The AMDIS Connection: Surveying a Sea Change
The inaugural CMIO 2010 Top Trends and CMIO Census gauged health IT leaders’ thoughts about the HITECH Act with three questions: Would the act achieve its goals within five years? Will more money be needed for it to achieve those goals? What were the biggest organizational obstacles to implementation? To a certain extent, the responses to these questions show how our perceptions of the HITECH Act, and health IT in general, have evolved nationally.
Participants are pretty ambivalent about HITECH’s chances of improving the efficiency and quality of healthcare via use of HIEs and health IT within the next five years. This is understandable, at a time that the economics in healthcare are so unstable. However, the majority of clinicians are still engaged: They’re saying, “we don’t have a great idea of how this is going to affect us,” so they’re going to take a wait-and-see attitude. This is human nature and it’s not surprising.
When responders were asked whether additional funding will be needed for HITECH to achieve its goals, the answers were interesting: Even though nearly everybody hates how much the federal government is spending in general, most seem to agree that we should spend more. Where should the money be going? Participants most often mentioned training, support for HIE mandates and integration of physician practices with hospitals. I would add that training must be targeted if health IT is to reach critical mass. One of the lessons that have been learned in IT adoption, going back over 40 years, is that the adoption of healthcare IT doesn’t occur after technology-savvy individuals adopt systems, nor does it occur when a simple majority of the population adopts it. Rather, adoption happens when clinically influential leaders start to embrace and use it. You’ve got to convince the individuals within the medical community who are influential in the practice of medicine. The era of selling health IT on the basis of its technical merits is over. Only by demonstrating value—either with published studies or by targeting the clinically influential medical professionals—will you get the big transformation.
As for the challenges to HITECH success in their organizations, survey respondents cited confusion and conflicting requirements, CPOE, evidence-based best practices and financing system changes. Many clinicians are saying CPOE is overemphasized. No one denies that CPOE is important, but should it be used as the key metric for transformation of American healthcare? No. CPOE, as implemented now, is still an administrative function. Legibility is a big benefit, but after that, its advantages over written notes taper off rather quickly, because implementation of clinical decision support is still so problematic with CPOE. Alerts, drug interactions and allergy checking are part of every modern EMR. However, the way it’s done is interruptive, it’s usually over- or under-managed, and we really don’t have any gold standard of real medical knowledge being incorporated into CPOE implementation.
I think we have a problem in terms of what is considered a benchmark of success with adoption of health IT in American healthcare, but that will fall away as more adoption occurs and drives better understanding of what it is.
Physicians have acknowledged that they can’t ignore health IT anymore. That’s the key inflection point that we should celebrate. Like a lot of other major transitions, the profession will undergo a maturation in its response to health IT over the next decade. Until that occurs, you’re going hear of both raging successes and horrendous disasters—it’s all part of a learning experience.