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When did you first start bringing healthcare technology into your practice?

When I was at UC Davis, I decided that the signout process on the weekend wasn’t working. It used paper forms that had notes like, “You have to see Joe Smith in tower three because he’s depressed.” I remember looking at it one weekend and saying “I can’t read this.” So I started a project that provided all the resident physicians with Palm Pilots so they could enter this information and beam it electronically to the on-call physicians.

What other technologies do you utilize in your daily practice?

My BlackBerry makes it easy to access my e-mail and calendar wherever I go. I also use it to send alpha-numeric pages to my residents; that way, I can be doing supervision over lunch but still be responsive to a crisis in the ER. I also use a Sony UX180 handheld that I can take with me if I need to remotely access information. I was also actually an early adopter of ePrescribing. I learned an early lesson: although ePrescribing has great benefi ts, it requires a significant amount of infrastructure to make it effective. Now, I use the NEPSI (National ePrescribing Patient Safety Initiative) solution from AllScripts [see 

], and send secure ePrescriptions to patients and pharmacies from my Palm Treo 750W.

What are the most significant developments in healthcare technology?

The idea that the appropriate amount of information can be delivered to you at the point of care. We’re still

working on that. Nowadays, if I pose the question “What’s been the trend in the patient’s liver function

test?” we can pick a range of dates and plot and see a trend graphically, which is helpful. I think the next big step is to connect that EMR data to real information and medical literature. We definitely need an EMR nationally. Right now, a lot of healthcare dollars and unnecessary tests are wasted on information that’s not readily available. A national information infrastructure is going to be really important for information exchange. But first there needs to be standardization of the EMR in terms of data format, and the government is really going to have to enforce a particular standard that all the major vendors can agree upon. In terms of disease surveillance, there should be centers where data can be exchanged for research and public health purposes.

Is there anything you’d like to say to our readers?

Physicians have been late adopters of technology. I would encourage readers to take a leap of faith, instead of taking the attitude that they want technology to be 100% reliable before they’ll use it. 

Articles

Our latest addition to the Pulse section will highlight physicians who are "bringing healthcare technology into practice." This month, we profile our newest Editorial Board member, John Luo, MD.

DocMVP: John Luo, MD

Growing up, I spent just as much time playing indoors, setting up elaborate GI Joe vs. Transformers wars, as I did

running around Wood-Ridge, NJ, with my best friend at the time, imagining we were being chased by Jason from Friday the 13th. I also played sports, went fishing with dad, spent hours in front of a ColecoVision, knew the meaning of the word triskaidekaphobia, and designed Pac-Man cereal before it was on the market (damn you, General Mills!)

From a very young age, kids’ television shows and cartoons were also a regular part of my childhood. Ask my mom, and she’d say I learned to read by watching 

(and also from the books she read to me each night, of course). I watched animated programs and educational programming when I was a kid; later in life, it was evening soap operas (

was my passion for years, seriously). The point is, I watched plenty of television throughout my baby/toddler/adolescent/teen years, and I’ve managed to make it this far without any indication of ADHD or other developmental problems.

I bring this up because of study results published in the February 2006 issue of 

 that supported the American Academy of Pediatrics’ (AAP) claim that it’s a mistake to let children under age 2 watch any television. The AAP also recommends no more than two hours of TV a day for children older than age 2. According to the study, kids’ time spent watching TV was “negatively related” to time spent with parents or siblings in other activities. Television viewing also was negatively related to time spent doing homework for kids age 7—12 and negatively related to creative play, especially among children under age 5.

Like Dr. Sanjay Gupta, I don’t follow the 

. I don’t agree with them because, despite my love of all things TV-related now and when I was growing up, I didn’t have trouble completing my homework (even though I spent more than an hour in front of the boob tube each day), a negative attitude toward school, or poor grades. Furthermore, my 3½-year-old son—who has been watching TV since he was one month old—performs brilliantly in school and does what he’s told as much as a 3½-year-old boy can.

