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Moving Forward on Clinical IT on Multiple Fronts

July 12, 2010
by Mark Hagland
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Web-Exclusive Interview: Asif Ahmad and Kevin Schulman, M.D., Duke University/Duke University Health System

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.

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

Asif Ahmad

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.

Healthcare Informatics: 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.

Kevin Schulman, M.D.

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?

Ahmad: One of our physicians has already integrated remote monitoring onto his iPad. People get hung up on specific devices. But if you architect your technology to be scalable, adaptable, and flexible, and if you don’t make everything proprietary, but instead make it secure, you won’t have problems. We have a virtual patient information network. So if you make the architecture flexible and secure, you can hook up any device. And there are security limitations on iPhones and iPads. But our systems do not leave any data on any device. So the way we do it, you just use your device to access information, and then no data is left on the device. And I’ve been a CIO for over 10 years. But even back in 2000, I never had problems with physicians in terms of their not wanting to bring devices in—they always have, even when the laptops were very clunky. Indeed, physicians have been some of the first adopters of pagers, cell phones, and now smart phones. The question is whether the vendors produce technology that they ike and want to use.