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One-on-One With St. Vincent Health CMIO Alan Snell, M.D., Part II

December 29, 2009
by root
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In this part of our interview, Snell says the Policy Committee was wise to tread lightly around CPOE.

A member of Ascension Health, the nation’s largest not-for-profit and Catholic Healthcare System, 1,600-bed St.Vincent Health is Indiana’s largest healthcare employer, with 17 health ministries serving 45 counties in central Indiana. The organization boasts 1,200 employees, 18 acute care sites, two LTACs, and 225 employed physicians. With $3 billion a year in revenue, CMIO Alan Snell, M.D., certainly has his hands full. Recently, HCI Editor-in-Chief Anthony Guerra caught up with Snell to learn more about how the CMIO role is evolving.

(Part I)


GUERRA: Do you think the battle to ensure clinicians are involved in the technology-selection process has been largely won?

SNELL: I don’t know if you can say the battle is won. I think CIOs are increasingly realizing they need heavy clinical input at the beginning of the process, and that does involve vendor selection. It’s not about device selection, although that’s important too, but it’s more about workflow and functionality, especially on the analytics side.

I think some organizations would say, “If we had to do this whole EMR implementation all over again, we would have paid a lot more attention to the output of the EMR system and being able to get the data and turn it into usable information and knowledge to improve our workflow and make us more efficient. And most importantly, to make a significant improvement in the quality of care delivered.” If you do it right, you can use the tools for that.

So what I try to do now is make sure that when we’re evaluating new tools and technology we’re not just looking at functionality, but also what’s the output going to be, and how we’re going to format that, and how we’re going to make sure we can extract that data and put it into meaningful reports that can be used in real timeand that’s what we’re striving to achieve.

And then the area parallel to that is the embedded decision support piece. I think, again, that’s something that, in the past, organizations have failed to recognize, but having that embedded decision support, so the order sets and the alerts actually guide physicians and help them make good choices, is what this is all about. So that’s where I see the role of the CMIO as being most helpful.


GUERRA: I Tweeted that I was speaking with you today and received a couple of questions. I’d like to ask you them now.


SNELL: Sure.


GUERRA: The first one is “Do you believe that doctors capture less information in an EHR because of typing, and what is your opinion on speech recognition to preserve the physician narrative?”


SNELL: Well, I don’t look at it as either/or, I look at it as both. I think you have to have a heavy penetration of structured documentation. You can supplement that with a narrative, because it’s hard to build templates of structured documentation which really cover everything that a physician learns while interacting with the patient in an exam room or at the bedside. And if you make it too difficult with structured documentation, then they’ll just take shortcuts and you don’t really capture the essence of that interaction.

Again, on the other hand, if you just do dictation — voice recognition or standard dictation — you’re going to miss out on reporting capabilities. So I think that you want to move toward as much structured documentation as you can achieve with good tools that are hopefully easy to use, and then you can supplement — especially the history of the present illness and maybe the assessment and a few other things — with a narrative. But things like the physical exam results and picking a diagnosis need to be as structured as possible.


GUERRA: The other question is “Do you have any thoughts on the preliminary definition of meaningful use before the ink dries’?”


SNELL: That’s a great question. I like the direction that they’re going, the HIT Policy Committee. There’s been a lot of criticism, of course, leveled toward them, such as they’re setting the bar too high, but I’d rather set the bar too high than too low. I know people are complaining and they’ve had thousands of comments about it, but I actually like the direction that we’re going, and everything that they’ve inserted in there is achievable.