Like Dr. Gupta, I too enjoy the “blissful reprieve” of my kids sitting still for 30 minutes while they learn about color, sounds, music, animals, art, dance, spelling, numbers, and reading from a Baby Einstein DVD. Other programs, such as those on Playhouse Disney, PBS Kids Sprout, Noggin, and Nick Jr., also fuel their imaginations. My infant twins are just beginning to dance and sing during these shows, and by supplementing these diversions with reading every night, I’m sure they’ll develop a fantastic imagination, just as my oldest has.

The truth is these TV programs and movies—supplemented by a two-day-a-week preschool schedule—have sharpened my sons’ minds, storytelling, and vocabulary better than anything I could have imagined. The digital wonders of advanced animation and the vivid imaginations of the shows’ creators are simultaneously entertaining and educating our kids as never before. Embrace it!

How do you feel about this subject? If you’re a doctor with kids, do you follow the AAP-recommended guidelines? If not, what shows do you allow your children to watch? Whether you agree with my sentiments or you concur with the AAP regarding television’s negative effects on kids, please drop me a line at 

, and I will feature your comments in an upcoming column.

For more on being a media-savvy parent, check out 

Growing up, I spent just as much time playing indoors, setting up elaborate GI Joe vs. Transformers wars, as I did running around Wood-Ridge, NJ, with my best friend at the time, imagining we were...

Hey Kids Watch This!

Electronic Health Records (EHRs) and other healthcare information technology (HIT) enjoy a tidal wave of support from politicians, including the leaders of our national medical societies, who constantly tout the benefts of HIT. We’ve been told that adopting ePrescribing in particular helps avoid prescribing errors, improve adherence to treatment guidelines and formularies, and monitor patients’ compliance with and response to treatment. It’s also touted as an excellent way to introduce informatics-phobic physicians to the wonderful world of HIT. In the face of all this enthusiasm, I was persuaded to take the plunge. I bought software, a PDA, a router, a dedicated printer (all interconnected wirelessly, of course), imported all my patient information from our practice management system to the new ePrescribing program, took the training, and was ready to go! Or so I thought. The plunge turned out to be into some very cold waters.

My practice management system (like many) is incapable of storing patients’ pharmacy or pharmacy plan data, which is fine, because the ePrescribing system I purchased couldn’t import this data anyway (or information about insurers). It all had to be entered when we wrote the first ePrescription for each patient. Furthermore, this information is a moving target—my patients frequently change insurers, pharmacy plans, and pharmacies, which means this data must be updated at every patient visit. Since I write prescriptions for 50 to 60 patients a day (25 or so clinic appointments plus messages I receive from patients and pharmacies for new prescriptions and renewals), the time required per patient for gathering and documenting this new information adds up to minutes and even hours of extra work time each day. In my experience, there’s been no time saved and thus no money saved. We’ve merely replaced phone/fax/writing time with an even greater amount of computer time.

My patients’ medication lists are no more accurate than before, as there is no way to import medication lists from patients’ other doctors. In addition, no technology will ever help us get a complete list of all the over-the-counter medications and herbs a patient is currently taking. We’ll have to continue to rely on the patient’s memory and willingness to share this information. My ePrescribing system does not have much of a pop-up alert system for drug interactions or allergic reactions. The medical informatics literature reports that when ePrescribing systems provide these alerts, they are frequently ignored, overridden, or disabled by physicians.

The literature also reports that formularies are not readily available, and if available, are rarely up-to-date or accurate; thus, pharmacy callbacks are not reduced. The roll-out of even the simplest standalone ePrescribing system can be complicated and time-consuming, and the time required to ePrescribe is often equivalent to the old pen/paper/fax/phone method. My own experience is that although ePrescribing can save some non-clinical staff time, it actually requires more clinical staff time. Current available ePrescribing systems are neither “plug-and-play” nor user-friendly.

After spending thousands of dollars to acquire the necessary ePrescribing software and hardware and spending hours in installation and training, I asked myself, “Was this the best use of these resources?” Could the time and money have been better spent? I also need a new EKG machine, some new oto-ophthalmascopes, and office furniture that is more comfortable for my patients. My wonderful staff definitely deserves a raise, which has now been directed to ePrescribing. Who has gained in all this? My patients may be a bit happier now that they no longer have to carry a written prescription to the pharmacy and wait for it to be processed. The pharmacist is probably happy that she no longer has to decipher my writing. The insurers and pharmacy benefit plans will probably be happy to save money when ePrescribing is able to keep my prescriptions in line with their formularies. I am sure Newt, Hillary, and Teddy are happy. As for me, I have spent a huge amount of time and money just so I can work longer and harder to provide the same service to patients as before. With apologies to all the technophiles out there, I am underwhelmed.

