The winners of the 2005 AMDIS awards for excellence and achievement in applied medical informatics have learned how to get people to buy into their programs for using health information technology: Loads of preparation; documentation of existing problems with explanations of how IT will solve those problems; customized, scenario-based staff training; and knowledge gleaned from past mistakes.
Out of a field of 66 applicants, the judges from the not-for-profit, Keene, N.H.-based Association of Medical Directors of Information Systems chose a hospital system, two physician-led teams and two individual physicians. The winners, who were announced in mid-May, will be honored at the AMDIS 14th annual Physician-Computer Connection Symposium in San Diego on July 20.
"The social aspect has always been key in getting adoption and I think these individuals and organizations have accomplished dealing with that aspect," says Rich Rydell, executive director of the
1,200-member organization of physician technology leaders. "Over the years, we've seen similar software systems installed at different locations with it being a success at one and a complete failure at the other."***
Thomas Tinstman, M.D., executive director of the clinical information systems division at the UC Davis Health System, earned an AMDIS award for implementing an electronic medical record, a secure patient-provider Web messaging system, a digital dictation-transcription system, an electronic verbal-orders system and Stentor's digital radiology system.
More impressive may be how he's been able to show evidence of why these things matter, perhaps the most dramatic example being when they measured how much time residents spent looking for films before and after the installation of the digital radiology system.
He found the new system saved more than 20 "physician years" annually.
Remembering his own experiences as a physician has helped shape the way Tinstman manages. "My personal objective is to make the life of the clinician simpler," he says. "It was my experience in 20 years of practice that, when hospitals tried to improve something, it made my life as a physician more difficult. So I tried to avoid that."
The foundation for this transformation has been EMRs, which Tinstman describes as a "patient-visit process-management tool." He says EMRs have been used at UC Davis for the "typical list" of tasks such as improving management of chronic diseases, keeping track of laboratory tests and online communication.***
Five years ago, Darrick Nelson, M.D., received a personal digital assistant as a gift from his wife. Now, as a result, more than 100 physicians at three-campus Christus Spohn Hospital Corpus Christi (Texas) have one as well.
Nelson heads the Christus Mobile Healthcare Team that was recognized with an AMDIS award for its use of PDAs to improve patient safety and access to patient information. Other members of the team included Manager of Clinical Applications Cathy Duffy and Application Analyst Esmeralda Comeau.
Nelson, the medical information director for the Corpus Christi Family Practice Residency Program, says the problem facing Christus Spohn physicians was a universal one: not being able to get all the patient data they needed when they needed it. The Mobile Healthcare Team was created to identify the scope of the problem and find a solution. "We looked at chart location on any floor in the hospital," Nelson says. "Only 30% of the time it was in the expected location in the chart rack," he says. Once, a physician was timed spending 17 minutes looking for a chart, he says.
In November 2003, the team demonstrated software for doctors, who then tested and ordered their own mobile devices. Within a few days, the PDAs were delivered, software and patient lists were loaded, some more training was given, and the days of hunting for charts came to an end. Physicians now update their PDAs by placing them in a sync station, which retrieves patient data, laboratory results, medication lists, clinical notes and more -- all in less than three minutes. Since the original rollout, electronic prescribing and charge capture features have also been added.***
When Fairview Health Services officials picked the emergency department at 148-bed Fairview Ridges Hospital as the first place to implement computerized physician order entry four years ago, they didn't realize they were also grooming their eventual medical director of clinical information systems.
"I walked into it backward," says Brian Patty, M.D. "The system chose the ED I worked in as the first site to go live with CPOE. As we rolled out to other areas, they kept tapping me. Finally, I said 'If you're going to keep doing this, make it an official position.' "
Patty earned an AMDIS award for getting 100% CPOE compliance in the Fairview Ridges ED, and this was done using a system he describes as "entirely carrot and no stick."
As a community hospital, Patty explains that the facility in the Minneapolis suburb of Burnsville doesn't "own" its physicians, so diplomacy and persuasion are used to get the job done. "We tell people 'Some time in the future, paper is going to go away and we're giving you an opportunity to learn this now,' and people have really taken it to heart," he says.
Besides persuasion, preparation and staff education have helped Patty to get people to buy into the CPOE program. The preparation included creating evidence-based, consensus-developed standing order sets that help physicians select appropriate medications and doses for common conditions they will be treating.***
Licking Memorial Health Systems in Newark, Ohio, has used EMRs for four years. Not content to use this for mere data collection, the 70-practitioner Licking Memorial Health Professionals group was honored with an AMDIS award for using data-mining and other techniques to launch quality-incentive programs, promote patient safety and improve community health.
Director of Medical Informatics Gerald Ehrsam, M.D., has used an EMR for physician offices to develop clinical "tools for success," such as protocols and prompts reflecting evidence-based best practices for disease management and wellness initiatives, and real-time decision support. A practicing internist for 30 years, Ehrsam has chaired the health professionals group's quality committee, EMR Task Force, and the 1-year-old Quality Data Development Project group.
"It's been a tremendous advantage for me to continue practicing," Ehrsam says. "It's very important for any group to have a medical informatics director who is still practicing so he knows what's going on at that level."
Ehrsam gives credit to the information system side. "One of the major reasons for our success is that the IS folks understand the clinical needs," he says. Patients are also involved. Exam rooms have terminals that physicians use as teaching tools, Ehrsam says, to show patients lab results and print informational handouts.***
Providence Health System-Oregon, a seven-hospital division of the 17-hospital Providence Health System in the Pacific Northwest, was honored with an AMDIS award for being an early adopter and wide user of medical IT. Anchored by the 409-bed Providence Portland Medical Center, the system's use of the Web-based Physician Portal gives physicians anytime, anywhere access to lab reports, charts, ECG and ICU monitoring waveforms, X-rays and other diagnostic images.
Dick Gibson, M.D., chief medical information officer for Providence Health System, says this made a huge difference for the on-call staff. "I think one of the more recent, more dramatic findings is that it's really changed the lives of orthopedic surgeons and neurosurgeons," Gibson says.
"When they're at home on-call, they can receive X-rays and other information from the emergency department online." Gibson says he was speaking to on-call physicians in May and he asked if this has saved any of them a drive into the ED and "all their hands went up."
All of Providence's 210 primary-care physicians have used EMRs since 1996. Patient information is electronically charted in the exam room, and prescriptions are checked for patient allergies and against interactions with other medications they might be taking. Computerized physician order entry is being tested this year in one hospital.
"The patient assumes the doctor has all the data they need to make a decision, but that wasn't the case with a paper chart," Gibson says.
Gibson says the principles he uses in developing the Providence IT applications are to find and nurture -- "and thereby retain" -- a smart and effective team and listen to the user.