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Through the Forest-With Purpose

September 29, 2010
by Mark Hagland, Editor-in-Chief
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Clinical Information Systems as A Source of Clinical Support… or Frustration
Mark Hagland
Mark Hagland

I was speaking recently with a colleague, a physician who is now an executive, about topics around evidence-based medicine and clinical decision support, when he told me about something that had happened years ago in clinical practice. Dr. X, as I'll call him, had a very healthy patient, a woman in her 30s, who had had two patient visits with him in the months leading up to her participating in a local runner's marathon.

As it turns out, Dr. X had neglected to order a routine mammogram for his patient, an omission he corrected during a visit following the marathon. The mammogram, when it was performed, revealed cancer, which fortunately was caught in a very early stage. The end result was a lumpectomy and a total excision of the cancer. Still, Dr. X felt terrible about this medical mistake. The point, he says, is that he very much wishes that he had had in place the kind of clinical decision support that would have prompted him to remember to order a routine mammogram in this instance.

Physicians these days have an incredible amount to remember. Actually, all of us professionals do; but if I make an editorial mistake, a person's name or professional title might appear incorrectly in the pages of our magazine, whereas if a doctor makes a mistake, it can potentially result in a patient's death. Given all the time pressures physicians are under, particularly as those in office-based practices try to make up for reimbursement cuts and changes by crunching even more patients into their already overscheduled days, the last thing they need is have to navigate cumbersome and difficult clinical information systems.

This month's cover story (page 10) looks at the challenges facing CIOs, CMIOs, and their colleagues as they try to help practicing physicians bridge the inpatient-outpatient computing gulf. The clinical information systems physicians use can be tremendously helpful in supporting them, but can also lead to frustration and headaches.

The core challenges are many. And, given the heterogeneity of clinical computing environments, as well as a rapidly evolving clinical IT landscape, it won't be surprising to learn that hospitals and health systems are all over the place in terms of how they're approaching the physician computing challenge.

Some more advanced organizations have already evolved strongly developed strategies, while others are just beginning to work through the myriad challenges facing them. I was particularly interested to hear the perspectives of George Reynolds, M.D., who until this spring was both a practicing pediatric intensivist and the CMIO at Children's Hospital & Medical Center in Omaha. On page 16, you can read about Dr. Reynolds’ transition to CIO (while retaining the CMIO title), and how he views the physician computing challenges his organization faces.

What's very clear to me is this: If someone as plugged-in as George Reynolds finds strategizing around the issue of physician navigation of disparate clinical information systems to be challenging, then it really is a challenging prospect. And it will take the collective wisdom and ingenuity of every IT professional, clinical informaticist, and clinician leader, to work through the forest of issues every organization inevitably faces in this area.

Still, there is more to this subject than just challenges. There is the opportunity to improve the clinical computing environment for physicians, and thus, to facilitate the improvement of patient care and of care outcomes. What could be a more worthy challenge/opportunity to address? I can't think of one-and neither can Dr. X.

Mark Hagland, Editor-in-Chief Healthcare Informatics 2010 October;27(10):6

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