Engaging Physicians With IT

A key goal for all hospitals in the next few years is using healthcare IT to create an integrated care system. Achieving this will help break down the barriers between physicians and hospitals as they link their services and prepare for new payment methodologies on the horizon, such as accountable care organizations.

The great majority of U.S. hospitals and practices still have a long way to go, including the two hospitals I run, Sacred Heart and St. Joseph's, part of Hospital Sisters Health System. Whether we reach our goal will depend on strong cooperation from physicians and how easy it is for them to adopt healthcare IT.

Look to the Heartland for solutions
Providing the leadership for such strategies won't be limited to hospitals on the West Coast or in the Northeast. Indeed, I believe many of the breakthroughs will come from the Heartland. There are several reasons for this.

The Upper Midwest, in particular, tends to have larger medical groups, which have strong organizational frameworks to adopt these new approaches. Also, our progressive tradition keeps us open to new solutions and we have a strong appreciation for technology. Up the road from us in Chippewa Falls, Wis., Seymour Cray developed the Cray supercomputer back in the 1960s and 1970s. Our embrace of IT solutions is documented in a recent CDC survey on installation of a "basic" EMR system in physicians' offices, with components like patient history and demographics, clinical notes, computerized order entry, and viewing lab and imaging results bears this out. While 25 percent of office-based physicians offices nationwide had access to a "basic" EMR system, 50 percent or more had it in Wisconsin, Minnesota, North Dakota and just a few other states.

Sacred Heart, St. Joseph's and the rest of Hospital Sisters are currently in the throes of implementing EHR in the hospital and in physicians' offices. My two hospitals went live with a Meditech system on Sept. 1, 2010. It will take a year to get the bugs out, but overall the start-up went well.

Involving physicians is key
The key to our current success, I believe, was getting physicians involved in planning from the very start. We wanted a highly collaborative approach and a shared vision, so we created a physician advisory committee to guide us. We also chose a physician champion and paid that person real money for his services. The other hospitals in our system did not pay their physician champions and saw more problems with EHR implementation than we had. A fully involved physician champion can drive installation and help our IT people create the interfaces physicians will use.

Physicians often complain that their EHR systems were "designed by geeks" who did not understand their workflow. This means you need your physicians to help design user interfaces that reflect how they work and what they need to know first. Only a physician can tell you what should go on page one of the interface. Your physician-advisers can tell your IT staff, "I really don't need that bit of information, but I always need this bit," or, "I would like the nurse to be able to see this bit right away."

One thing we emphasized was making sure physicians were well trained in the new system. Physicians who don't know how to use EHR will get frustrated and won't want to use it. Every one of our physicians completed EHR training in early August before implementation. We focused on training the late adapters who were less enthusiastic about the switchover.

We made it clear that healthcare IT was very important to us by holding a day-long information forum a week before we went live. We brought in Howard Messing, the president of Meditech, to speak at the event. I went to Boston to ask him to come. Presentations at the forum included such topics as the future of technology and its role within healthcare reform, meaningful use standards and other innovative clinical technologies.

Other ways to improve IT networks
We are also helping employed and independent physicians set up their own office-based EHR systems. The AHA reports that 30 percent of hospitals are putting in IT systems for employed and independent physicians. In our case, we are offering the Allscripts Electronic Health Record and Practice Management solution for both employed and independent physicians over the next three years. HHS granted Stark law exceptions and anti-kickback safe harbors for this activity through Dec. 31, 2013, to encourage hospitals to help independent physicians with EHR. Hospitals are very interested in helping their physicians with IT. A July 2010 study by the consulting firm CSC found one-third of hospitals had offered financial assistance to physicians for EMRs.

However, even when hospitals and practices have EHR, they are often stymied by a lack of interoperability that reduces the systems' usefulness and discourages physicians. Without interoperability, systems must be called up separately, and data cannot easily be transferred. This is somewhat akin to having too many remotes in your living room — one for the TV, one for the satellite connection, another for the DVD player — and not knowing how to use any of them. A 2009 study by the Robert Wood Johnson Foundation found that poor interoperability "reduces the potential value of these systems and may have a dampening effect on adoption."

We have been using Novo Grid by Medicity to create interoperability. The software builds a local exchange connecting the hospitals, physicians and other sources of care. The goal is to be able to view information all at once rather having to log into multiple systems. Physicians in our system were really impressed when they could immediately go from viewing a report to viewing a related image on a separate PAC system. This kind of amen moment can help turn skeptical physicians into believers.

Another looming problem is the need for ultra high-speed broadband for some healthcare IT transmissions such as PACs. A federal grant, announced Aug. 2010, provides $11.5 million to Western Wisconsin organizations, including Hospital Sisters, for a demonstration project to construct more than 200 miles of fiber-optic cable that can be used for ultra high-speed transmissions. Work on the fiber-optic lines began this year and could be completed within three years.

We expect many benefits will flow out of all our efforts to create a reliable IT network. First, the experience of working together on these IT projects will help us to become more aligned. Second, once physicians feel comfortable using the new systems, they will appreciate the advantage. Third, these systems will make us more efficient and are essential for new payment systems like ACOs. And finally, and most importantly, they will improve quality of care.

Stephen F. Ronstrom has more than 25 years of hospital leadership experience, having served for the past 12 years as an executive in the Hospital Sisters Health System. He is currently president and CEO of the Hospital Sisters' Western Wisconsin division, which includes 344-bed Sacred Heart Hospital in Eau Claire, Wis. Learn more about Hospital Sisters Health System.


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