Daniel Newman, MD, Chief Medical Information Officer (CMIO), MEDfx
Working in healthcare IT (HIT) gives us a unique perspective on the future of medicine. Many of my clinical colleagues are aware that change is coming through Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), but they are unsure of how and when, leading to significant anxiety and fear. Many are concerned that the coming changes will make it more difficult to deliver care, not easier.
Since HIT is a major driver of this change, it is often viewed with the same anxiety and fear. Nevertheless, there are changes we all know we want. Many times in my career, I have been approached by clinicians with questions about their HIT systems: “Why can’t we just have access to all the information?” “Why is the quality of information is so poor?” And my favorite: “I installed Microsoft Office last week, and it was easy. Why are you making this so complicated?”
The truth is that HIT is complicated, and the complexity is going to increase. Whenever I hear providers ask questions about HIT, I always try to remember that each has an underlying goal around some aspect of clinical care. Their questions are not really about technology; they’re about care delivery. I firmly believe that clinicians want better information – they want to give better care, and they want to be a clinician, not an administrator.
HIT can empower clinicians, but it can’t solve all of their problems. Health Information Exchanges (HIE) hold great promise, but they do have challenges. The changes that we will see in medicine are not really driven by technology but are rather about what the technology delivers, which is data liquidity and, more importantly, knowledge liquidity.
Increasing the comprehensiveness of data through an HIE, running analytics and reporting on that data to gain knowledge about individuals and populations and then delivering real-time, actionable, easily understood information to clinicians is the Nirvana the C-level executives at ACOs and PCMHs have been waiting for, but what about the average clinician?
When my colleagues compare installing Microsoft Office to implementing a full-scale HIT solution, my instinct is to cringe and maybe even laugh. But the comparison is important because it demonstrates how complex and counterintuitive many of our HIT systems are from the clinicians’ point of view. Clinicians want a system that is intuitive to use and complementary to their patient care workflow.
The anxiety produced by changes around ACOs and PCMHs are quite real. Medical professionals are rarely trained to treat patient populations in a team-based format; the focus has always been on individual point-of-care medicine. Shared data now allows us to monitor entire populations, drilled down to the individual level. As a HIT professional, I admit even I get anxious thinking of what to do with this abundance of new information, which can seem overwhelming.
Clinicians’ experience with many of our current HIT systems does not instill confidence that we will make this new onslaught of knowledge particularly useful.
In the end, both HIT and clinical care professionals share the same goal: improved patient-centered care delivered in an efficient manner that allows providers to be better clinicians. I believe firmly that for ACOs and PCMHs to be successful, they need the complex information and data-sharing capabilities an HIE can provide. But we must remember that the knowledge obtained from this data must be presented in intuitive and directly actionable forms to the provider and patient in order for us to achieve our objectives.
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Dr. Newman is the Chief Medical Information Officer for MEDfx and is the former Chief Medical Information Officer and Clinical Product Manager of the eHealth solutions group and General Electric. Prior to his work with GE, Dr. Newman was the Chief Medical Information Officer (CMIO) of Boston Medical Center (BMC). He is an Assistant Professor of Medicine at the Boston University School of Medicine and a Senior Fellow at the Boston University (BU) School of Management’s Health Policy Institute. In his current position, Dr. Newman sets clinical product strategy and direction of the development of new innovative tools for Population Health Management and Accountable Care. Dr. Newman holds an MD in from Georgetown University School of Medicine and an MBA from Boston University.