Everest “Tad” Whited, MD, PhD, is a board-certified family practitioner with a solo practice in Plano, TX. E-mail 

Electronic Health Records (EHRs) and other healthcare information technology (HIT) enjoy a tidal wave of support from politicians, including the leaders of our national medical societies, who...

The HIT Contrarian: ePrescribing: Not So Fast, Amigo!

In last month’s column, we looked at several reasons why you might want to create a practice website and explained how to register for a domain name. This month, we’ll examine several approaches to building a website, ranging from very cheap to very expensive.

Let’s start with the basics: a website is a collection of pages transmitted from a Web server to a Web browser. Each page is represented by a document written in Hyper Text Markup Language (HTML), which describes the structure of text-based information in a document by designating certain text as headings, paragraphs, lists, etc. In addition, HTML allows the text to be supplemented with interactive items, such as submission forms, images you can click on, and other objects.

If your head is already spinning, you may want to consider the easy, albeit expensive, approach to website design: let a professional do it. If you don’t have a lot of technical know-how and money is not a major concern, building a practice website can be a completely hands-off experience. You can outsource the entire job to a professional website designer, who will build your site for a fee. While this is certainly the most expensive option, you will personally spend the least amount of time on it, and you should get a website that looks professional and is customized to meet your specific needs. There are many website designers out there; the key is finding the right one for your practice. Treat this as you would any other search for a professional service provider. How did you find your lawyer, accountant, or cleaning service? Most likely it was through word of mouth, a recommendation from a colleague, or an Internet search.

Use the same route for finding a website designer. Keep in mind that the designer can’t do all the work for you. You must provide the content (including text and photos) and be able to describe what you want your website to do. A second approach is perfect for those with limited technical skills and budgets. There are several companies that let you build a website online using pre-designed templates that you customize by adding your own pictures, graphics, and text. No HTML programming is required, and you can literally drag-and-drop elements into a web page.

 are two of the more popular companies that offer this service, although a quick 

 search for website designers will reveal hundreds more. This is a fast and inexpensive way to go. The downside is lack of flexibility and a cookie-cutter approach that may leave you with a site that looks like many others. The last approach I want to share with you is a relatively new one. If you’re short on technical know-how, time, and money, but you still want a unique and customized website, the answer might be to hire an overseas designer. There is a vast talent pool of programmers and designers in countries like China, India, and Romania, many of whom are willing to accept small-scale jobs at surprisingly low cost.

 provide an opportunity to tap into the global website design community, just like big companies do. You post what kind of work you need done and how much you’re willing to pay, and then people bid on the job. It isn’t always easy to evaluate vendors, and language gaps can lead to misunder-standings, but the upside is that you can get quality custom work done for a fraction of what it might cost in the United States.

Whether you’re building a website yourself or hiring a professional, please keep one thing in mind: you’ve got less than 15 seconds to make an impact before your audience is gone. Don’t include huge, flashy graphics that take forever to load. I don’t wait for them to appear on my screen, and I’ll bet that you don’t either. Opt for an easy-to-navigate site that prominently displays relevant information in an aesthetically pleasing design. Next month, we’ll take a look at how to fi nd a service to host your website.

Dr. Bertman is Physician Editor-in-Chief of 

. He is also a Clinical Assistant Professor of Family Medicine at Brown University and president of 

, a leading developer of Electronic Health Record (EHR) software. He is the founder and president of 

, a consumer website focusing on personal medical topics. He is in private practice in Hope Valley, RI.

In last month's column, we looked at several reasons why you might want to create a practice website and explained how to register for a domain name. This month, we'll examine everal approaches to...

Building a Website the Easy Way - Part II

 media barrage in the wake of Apple’s announcement at 

 earlier this year. So, does the iPhone live up to all the hype? Well, almost.

