CIOs have a tricky path to walk with clinical IT

CIOs have a tricky path to walk with clinical IT

As I gathered information for this week's FierceHealthIT issue, a couple of items stood out for me--both suggesting that CIOs have some special challenges to face with the latest round of clinical IT deployments.

One item, a blog post by a hospitalist, talked about the ways in which his hospital's EMR, despite its benefits, could cause problems by encouraging clinicians to wander away rather than congregate and share information with nurses and each other. He describes how, in the unit where he does clinical ward attending, doctors scatter after they're finished seeing patients, since they don't have to hang around in the unit's charting room any more.

"Since the system can be accessed remotely, after a long day I might not only leave the floor," notes the hospitalist, Dr. Robert Wachter. "I might leave the hospital, writing my notes from my favorite easy chair, half an eye on Jon Stewart quipping on my Tivo."

Another item, drawing on a panel discussion between hospital CIOs, notes that most are concerned about integrating revenue cycle management systems with clinical information systems--a necessity given that their income will be dependent on meeting clinical standards set by pay-for-performance programs.

The problem is, the CIOs aren't confident that the current gen of revenue cycle management platforms are up to the task. "A lot of us are asking our clinical vendors about their revenue cycle products, and, unfortunately, a lot of those products aren't ready for prime time yet," said William Spooner, CIO with Sharp HealthCare. That raises not only questions about hospitals' ability to collect, but also as to whether doctors will get paid less due to the failings of support technology.

Between these two issues--the social effects of new clinical IT, and the changes wrought by P4P--CIOs have huge change management issues to address. With doctors being simultaneously encouraged to wander away the point of care, and required to document what they do exactingly within clinical IT systems, there's a little bit of a conflict here.

It seems to me that hospitals will be hard pressed to make P4P work if doctors are working from home, on their cell phones and wandering throughout the facility. After all, it's simply human nature to care less about P4P-related care rules (particularly externally imposed rules set by payers) if you don't have to look your colleagues in the face that often. At the same time, though, there's no stopping distributed clinical IT, nor should there be; there are just too many benefits to giving doctors remote and distributed access to data.

All I know is that this would be a great time for CIOs and other provider execs to think hard about how they're going to deal with the reduction in face time distributed clinical IT can foster. Automate anything you like, but without teamwork, the broader goals provider execs have just won't be in reach. - Anne

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