Doctors on Board

As has historically been the case with IT, success usually starts with a few early adopters. That’s what Dr. Robert Kolodner, acting deputy CIO for health at the Department of Veterans Affairs and acting chief health informatics officer for the Veterans Health Administration, has found. "You go with the people who are excited and willing to try things out early on," says Kolodner, whose federally funded organization has given all 163 of its facilities access to EMRs and CPOEs. "You kind of work out the kinks—there are always kinks—with the group that will be much more tolerant when things don’t go completely right."

These systems don’t succeed unless clinicians are involved from the get-go. Many IT shops with successful EMR implementations have doctors, nurses and pharmacists on staff who spend part of their time in IT and part of their time with patients and medical peers. This helps give the CIO credibility, but it also makes the systems work. With earlier versions of CPOEs and EMRs, IT departments had to build in error-checking functions and definitions by themselves. Now, vendors are building more rules and definitions into the products, but individual hospitals still need to modify the systems to fit their policies.

For example, at Kaiser Permanente Northwest, the EMR system used to issue alerts for all female patients who were due for mammograms. Physicians showed that some patients didn’t want the tests (for cultural reasons) or didn’t need them (because they’d had mastectomies). "We needed to find a mechanism to turn off the alert for certain patients," says Dr. Homer Chin, Kaiser’s assistant regional medical director for clinical information systems. "There are thousands of little things like that." Working closely with the vendor, Chin’s group has fixed a number of these kinks, and now Kaiser is planning to roll out the Northwest system to the organization nationwide, to the tune of $1.8 billion over 10 years.

Bottom line: It pays to listen to your doctors. But dealing with them takes patience. The more physicians use the system, the more tweaking needs to be done. Intermountain Health Care, for instance, has managed to get physicians to enter patient notes directly into the computer systems. To get there, the IT department worked closely with physicians to develop what CIO Carvel Whiting calls "hot text"—templates that physicians can pull up for certain types of visits and fill out with just a few keystrokes.

Whiting now has some happy customers. "I was in a meeting a while ago with a number of docs in our clinics, and they said, ’If I had to do this the old way it would take me an extra hour-and-a-half a day,’" he says.