Achieving Meaningful Use Requires a Physician-Centric Approach to IT

Hospitals have been heavily computerized for decades, but those systems have done little for physicians.  It's ironic: Physicians are avid users of technology that actually helps them — witness the prevalence of smartphones and, more recently, iPads in the hands of physicians — but those same physicians will bend over backwards to avoid using typical hospital information systems.

Physician adoption of CPOE (computerized physician order entry) is notoriously awful. We're talking about software that has been around in some form for nearly 40 years; yet as of KLAS's most recent survey, less than six percent of hospitals had all their physicians engaged with their CPOE system.

Hospitals have a vested interest in getting their clinicians to use IT, now more than ever with so much American Reinvestment and Recovery Act money being dangled in front of them contingent upon physician meaningful use. All too often, however, the current hospital approach to the ARRA equation is to force or shame physicians into using the existing HIS "for the sake of the greater good." However, the "greater good" has never really been demonstrated or quantified across the board; and, within the walls of the hospital, the physicians do all of the "meaningful work" and the hospital gets all of the "meaningful money." In addition, physician productivity is almost universally negatively impacted, and personal incomes and/or lifestyles suffer.

However, IT adoption by physicians can yield significant benefits to hospitals, including enhanced physician productivity, improved patient safety and care, and optimized revenue — if IT is done right.

For this to happen, hospitals need to deploy physician-friendly systems to complement the IT infrastructure they already have in place.  Note that I did not suggest hospitals rip out and replace their existing IT infrastructure; that would be ridiculously disruptive, expensive, and largely unnecessary, since for the most part it works well for what it was intended to do — run hospital operations. Rather, hospitals should regard physician-friendly systems as an "overlay" on top of their HIS.

A physician-centric approach to healthcare IT should be grounded in five key tenets:

1. Respect the way physicians practice medicine. Physicians work hard enough caring for patients; don't make them work harder and less efficiently by forcing them to adapt their workflow to accommodate the design of computer software. For years, hospitals have deployed systems to automate processes, such as order entry or charge capture, that heavily impact physician workflow — but the system design did not take physicians (or their preferred workflow) into account.

To drive physician adoption and meaningful use, hospitals must "retrain" their systems to work as physicians already do — or better yet, improve the physician experience in terms of ease of use and workflow efficiency. Whenever and wherever possible, hospitals should implement software that was designed with physicians in mind. The easier you make it for doctors to use technology, the more they will use it.

2. Ensure IT systems offer physicians a compelling benefit. There is nobody, in any profession, who would gladly embrace a mandate that says:

As of tomorrow, this task that you never really enjoyed doing, and have always done in a particular way, must now be done in a new and totally different way; and this new way is going to change your workflow, lower your productivity and cost you money.

That basically describes the situation with order entry and most attempts to implement CPOE. For decades, doctors have entered orders with pencil and paper, or dictated them to a nurse, and generally it has worked well from the physician's perspective. To persuade doctors to switch to an unfamiliar computerized ordering process, the benefit statement will have to be more compelling than, "It won't take you any more time than what you're doing now." The absence of a penalty is not a benefit. CPOE has to deliver greater speed or greater accuracy, and preferably both. For CPOE to be faster for the physician than paper and pencil or calling a nurse, the user experience had better be thoughtfully designed.

3. Let physicians practice anywhere, anytime. Doctors always have been "mobile" professionals, and that's truer today than ever before. Advances in mobile IT, such as the new generation of "tablet" computers (e.g., Apple iPad, Samsung Galaxy), make it possible for physicians to stay connected to patients, their records and their care from beyond the four walls of the hospital or the office. In fact, at the recent HIMSS11 conference, HIT industry analyst John Moore predicted 100 percent physician adoption of smartphones and tablets by 2014. Hospitals, therefore, must enable "physician mobility" through hospital information systems, since the handheld devices alone, without the information access, are of limited utility.

4. Don't change everything at once. Hospitals are wise to take an incremental approach to automating physician workflow. For example, CPOE needs to work anywhere along the "all paper" to "all electronic" order entry spectrum. Hospitals need a practical way to immediately implement — or incrementally evolve toward — a full CPOE process from any starting point, and move at their own pace toward the goal of 100 percent adoption throughout the organization within three years to meet the timeframes of the HITECH Act. Such flexibility allows a hospital to solve existing problems, such as verbal orders, by implementing an electronic-to-paper process as an interim step before having all electronic data interfaces in place. Hospitals should let physicians start to use CPOE even if all back-end departmental systems are not fully automated.

5. Focus on the parts physicians see first. Physicians don't care about a hospital's back-end system; what matters to them is their experience interacting with software applications that directly touch their processes and workflow. That means hospitals should focus on offering their physicians the best user experience possible for reviewing patients' charts, ordering tests and labs and checking the results, writing progress notes, entering charges, and signing out — all that doctors do on a daily basis. Making these systems as physician-friendly as possible is what will generate sustained meaningful use. For the most part, existing HIS do a good job automating the finance and operations functions at hospitals; the systems are well entrenched and well used. So "if it ain’t broke, don't fix it."

Taken together, these five "tenets" provide directional guidance for hospitals as they consider how to create physician-centric health information systems. The criticality of such systems is not in doubt; only the particulars — what specific functionality gets offered to physicians, how and when — should be up for discussion. And as for timing, from the physician's perspective, the sooner, the better.

PatientKeeper is a leading provider of physician health information systems, enabling physicians and hospitals to focus on their patients, not technology, by providing highly intuitive software that streamlines physician workflow to improve productivity and patient care. PatientKeeper's CPOE, physician documentation, HIE and other applications run on desktop and laptop computers and virtually all handheld devices and tablets. PatientKeeper integrates easily with hospitals' existing IT infrastructure to create the most cost-effective solution for driving physician Meaningful Use. For more information about PatientKeeper, which is headquartered near Boston, Mass., visit or call (781) 373-6100.

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