Rowing Together

In southeast Florida, Christi Rushnell and James Shaffer, M.D., have been crafting an EMR implementation strategy that is strongly physician champion-based. Rushnell, vice president of information technology at the three-hospital HealthFirst Inc. system based in Rockledge, and Shaffer, the medical director of the health system's electronic intensive care unit (eICU), have been focusing on phasing in physician and nursing documentation and CPOE over time and across their organization's three facilities (set to become four next year). In addition, because most physicians in South Brevard County are already live on some form of EMR, Rushnell says her team's strategy will emphasize the health information exchange (HIE) aspects of data-sharing and computing.

Daniel Barchi

Lessons from Pittsburgh

What elements do all these organizations and strategies have in common? Fundamentally, all those interviewed for this story agree, clinical IT implementation is about several things: clinician workflow, care delivery systematization, strategic planning at the highest levels of the organization, strong execution, and, ultimately, a successful culture. Indeed, because of the complexity of hospital and health system organization operations, the complicated nature of relationships among the various stakeholder groups involved, and the challenge of moving forward quickly in the current policy/reimbursement environment, CIOs, clinical informaticists and industry experts all agree that the only way that patient care organizations will succeed across their clinical IT implementation challenges will be to build strong, skilled, highly capable, leadership-supported clinical informaticist teams-now.

But before CIOs rush out to start to populate such teams, clinical informaticist leaders say that CIOs and other IT leaders need to consider how different these teams will necessarily be, regardless of whom they report to (and team members may or may not report to the CIO in an organization, depending on a variety of factors). “One thing that most CIOs do tremendously well is that they have a management team, and they'Re used to having a point-to-point reporting system, so that, when they speak, their managers generally follow in lockstep,” says G. Daniel Martich, M.D., associate chief medical officer and CMIO at UPMC health system. “With clinicians, it's a different situation altogether. There's largely an equal playing field, and everyone has almost an equal vote in how things should be run. Everyone's got veto power.”

Each of us brings something unique to the table, and we all appreciate that. It's a synergy that's hard to put into words, but you know when you have it. - Marianne McConnell, R.N.

And Martich knows whereof he speaks. Having been system CMIO for over 11 years at UPMC, and having been involved in clinical informatics work in some form since he joined the organization 18 years ago, he has been by definition a pioneer physician informaticist. Working closely in tandem with Dan Drawbaugh, UPMC's senior vice president and CIO, Martich has helped lead the implementation of the full range of clinical information systems across the UPMC organization. What's more, he and his colleagues have shown national-level leadership in leveraging clinical IT for dramatic improvements in patient safety, care quality, efficiency and other areas. But, says, Martich, really good clinical informaticists are always going to be challenging to find and groom, and, he adds, it has taken years for his team of informaticists to build the team-ness they now have, and which professionals across the UPMC organization frequently remark on.

To be successful, Martich says, “Clinical informaticists first have to be respected clinicians. Then, they've got to know technology to some extent; and their communication skills have to be exceptional, because they'Re going to be taking a lot of guff from clinicians at times. The physicians will be frustrated that they can't do their jobs in the same old way anymore; and most clinicians don't usually know how to ask the right questions. That's where the translation aspect comes into play for many of us.”

Marianne McConnell, R.N., UPMC's executive director, clinical and operational informatics, agrees with that assessment. “What informatics is all about is the interaction with the end-users and understanding the workflow. And this is a team of informaticists who really does understand what the work is about, and that can dissect the workflow and put it back together in a better way, with the end-users’ input. We all started out with applications that had limitations; but if you have people with vision and who can build a strategy, they can improve those applications.”

As for the UPMC team of clinical informaticists, McConnell says that “We feed off each other, and are very reliant on each others’ overlapping skills and knowledge. Each of us brings something unique to the table, and we all appreciate that. It's a synergy that's hard to put into words, but you know when you have it.”

Dan Martich