So much has happened in the arena of clinical computing in the past 10 years that it would take a book-length white paper to map out just the key currents and cross-currents in terms of major developments. Yet one thing has been, and remains, true throughout: making computing work, in every sense of the term, for practicing physicians, has continued to be at the crux of the Gordian knot of issues to work out.

That’s not surprising, since physician workflow optimization continues to be a key driving factor in improving the quality, cost-effectiveness, and patient-centeredness of healthcare delivery, given the centrality of the physician role in care delivery, especially in the United States.

Now our industry stands at a nexus point in several respects. To begin with, the passage of comprehensive healthcare reform, in the form of the 2010 Affordable Care Act, is pushing all providers to improve the value and effectiveness of the patient care they deliver, via such mandatory programs as the value-based purchasing program, the healthcare-acquired conditions reduction program, and the avoidable readmissions reduction program; as well as via such voluntary programs as the shared savings programs for accountable care organizations and bundled-payments contracting. In addition, on the purely physician practice side, the Physician Quality Reporting System continues to ramp up its requirements for outcomes quality documentation.

Add in two other gigantic phenomena—requirements for physicians and hospitals in the meaningful use process under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is mandating physician adoption of electronic health records; and private health plans’ creation of a broad range of healthcare reform-related programs—and, when all those phenomena are put together, physicians across the U.S. are being pushed collectively over an important tipping point, since meeting all those many requirements is becoming impossible in a paper-based environment.

But the moment a group of doctors realizes they must convert to an electronically based practice, they also realize that they cannot do so chained to desktop computers for 12 hours a day. At the same time, however, physicians, being educated, affluent Americans, are not surprisingly embracing smartphones and tablets in their personal lives, just as much as (and sometimes even more than) their fellow Americans. Thus, the overlap of these disparate trends has led to the burgeoning “BYOD” (bring your own device) phenomenon, which is rapidly upending older dynamics between healthcare IT leaders and physicians—particularly the dynamic in which CIOs and other IT leaders were having to go to extraordinary lengths to get doctors to do anything electronically in their work lives.

Now, with the easy availability of mobile tools, BYOD has overturned assumptions and put physicians in the position of demanding more—more connectivity, better wireless infrastructure, better support for devices.

As I write about in the first article in this month’s two-part cover story package on mobile computing, CIOs, CMIOs, and other healthcare IT leaders are having to figure all this out, in a process that is inevitably iterative and evolutionary (as is the process of achieving patient engagement via mobile devices management, as Associate Editor Gabriel Perna writes about in his companion article this month). Along with those two pieces, we're going to be conducting a two-man podcast on some of the issues we found in our separate pieces and where mobile health stands at the moment. That should be up later this week.

Healthcare IT leaders, both from some of the largest integrated health systems in the country, as well as in small-to-medium-sized medical groups, are gradually figuring it all out. As they do, they will inevitably share their learnings with their colleagues nationwide. For some healthcare IT leaders, the relatively sudden reversal of previous IT-physician dynamics is a bit discombobulating; but really, isn’t it best, in the end, that doctors are now involved in helping to shape the healthcare computing future, anyway?

Sincerely,

Mark Hagland
Editor-in-Chief