One-on-One With Caritas Christi SVP & CIO Todd Rothenhaus, M.D., Part III

But I can see that if you’re a hospital that can’t spend anything on EHR adoption for affiliated physicians, you could certainly find that groups are leaving you. These EHR dollars are small compared to the dollars that you’ll see by aligning with different IPAs. I mean the stronger IPAs generate major money, that’s just a fact of life, so this is only a part of the budget for an independent physician practice. But I do think that groups will align with the systems who have more means, just as they have been doing in the past based upon rates they can get from insurance companies.

I think it’s an accelerator to what’s already happening, which is this alignment, almost an exclusive alignment relationship with different health systems as opposed to the freelance doc who admits patients to four or five different hospitals and doesn’t really have a tight alignment with any one of them.

GUERRA: Tell me about lessons you’ve learned from working on CPOE. Does being an M.D. give you special insight into how to make it work?

ROTHENHAUS: That’s a good question. I think there’s a couple of things. When I started at Caritas Christi my first position was chief medical information officer. It’s a new role, and I thought it would be a great way of getting into the administration. It was a great pathway. I think that the CMIO role is there to translate requirements between the IT department and the clinical community, and it certainly doesn’t have to be a chief medical role, it can be a nursing information officer or a clinical information officer, but there is this stronger and stronger role to have clinical people embedded in IT.

It’s surprising that you can go to places that are implementing the same system – whether it’s a hospital system up on the floors or an ED system or an anesthesia system – but two customers can be implementing the same system with wildly different results. The physicians can have their shields up on one side and they can embrace it on the other. So obviously the implementation and the clinical transformation is critical, because the software is the same and physicians are fundamentally the same, although it may be the cultures at institutions are different. But the wildly divergent success of projects based upon the same vendor offerings is a real tip off that there are ways of messing this up and ways of doing it well. And I think having clinical people embedded in IT is the key.

The one advantage I might have is that I was part of that culture so I know how to work with reluctant adopters. It’s also important to be a realist and say, “Well, this is the way it’s going to be; it’s going to be hard for the first six months in your practice and there’s no way around it, but eventually you’ll like it. I promise you.”

I don’t really see myself as having any real ace in the hole. The CIO skill set is so diverse that I don’t feel like there’s really much of a leg up that I get from being clinical anymore. I do like being clinical, and it helps to be clinical when I go to certain meetings, but it’s in no way a true differentiator. You can be a great CIO without being a clinical person.

GUERRA: So having been a physician doesn’t mean you have a silver bullet that other people don’t.

ROTHENHAUS: Well, it has to do with the culture of that physician relationship. Within our own health system, we don’t want to alienate our physicians by creating awful workflows and inconveniencing them and making it a hard place to practice medicine. You just don’t want to do that.

Note that the first wave of wonderful articles about IT adoption in healthcare all came out of teaching hospitals. If you think about it, the most talented labor pool in the world is house staff. I mean, they’re brilliant people, they’re all young, and they can do anything. And so you could give them a terrible system and they would make it work, and they’ll work harder just to churn through because they want to get home at the end of the day just like anybody else. But you take a guy who is worth something to your hospital and is busy and could go to a hospital right across town instead of your place; you really don’t want to damage that physician alignment by creating bad stuff.

So a lot of hospitals will look at this and say, “The physicians don’t want to do it,” and they just stop. Other places – whether they have house staff that are going to bear the brunt of most of the work, or they have strong leadership – will just push it through regardless. Maybe it’s a hospital that has no competitor locally, so they’re not going to damage their physician alignment by doing CPOE. But those middle-ground hospitals where that’s a big issue, I think it helps to have physician leadership in the IT department to do the job as well as you can possibly do it. It’s important to get into a collaborative cycle where you’re building the system, taking a look at it, showing it to the docs, showing it to the nursing staff and saying, “Does this work for you?” and then going back and doing it again. It’s almost like regression testing. You just want to keep going through it until you take away as many clicks and take away as many menus and pop ups as you possibly can. You need to clear all that away and make it physician or clinician friendly.