Frustrated with Existing Systems, Hospitalists Collaborate to Improve Health Information Technology


Attendees make their way throughout the tradeshow during the HM14 schedule at Mandalay Bay Resort and Casino in Las Vegas, Nev.

Attendees make their way throughout the tradeshow during the HM14 schedule at Mandalay Bay Resort and Casino in Las Vegas, Nev.

LAS VEGAS—Hospitalist Amy Knight, MD, isn’t a chief medical informatics officer (CMIO). She calls herself a “CMIO lite,” a nod to her title as medical advisor to the department of information services at her home hospital, Johns Hopkins Bayview Medical Center in Baltimore.

But, CMIO or not, she was among the first cohort of 450 medical professionals to be board-certified in medical informatics last fall after an exam for the specialty was created by the American Board of Medical Specialties.

Now Dr. Knight, who serves as a technology advocate for SHM, thinks more hospitalists should follow her lead.

“I had a little chip on my shoulder because I didn’t do a fellowship in informatics,” said Dr. Knight, who nonetheless worked on Bayview’s implementation of computerized provider order entry and electronic provider documentation systems. “I wanted some sort of recognition for everything I’d been doing. We’re already doing it, so let’s get some recognition for it, some credentials—and also, some standards for what the minimum needed to do a good job are.”

Kendall Rogers, MD, FACP, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee, agrees. He wants as many hospitalists as possible to “establish ourselves for the informatics role we have taken.”

Whether it was lamenting clunky electronic health records (EHR) systems, discussing Dr. Rogers’ push for so-called “techno-docs” to consider the new board certification, or lobbying for people to interact more with SHM’s Hospital Medicine Exchange (HMX), hospitalists at HM14 took the opportunity to focus on the growing pains of health information technology (IT).

For Mohammed Morad, MD, a hospitalist at Indiana University Health Ball Memorial Hospital in Muncie, the paramount frustration is the trouble providers have with EHR systems that are built for physicians but don’t seem to consider the end user.

“These EHRs are designed to make your billing easier,” Dr. Morad said. “[They’re] not designed for patient safety or quality measures. Now they’re trying to implement some of these tools, but the very challenging, especially for physicians who are not tech-savvy enough. Even [for] newly graduated doctors with iPhones, it’s still a challenge. It’s not user-friendly.”

Dr. Morad’s biggest frustration with the technology is how time-consuming it is. Although electronic input is clearly more advanced, more communal, and more privacy-focused than hand-written notes, current systems that require physicians to spend hours upon hours building order sets or typing out notes waste too much valuable time, he said.

“You spend more time with these EHRs than you spend with your patients, because you have to put the orders in, you have to write the note, you have to look at previous reports,” Dr. Morad added. “In a way, it helps in gathering the information that you need in one place so before I even see the patient I know what the echo[cardiogram] showed, what the chest X-ray showed, what the previous consultant had seen....but how easy is it to get all this? It takes more time than it should.”

Uzoeshi Anukam, MD, from Grand Prairie, Texas, looks over the HM14 schedule at Mandalay Bay Resort and Casino in Las Vegas, Nev.

Uzoeshi Anukam, MD, from Grand Prairie, Texas, looks over the HM14 schedule at Mandalay Bay Resort and Casino in Las Vegas, Nev.

Despite expressing frustration with current systems, most hospitalists are cautiously optimistic about advances in technology. Dr. Morad is hopeful that future iterations of the systems will be “more intuitive” and consider physicians’ needs instead of creating templates that individual institutions have to spend time and money customizing.

“Compared to any other software, they’re behind,” he said. “They’re not going to get better unless some people step up and try to make them better, especially from a physician perspective.”

Gaurav Chaturvedi, MD, head of the hospitalist team at Northwestern Lake Forest (Ill.) Hospital and chair of SHM’s IT Quality Subcommittee, said part of the problem is that vendors have a captive audience. Hospitals are motivated to take advantage of health IT incentive payments, which were funded under the Health Information Technology for Economic and Clinical Health Act provisions of the American Recovery and Reinvestment Act of 2009. Because healthcare reform is pushing the industry to digitize medical records, IT firms have built-in customers. That, Dr. Chaturvedi said, has stifled competition and hampered innovations tailored to doctors’ needs.

Hospitalists must work together to discuss end-user issues and prompt improvement, he added. To that end, SHM technology committees are working on white papers that will recommend best practices related to health information technology. While the papers are still in the planning and polishing phase, the idea is to view the overall landscape to give HM group leaders a framework of what they should be focused on.

“We want to keep vendor-neutral,” Dr. Chaturvedi said. “We all have the same types of issues to work with. We should work it out together.”

Dr. Rogers noted that SHM has met proactively with vendors to provide input on potential improvements, but that the process is ongoing and will likely take years.

“The best is still pretty bad out there,” he added.

Meanwhile, he urged hospitalists to share concerns, complaints, and success stories via HMX, an online portal hospitalists can use to communicate their views on a variety of topics, post responses, and share files. The online community—launched three years ago but rebranded under its current name in 2012—can be a repository for advice, ideas, or commiseration but is useful only if it is adopted. If more hospitalists log into the system and begin to use it, participation will breed greater value and vice versa, he added.

“We’re still in the build-up phase,” Dr. Rogers said. “We want to get people in all discussion forums to a tipping point.”

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