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Wednesday, January 19, 2011
Electronic health records signal changes in hospital IT strategies
By Julie M. Donnelly, Boston Business Journal
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Scott MacLean, the chief information officer at Newton Wellesley Hospital, has a bird’s eye view of what it really means to comply with the “Meaningful Use” guidelines the federal government has established to determine whether or not hospitals and doctors will be eligible for financial incentives tied to electronic health records initiatives. He is the CIO of a community hospital, but it’s part of the largest health-care delivery system in the state, Partners HealthCare, which also owns large teaching hospitals Massachusetts General Hospital and the Brigham and Women’s Hospital. He spoke to Mass High Tech about where the rubber meets the road, in trying to move from gathering health data, to using that data to improve quality and reducing costs.
MHT: The Economist magazine recently surveyed 100 American CIOs and found that many felt their role was changing: more than just the computer guy, they said they had more of a strategic role concerning cost and quality of health care. Do you find that your role is changing?
MacLean: The truth of the matter is that I don’t feel that either the hospital administration or the physician leaders view IT as a strategic asset yet, it’s still viewed as more of a support function. The discussion we had today for instance was, is “Meaningful Use” a compliance issue or is it something that we’re really going to engage in to make clinical care better and have incentives for it. I think we’re on the verge of talking about how we might use technology to make work flows better and make us more competitive with patient portals and those kinds of things.
MHT: Really? I’m surprised, given the high level of investment Partners has made in its HIT systems.
MacLean: There’s a difference between what happens at the corporate level at Partners, and at the teaching hospitals, Mass General and the Brigham, versus what is happening at a community hospital like Newton Wellesley. The margins are very thin, we are trying always to keep our costs under control. We have excellent information systems here at the hospital, especially given the complexity of the integration with Partners. But I don’t feel like we’re at a place where we would have those high-level discussions where we would use information technology as a differentiator, yet.
MHT: But there are some pilot programs?
MacLean: We use Computerized Physician Order Entry (CPOE) and we can clearly show that we have reduced medication errors, and we feel our quality is better because of that. One area we are piloting is radiology decision support, meaning, does the physician order too much high-cost imaging for the efficacy of that imaging... Say I walk into a primary care office and I want an MRI because I have a sore neck, then the doctor would type in the diagnosis and the system would tell you if an MRI is appropriate for that diagnosis.
MHT: How do doctors feel about that?
MacLean: Well, now that’s only at the Brigham and Mass General, but it’s coming here this year. So we’re having discussions with our physicians about what that means, in terms of who would have access to that data, and what in aggregate we might do with that data, how we might measure it, or ask them to do something different. There’s a piece about oversight and measurement that they’re concerned about. And then there’s the complaints we’ve heard for years about cookie cutter medicine where the computer is doing all the work. Any of us who are sophisticated about the use of computer technology in really any industry, you have professional talent like a physician and the computer is not replacing it, it’s a knowledge management tool, a decision support aid, so the professional’s brain can be utilized most efficiently.
MHT: Which doctors would you say are the most open to change in the HIT arena? Is it certain specialties, doctors inside versus outside the hospital, generational?
MacLean: In general it correlates with age, but not always. So you could imagine that the young physicians that are just coming into practice, that they are waltzing in with their smartphones and they are demanding having applications on them and they are questioning why there is documentation on paper. And there are some older physicians that are looking to retire before they adopt an electronic medical record. But there are also some great leaders and outliers on both ends of the spectrum. We have some older physicians that are great champions of technology.
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