Marion Ball, Ed.D., is a fellow at the IBM Research Center for Healthcare Management and professor at the Johns Hopkins University School of Nursing (both are based in Baltimore). She is also co-chair of the executive committee for the Technology Informatics Guiding Education Reform (TIGER) Initiative, which was formed in 2004 to bring together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health IT. A highly respected expert in the field of healthcare IT, Ball has authored several pieces, including an article in Methods of Information in Medicine that examined why clinical information systems are failing. Recently, Associate Editor Kate H. Gamble spoke with Ball, who is also a member of the Healthcare Informatics Editorial Board, about the report’s findings, the mission of the TIGER Initiative, why IT adoption is still low, and the importance of involving clinicians in the planning, development and implementation of IT systems.
KG: What was your impression of this year’s HIMSS conference?
MB: Well I’m a little prejudiced because I was there when it started, and I think that now, it’s just out of control. It’s become too big, and it’s frustrating. This year particularly in Chicago, just the enormity of having to walk one end to the other, I just felt I did more walking than learning. It wasn’t one of my favorite HIMSS conferences.
But I’ll tell you what was gratifying. We did a workshop on healthcare 101, and we had so much interest that we had to turn people away. There is a great interest in healthcare informatics and how the whole field is developing for new people. The workshop was for newbies who don’t know anything about how the CEO, the CIO and CFO work together within a healthcare setting. So that’s what our course was. That part of it was good.
I’m a former (HIMSS) board member and I know that they were very concerned as to what the turnout might be. They had a lot of attendants, but it needs to be restructured so that one can get more out of it, in my opinion.
KG: I agree. Let’s talk about the report you co-authored that was published in Methods of Information and Medicine. The basis seems to be that one of the key reasons why health IT adoption is so low has been the failure to provide HCPs with effective and efficient health IT systems. Is that fairly accurate?
MB: Yes, but you have to be a little bit more precise in that they’re not getting the information that they need at the point of care. In other words, we give them so much information that it’s like they’re being fed with a fire hose and everybody gets it from the same fire hose. So the physicians who are internists and obstetricians and psychiatrists all get the same template. If you’re a gynecologist, you don’t need to have the information that four years ago a patient broke her leg when she’s there for an OBGYN checkup.
These are the types of things that the vendor community is addressing. So the problem with the clinical users, which is the physician and the nurse, is they do not use existing healthcare IT from the vendors that gives them what they want. And instead of making their life easier, we’re making their lives more difficult. So the whole idea is, how can we make them do less work and not more work. It’s very simple, but those are the kind of key words that people will resonate to. We want to do less and have the technology with some decision support and some really good behind-the-scenes, easy programming do a better job for us. So that’s primarily what the situation is.
KG: And a large part of that is not just providing the information a clinician needs about a specific patient, but also delivering that information in a way that’s tailored to their individual needs?
MB: That’s right, so in other words, the system must adapt to the user, and not the other way around. It needs to cater to what we need, and not be set up so that we’re serving the computer. And we need a rapid adoption; it’s got to be the iPhone of the future, where it’s intuitive, where it really helps, and where people will embrace it.
Right now, we have to be adaptable to any of the vendors’ healthcare systems, and that’s not the way it should be. They need to be adaptable to the physician, the nurse and the pharmacist; not the other way around. And in product development, we need much more significant input from physicians and nurses who are in the line of fire, at the point of care, to say, ‘look, this is what we need when we’re in the emergency room. This is what we need when we’re in a doctor’s office in the private practice.’
Why should I have to go from every terminal and put in my password ten times and then change it every 90 days? It’s more difficult to get into the system than to look at the patient.
KG: That’s a huge problem, obviously. Do you think vendors need to utilize clinicians more in developing solutions?
MB: The thing is, they’ve developed these systems over the last 20-30 years and they’ve got millions invested. All you need to do is look at the Cerner or McKesson systems. When you watch a nurse at the station, you can see that it is a major operation just to get to the lab results. We’ve been at this for almost 40 years, and we still have, at the maximum, 18 percent physician and clinician adoption. That tells you something. It’s not giving them what they want — that’s the bottom line. So we need to find out what it is that we really need at the point of care.
KG: We are starting to see some really nice innovations. What are some of the technologies that you think have the potential to deliver the information that clinicians need at the point of care?
MB: One wonderful example is the University of Pittsburgh’s smart room. It’s a disruptive technology that tells the nurse or phlebotomist immediately when they walk in that a patient is, for example, latex intolerant. It comes up on the screen — it’s not at the nursing station on a computer where they have to go through all of the dropdown menus and look up allergies to find this out. You walk in, the two badges between the provider and patient connect, and the screen says, this patient is latex intolerant. So when they take that patient’s blood, they know immediately to take off their gloves, otherwise that patient is there for another two or three days. Not that they didn’t know it, but it wasn’t information there when they need, where they need it and how they need. That’s what’s missing.
Another scenario is the dietician walks in with the patient’s breakfast, and a light goes on in front of the screen that says, this patient is NPO (nothing by mouth). That means don’t give them anything to eat because they’re being operated on today. So the dietician can take the tray right out. First of all, you don’t have to waste the food, and second of all, the patient doesn’t have to stay another extra day because they were given breakfast on the day of surgery. These are all very simple things, but, as people will say, the devil is in the details.
Those are two good examples of it, never mind the more complicated things. It’s things like notifying caregiver with a screen that comes up and it says, ‘this patient is hard of hearing’ or ‘this patient is blind.’ What happens is people give instructions and walk out, and they don’t realize the patient doesn’t hear them.
But where do you need that information? Not in the computer, but at the point of care.
KG: It sounds like the type of technology that could really impact quality of care. Is this something that’s only available at a few facilities right now?
MB: It’s very limited. But it’s just a brilliant breakthrough. We’re looking at a lot of disruptive technologies. We’re also looking at, in some cases, where you can do charting or nursing documentation verbally while you’re with the patient, and not have to take notes and go back to the nursing station and put it into the computer. We’re looking at where it can be used well and where it shouldn’t be used; if you can chart while you are with the patient using hands-free technology, then you can use your hands to soothe the patient or to straighten up the bed instead of being tied up in the room typing something into the laptop or the PC.
And nurses will tell you what they like. You’ve got Vocera and Vocollect, different companies that are starting to do that. But again, who is going to be developing these? It’s got to be physicians, nurses and pharmacists, very much involved in the entire development, implementation and planning of these systems.
Part II coming soon