With HITECH making physician acceptance of CPOE more important than ever, getting the user interface right is paramount. Unfortunately, most HIS vendors have spent the last few decades optimizing their products to capture transaction and store data. Thus, physicians are often left wanting when trying to navigate green screens using function keys. To address this need, those same HIS vendors have gone back to the drawing board in an effort to make the docs happy. But third-party vendors have also been working to fill the breech, including PatientKeeper. To learn more about how this vendor is making core HIS offerings palatable for physicians, Healthcare Informatics Editor-in-Chief Anthony Guerra recently caught up with CEO Paul Brient.
GUERRA: The timelines for HITECH seem quite aggressive. What are your thoughts?
BRIENT: Well, that’s an interesting question. Certainly, I think from how meaningful use has been described so far — putting aside the timeline — it’s very consistent with where just about every hospital system was going with their automation. And at some level, I think healthcare IT gets a bad rap. People say, “Well, gee, we don’t spend enough money on technology,” so as a technology provider, I can’t help but agree with that, but I’ve been in this industry for 20 years, and there’s been a tremendous amount of automation in hospitals, a little less so on the physician practice side, but I point out that every single practice in the country basically has a practice management system all by themselves. Why? Because they had an ROI. The ROI on ambulatory EMRs been a little questionable so adoption’s been slow. But on the inpatient setting, the core clinicals are all automated, people are doing bar code administration, and PACS is almost 80 percent penetrated. So a lot of work is already done, and everyone knew that eventually we would do CPOE and we do physician documentation.
So, at a conceptual level, I think meaningful use is very congruent with the direction the industry was already heading. The timing, obviously — and the point of stimulus is to change things — is very different than where people were going. CPOE was very much on the “later” category. Almost every one of our customers were saying, “Hey, we know we have to do it, but that’s not even next year’s project, that’s down the road.”
The question is how far forward do we bring it? If they put it out too far away, everyone’s going to just keep ignoring it, and no one wants to do that. If they make it, “Hey, you’ve got to have it all in next October,” which they’ve kind of threatened to do a little bit, that’s just too soon. It’s taken them almost a year to come up with a definition of meaningful use. It’s not reasonable to say, “In six months, you’re going to have to implement it.”
GUERRA: That’s a good point.
BRIENT: I think, just from discussions I’ve had, they’ll recognize that. So there’s a balance there. You’ve got to make it urgent and yet you’ve got to make it somewhat doable. My general view is that one of the disconnects is CPOE has largely not worked in the community setting. In the academic settings, yes, in places where you own your doctors, okay, but in the traditional community setting where there are no residents and only the admitting physicians, it has not been successful. We’ve got a lot of clients that have tried to deploy it and have failed.
So just saying, “Go do it,” isn’t going to solve that. We’ve got to figure out a different way to do it, and PatientKeeper, as a company, has a very different approach. We’ve got to do it differently in the community setting, and I think that’s the real rub. I don’t have a great solution for it, but what really needs to happen is several rounds of innovation in the community hospital space to get community-based CPOE to work before we can really be guaranteed of success as an industry. I think that’s the rock and the hard place, and if I were king for a day, I’m not sure I would necessarily change the trajectory, but that is a real rock and a hard place situation.
GUERRA: Let’s say they come in on the aggressive side, do you think the greater likelihood is that people will just, as you said, possibly ignore it and say it’s too hard, or do you think there could be instances of trying to do this before people are ready, resulting in some major disasters?
BRIENT: I think there are definitely going to be both, and some of our clients have already explicitly said, “Hey, we’re not going to go try to do the ARRA thing. CPOE is already part of the plan, documentation is already part of the plan, we’re going to keep that plan but we’re not going to change the plan to meet the ARRA deadlines because we don’t want to be in the second category of trying to do this before we’re ready and failing.” The folks writing the legislation are pretty clever, they haven’t said that you have to go try, they’ve said you have to succeed to get the money.