The 2006 AMDIS award winners for distinction in applied medical informatics are all working toward one common goal: to implement an electronically based record system that will create a faster, more-accurate medical practice within their healthcare system.
The Association of Medical Directors of Information Systems has recognized five individuals and three healthcare teams with its annual award. From more than 60 nominations, the winners each deserve special recognition for their excellence and successful achievements, says Rich Rydell, president and executive director of AMDIS. The almost 1,800-member organization of physician-technology leaders designated six judges. This year the judges decided on the following professionals:
Richard Dick is the founder, chairman and CEO of You Take Control, a privacy-management firm that gives members the opportunity to essentially take control of and make a profit from all sensitive information about themselves. The firm, located in Alpine, Utah, allows outside research companies, both organizational and governmental, to send a request to view information that members then approve them to see.
The main goal of this company-one of Dick's many ventures-is to empower individuals by giving them the opportunity to sell access to their personal data. "If (outside sources) have to obtain permission to access your data, then you decide if they can have it and at what price to have it for,'' Dick says.
Dick has maintained a long career in informatics. Esther Dyson deemed him a "key man'' in the history of electronic medical records in the January 2005 issue of Release 1.0. Dick says he will continue to work on finding ways to "remove ambiguity in data'' and distributing it. "I try to work on things that have the broadest overall impact, which may take more than my lifetime to see (its) completion,'' Dick says.
Cort Garrison, M.D., is the medical director of informatics for 417-bed Salem (Ore.) Hospital Regional Health Services and has been working to computerize the physician office for about 10 years. His main focus is completing the Epic EMR system for the organization. His goal is to have 100% computerized physician-order entry established by 2007.
"Information retrieval is the bottom line. There's no reason I can't get the files I need when I need them. And if the only barrier is to put it in an electronic format, then we will.''
However, like other IT specialists, Garrison has to contend with a significant learning curve. He says many of the physicians "don't know how to use a computer. Do they understand why it's doing what they want it to do or do they click around to find what they want?'' Garrison says.
Garrison is providing voluntary "Computer 101'' classes for those who are unfamiliar with computer programs that will be important when Epic launches. Garrison's team started the rollout in November 2005 with 18 physicians, and plans to start official training for the rest of their 440-member physician group in October 2006.
Eric Pifer, M.D., has led the implementation and customization of clinical information systems with the University of Pennsylvania Health System, Philadelphia, since 1998. As chief medical informatics officer and associate professor of medicine at UPHS, Pifer has succeeded in having 100% CPOE performance. Its CPOE system has been in use since 1997. Pifer was not available for comment at deadline.
Michael Russell, M.D., is the associate chief information officer, associate professor and practicing pulmonologist at the 753-bed Duke University Hospital in Durham, N.C. He earned an AMDIS award for leading Duke in installing a CPOE system for 650 beds and more than 680 physicians. This represents all adult services with peaks of about 30,000 orders per day.
"CPOE is not for the faint of heart,'' Russell says about implementing the Horizon Expert Orders system that Duke launched in September 2004. "It's invasive to the workflow and the way people get their work done ... so anytime you change the relationship between the doctors and nurses and pharmacists, it's a challenge.''
During his 22 years at Duke University, information technology has taken up more and more of his time, he says, and he welcomes it. Russell's undergraduate work in electrical engineering gave him the experience in informatics that led him to where he is today. "That aspect of computerization has always been a personal interest of mine,'' he says.
Neal Seidberg, M.D., the physician leader of the CPOE project for SUNY Upstate Medical Center, Syracuse, as well as a practicing intensive-care unit pediatrician, has successfully implemented a CPOE system throughout the center. The SUNY Upstate Medical Center is the main educational hospital for Upstate Medical University in Syracuse. Under Seidberg's leadership, SUNY was able to get a CPOE system up and running in less than two years.
Seidberg says the system's realization went smoothly thanks to the online training system he and his team created. "Medicine turnaround time has gone from an average hour to two hours for drugs that you'd like to get within an hour, down to a turnaround time in the pharmacy of 14 minutes,'' he says.
Aside from his CPOE responsibilities, Seidberg spends about 50% of his time working in the ICU. He enjoys the balance of the two careers and says he can't choose a favorite.
"They're both so different in some ways, but in a lot of ways they're the same; it's the same kind of problem-solving so sometimes it's a natural progression. It's trying to make care better for your patients,'' he says. "They give different challenges. It's been a fascinating little ride.''
Covenant HealthCare in Saginaw, Mich., is the sixth-largest hospital in the state with 521 beds; providing the only neonatal, pediatric and pediatric ICU services in the region. Covenant assembled a team to find potential technology solutions to the system's time-consuming paper-based processes. They decided to use a physician portal and mobile applications from PatientKeeper.
The data-management system provides physicians with updated patient lists through a Web browser that is accessible to administrative teams throughout the office via personal digital assistants.
Covenant piloted the project with a small group of physicians in August 2005, and its current user count is more than 200, says Keith Grantham, Covenant's director of information technology. According to Grantham, Covenant recently elected to go with the Epic EMR system. Its goal is to implement Epic and go live by fall 2007 with hopes of having 100% CPOE by 2008.
Adjusting to a new system in a short amount of time is a challenge. "Some (physicians) have a learning curve; some are just technologically challenged,'' Grantham says.
To counter that, Grantham says the team has employed refresher courses and physician assistants to help speed things along to ensure a full understanding. "We want to walk before we run,'' he says.
Marshfield (Wis.) Clinic was recognized because of its work with tablet PCs.
According to John Melski, M.D., medical director for clinical informatics and practicing dermatologist for Marshfield, the rollout with tablet PCs has been better than expected. The clinic has about 1,900 physicians who currently work with tablets, and Melski estimates that 2,500 will be in the system by 2007.
The team is working to improve the quality of the system and better streamline the entire electronic-research process.
Ensuring the system is perpetually up and running is another issue because "People become dependent on the technology and increasingly intolerant of disruptions,'' Melski says.
Having a solid infrastructure is important, and Melski says it will be something the team will continuously work on to advance. "I think the big frontier is IT support, the fundamentals and the basic framework of medical informatics is to collect the information,'' he says. "(And) looking at what's happening in our practice and looking for any opportunity to try and do it better.''
Piedmont Healthcare, a three-hospital system in Atlanta, achieved 100% CPOE usage in all their hospitals within two years of the system's implementation.
The team took on the task in January 2004 and accomplished a full adoption rate in March 2006.
"On March 1, we incinerated them all,'' says William McClatchey, M.D., chief medical information officer for Piedmont, in a recent story for Health Management Technology magazine. At Piedmont, "No one writes any orders on any kind of paper anymore.''
The team uses a CPOE system from Eclipsys Corp., a product called Sunrise Clinical Manager.