With no direct representation on ONC’s Policy or Standards Committees, the Association of Medical Directors of Information Systems (AMDIS) is setting up its own soap box. In conjunction with Compuware, AMDIS has launched www.meaningfuluse.org , where it hopes the industry will engage in conversation around the issues that are near and dear to the organization’s heart. But AMDIS President Bill Bria, M.D., doesn’t sound like a man who can be shunted aside. In this interview, HCI Editor-in-Chief Anthony Guerra talks with Bria about his plans to be heard.
AG: Is AMDIS putting out a position on meaningful use, which we’ve seen a number of organizations do? Is that part of the site you’ve set up?
BB: That’s going to be part of the outcome of the site. What’s there right now is a Wiki that we’re going to use as a way of accumulating information because we think that it’s a revolutionary process rather than just sticking a stake in the sand and saying, ‘That’s the way it is.’
The idea of defining (meaningful use) is important, but it’s probably not as important to AMDIS as the conversation. The conversation is not only amongst our group — the physicians that have the responsibility for HIT leadership around the country — but also with the public and with many other experts.
AG: Are you concerned that if you don’t issue a position paper, you’re views won’t be heard?
BB: We don’t think so because we’re the doers in healthcare IT, and we know this is not going to be a quick thing. This is going to go on over the next decade, which is a reasonable timeframe of how long this will take to do. And what it is, is the transformation of American healthcare, nothing less. The notion of meaningful use has to evolve, it must evolve, from a bar that you need to get over in order to receive a certain amount of incentive dollars (which is what everybody’s proximal discussion is about) going on to when do you really know that it’s made a difference in the quality and the safety of the healthcare delivered in this country.
It’s that goal — with the use of information technology as an intrinsic part of medical practice in America — that AMDIS is all about. The notion of making people understand that this is a marathon, not a sprint event, I think is extremely important for a number of reasons.
The political will to get to where we are right now really required the era of Dave Brailer and Robert Kolodner and so many others, even in recent times, never mind folks that go back several decades. The idea that America must keep it’s eye on the prize of improvement in the safety, quality and the cost of healthcare, those points have been made but they haven’t been understood enough yet. So, the notion of it being only one brief point in time, I really can’t accept that because what I think is going on is that the discussion of what’s at stake with the meaningful use of information technology in American healthcare is just beginning. That’s not to excuse it, I mean it certainly would be easy for us to come up with a bulleted list of physician statements and some of the things I’ve just said to you, but the idea is to let everyone in on the discussion. We need to discuss what’s being presented now, which is that HIT is the answer to so many problems in healthcare in the country.
AG: I didn’t see that AMDIS had any people like yourself on the Policy Committee or the Standards Committee, is that correct?
BB: We have members on there, Wes Rishel, he works for Gartner, but he is an AMDIS member.
AG: Does it make a difference that he is representing Gartner and not AMDIS? Would it be nice to have someone representing AMDIS?
BB: Absolutely, it would be nice. Do I think that there is a shared vision from the standpoint of physicians and others in many different roles? In this, yes, I really do.
AG: There are many physicians involved in some way, especially that testified before NCVHS, but I have not heard much of the perspective that I think you want to bring to this discussion, which is the ‘doers’ perspective from those on the ground, talking about physician adoption in the small practices and the problems that are still there.
BB: There’s more than a ray of hope; there’s a pretty bright light of hope. One of the reasons I feel that way is because during HIMSS we had the opportunity on two occasions during the meeting to have protracted discussions with Chuck Freidman and members of the ONC. The first meeting is one I called; I contacted Chuck and I have known him for years, and we had a presentation of a white paper on CDS (clinical decision support). The second one he did for two hours and he called the meeting, and he brought in all the other different groups that were involved. Chuck went out of his way – as a matter of fact, we’ve got a phone call coming up in another couple of days to continue to follow up on this. He represented, in his own words, that the AMDIS perspective on this is extremely important and the ONC recognizes that. So I don’t think that was platitude, I don’t think that was assuaging any fears or anything. I think he gets it, I think there are a number of people in the ONC office that get it.
Are we satisfied that we don’t need to continue to represent this dimension of the discussion and we can just relax? No, we’re not satisfied. That’s one of the reasons why we did meaningfuluse.com. So we think there really does need to be an understanding that, beyond policy, beyond politics, beyond even the incentive dollars, all of which are important, there is the perspective of people that have achieved the implementation of information technology and the practice of medicine in many different settings. If there’s one thing we know, we know it’s not an easy task, it is not a brief task.
Here’s the most important message I can give you; the idea some people represent that possession of an EMR is the whole point is incredibly wrong. It’s, in fact, the integration of information technology into the mainstream practice of medicine and its influence on decision making, quality infusion into that decision making process that is the point. That’s a longer term issue.
AG: Do you think that EMRs are where they need to be – in terms of both usability and cost – to achieve widespread adoption in small practices?
AG: So how do any of these grand plans work without that?
BB: One of the ways to move people forward is peer pressure. If nothing else, medicine is very much a group mentality. Even though physicians like to think of themselves as individuals, we’re all concerned about not being up to date, about not being with our peers with regards to medical information, with regards to decision-making skills, and procedural skills. We have to get enough movement and we have to get enough attention to create pressure. We are an organization that has demonstrated that it has a positive impact on safety and quality, and so there is not just a belief system, there is a demonstrated knowledge within our group that this is achievable and our profession, medicine, should recognize it as such.
AG: I have to tell you, I’m just stunned between these two committees – there’s 43 people in total – that there’s not a high-level member of AMDIS represented.
BB: Well, from your lips to God’s ears – whoever happens to be God this week.