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Live From HIMSS: The AMDIS Physician's IT Symposium - Part One - Who needs physicians?

April 5, 2009
by Joe Bormel
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Live From HIMSS: The AMDIS Physician's IT Symposium -



Part One - Who needs physicians?






Photo from HIMSS 2009:

Bridge to where?





(Link to Part Two)




All of the HCI Bloggers have, in one way or another, touched on the roles of physicians in HCIT. The topics of "physician" -- adoption, resistance, leadership, involvement in CDS, involvement in {order sets, reporting, quality, ...} -- are all well recognized domains with which HIMSS members are very familiar. They're all likely to impact success against achieving the ARRA hurdle requirements, whatever they are. (We'll know next month, of course, at least at the public comment phase.)




As a definitional thing, I'll group physician roles into three:

Executive Sponsorship,

Change Agents, and

End-Users. AMDIS has, for more than 10 years, been among other things, a social network for the former two groups of physicians. Almost all of AMDIS members are CMIOs, or functionally equivalent in provider organizations. It's a very strong and smart organization. For the last ten years, I have encourage physicians in HCIT leadership at their institutions to join and attend AMDIS events like this one.




Well over 200 physicians came in Friday night to attend the all day meeting on Saturday. (Thanks Bill for count.) Almost all had 10+ years of Medical Informatics experience, many with multiple vendors. About 75% (based on last years survey with AMDIS/Gartner) are still seeing patients; most have well over 10 years of medical practice experience, like me, in very demanding practice areas including critical care medicine, surgery, demanding primary care, and just about every other medical specialty. Interesting. Informatics has come of age.




If you are a physician working in this world, you're really not alone. It just feels that way!




Here are a few observations and recommendations:




In perhaps the last 5-7 years, the work of CMIOs has blossomed. For the first time, I'm hearing:





[Multi-hospital system - containing AMCs, community hospitals, long history of industry leadership]

"We've determined that we needed a separate CMIO for inpatient and outpatient. There's more than enough distinct work for two full time CMIOs. The inpatient and outpatient work is different and both are critically important to our organization. With ARRA, we only see that increasing."





[different organization/ different state, community hospital ]

"We have 4 CMIOs in our organization."




On the other end of the spectrum, there are large number of organizations that are still not prepared to hire one. Budget is one big recurring driver. There were a few practicing physicians from organizations that did not have a CMIO or equivalent role, such as a director title or VP of Clinical Services, with a leadership responsibility related to HCIT.




What's telling here is their strategy to field that work. Options if you don't have a CMIO and won't in 2009:




1)

Bring in an MD consultant. Several of these accomplished and proven docs were at the AMDIS meeting, often facilitating with obvious aplomb. There are things like readiness assessment, physician leadership development, and roll-out/usage buy-in that may be best done by dispassionate, experienced third-parties.




2)

Staff it internally with a non-MD. I've seen this work well several times, when it's adequately staffed, and the work could be effectively led by an IT-savvy nurse, and when that nurse reported to the CNO (not the CIO, IT director, etc., ... sorry).




3)

Have your IT vendor staff the role. I'm explicitly not describing my current organization's recommendations, either for or against this approach. Based on my experience with other vendors, vendor physicians or other vendor professionals work best when they are subordinate to peer-level, employed physicians of the health system. At least for several months, this is often full-time, on-site work. Note that organizational barriers are never effectively managed by outsiders.




4)

Other options?




In my opinion, that's roughly the order of desirability. Again, I am not speaking for any vendor or other organization.




With ARRA incentives on the horizon, here's how AMDIS' Bill Bria summarized the situation, regardless of how you staff the physician leadership, drawing from a classic movie:





I was the first audience member to correctly identify the movie. Can you name that movie?

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Comments

Joe, I wish I was there. Thanks for the report. As a disclaimer, I am not impartial as I am considering executive positions and also have been part of each of your described scenarios. I do have some strong opinions.
I am impressed when CMIOs somehow have the time and energy to practice medicine and run a clinical systems department. This seems to work best when implementations are already down the road. The early phases of implementations are so time and energy intensive that it helps to have a full-timer. I also find that in the early days an outsider has a better chance of dodging all of the internal politics that plague start-ups. Also physicians seem to respond better to an outsider who has already been through the process before.
I have to agree that I too have seen a nurse successfully manage an implementation. There were physician "figure heads", but the real driving force and management was extraordinarily managed by a nurse with 10+ years of informatics experience. It isn't just the medical staff that gets impacted by the EMR and a nurse can sometimes connect better with all stakeholders.
My only disagreement is with having vendor physicians subordinate to employed physicians. Often, the consultant is called in after a failure or at a point of crises. It is a terrible spot for a consultant as everyone is defensive and often persistent in maintaining their personal course of action. Too many consultants make concessions to the employed leadership in order to preserve good will and avoid conflict. By accepting leadership a consultant can reshape the implementation from the top down and avoid some of the inevitable power struggles. Although never easy, organization barriers (so culture specific) can be managed by a strict set of policies and procedures and appropriate governance. Sometimes an outsider can best drive that initiative.
I am looking forward to future reports.
Jim

Jim,
Great points.

I am not a fan of the 'vendor physician,' subordinated or otherwise, in the role of visionary, facilitator or, heaven-forbid, change agent. You summarized the common scenario very clearly.

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Joe Bormel

Healthcare IT Consutant

Joe Bormel

@jbormel

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