create innovative organizational forms? And how would IT apply to that? We're looking to answer those questions.

HCI: What is your strategy around clinical IT at Duke?

Ahmad: We like to think for ourselves. And one of the things I've seen is that the EMR vendors tend to focus on functional issues such as how you get from point A to point B; they really don't put intelligence into the system to determine whether you got from point A to point B optimally. So our strategy is either to work with the big EMR vendors to customize their products, or for us to go ahead and put systems around those EMR products. No commercial EMR really focuses on active engagement with the patients, so we've created a patient portal. And to build the best practices around clinical care models, you really have to engage the patients. No commercial EMRs right now really optimize patient portals. So we've built a very interactive patient portal, which gets data feeds from the EMR system, but really drives patient interaction around wellness.

So our clinical IT strategy is really about driving what Kevin has already said, which is creating clinical value at the bedside or at the side of the patient, even at home; so we're trying to drive consumer adoption, positive patient outcomes, and positive financial outcomes for the system, by aligning clinical IT in the disparate packages available in the market, around our own systems. And it's very much focused around healthcare analytics and business intelligence.

Schulman: I've been involved in a project looking at how we get patients access to their own information. There are two sides to this equation: What's the right architecture to allow patients to get access to their own information and have a continuity record? And how can we bring the information to them in a portal, as we're doing at Duke? So we've spent the past two years integrating the different clinical data sets, and we're now integrating them into the clinical data repository, through the portal. And in terms of patient imaging, you come here to get cardiac catheterization and angioplasty, but you go back to your referral site, and then you can't access the films. We've just brought that data repository live.

Ahmad: And again, this was driven out of the need to provide just-in-time communication to the patient and to the provider (whether the provider is at Duke or not), and two, to let the patient own their own information. It still amazes me in 2010 how few organizations believe in giving the patients their information, even though the federal government has a rule on that, in the context of HIPAA. From the IT side, from the EMR vendors to hospitals, they tend to make it virtually impossible to make that happen.

HCI: What is your strategy around handheld mobile devices, especially those being brought in by physicians and other clinicians on their own?