The iPhone comes in 4GB and 8GB varieties at $499 and $599, respectively, and its real estate is dominated by a 3.5-inch display. The device itself looks beautiful, and with a resolution of 320 x 480 x 160 pixels per inch, the videos and photos look great. It has a “smart” screen that shifts automatically to a landscape orientation when you start to play a video or view a wide Web page; or turn it on its side to read e-mail, look at photos, or browse the Web.

The iPhone is easy to use (it does away with the stylus and most buttons) and is an ergonomic delight to hold. Whereas other phones in this category are intended to be used mainly for business (eg, BlackBerry, Treo, and Windows Mobile devices), the iPhone is also built for fun and is therefore more entertaining than its predecessors. So what’s wrong? A lot or very little, depending on how you use your “smartphone.”

 to sign up for a two-year wireless plan from 

, the exclusive carrier in the United States. If you are already an AT&T customer, you merely add the $20 iTunes plan, which provides you with unlimited data, but you cannot access the iTunes store from the phone. The phone interface is clean and simple, but takes more taps to reach than on many other smartphones, because there are no dedicated hardware phone buttons. You also cannot just start typing a name or number, but must scroll through a list of favorites, through your recent call list, or your entire contact list. However, the “

” feature shows the names or at least the phone numbers of people who have left you voicemail, so you can quickly listen to those you want. Yet, the phone’s 

Perhaps the most controversial of its features is the omission of a physical keyboard in favor of a virtual, on-screen one. It does take some getting used to, but the smart software corrects typing errors on the fly. One downside is that the keyboard only works in vertical mode and does not rotate when the device is horizontal. Instead of poking at icons with a plastic stylus, you use fingertips and intuitive gestures. For example, a flick of a finger sends you scrolling through your contacts list or your music library.

You can zoom in on a photo or Web page by spreading two fingers apart (a “reverse pinch,” as Apple has tagged this move), then zoom out by pinching them together. Its 

 browser first displays the entire page in miniature format (though without Flash graphics), and you can enlarge and pan as needed. When not using 

, which is just too slow to enjoy the lovely Safari interface.

, Apple has customized its software for the iPhone interface to take full advantage of the built-in Web browser. No download is necessary, and if you already subscribe to Unbound, the website will automatically determine what device you are using. The iPhone can connect with most popular consumer e-mail services, including 

, and others. (I have also been told that 

e-mail services can’t be used on an iPhone, but Yahoo Mail supplies free BlackBerry-style “push” e-mail to iPhone users.)

The built-in iPod handles music and video perfectly, and has all the features of a regular iPod, but now, fi nger taps and flicking move you through your collection. There’s also a version of the “cover flow” interface, which allows you to select music by flipping through album covers and tapping on the song you want. There are 

, or small programs, for accessing weather forecasts, stock prices, and 

s, which includes route directions, but no real-time navigation. Another widget allows you to stream videos from 

However, you cannot install programs unless they can be accessed through the browser. For example, you can use Unbound Medicine’s Web references, but you cannot download a text to your iPhone and carry it with you. You cannot download a text from 

For the gadget-loving physician who wants a whole new experience in a phone, the iPhone is a pleasure to use, shortcomings and all. 

It's been impossible to avoid the iPhone media barrage in the wake of Apple's announcement at Macworld earlier this year. So does the iPhone live up to all the hype? Well, almost.

The iPhone Offers iNfinite Possibilities

Most physicians choose clinical medicine because they want to make a positive impact on patients’ health. Tom Wessel, MD, is no exception. And that’s the reason he left the bedside.

"I saw that through information technology (IT), I could improve clinical care for more patients than I could through one-on-one practice,” says Wessel, who left his family medicine practice four years ago to become 

Medical Information Officer at Spartanburg Regional Healthcare System

 in Spartanburg, SC. Wessel joined an increasing number of physicians who straddle the clinical information technology divide as clinical informaticians (or “informaticists”). The demand for physicians with expertise in informatics is being fueled by the widespread adoption of electronic medical records (EMRs) and the recognition of the critical role of IT in patient safety. The result has been new career possibilities for informaticssavvy clinicians. “Virtually every hospital, clinic, physician office, or other healthcare provider organization will in some way utilize [IT] solutions in the coming years and will need healthcare professionals versed in informatics to assist with the implementation, use, and success of these systems,” said 

 (AMIA) President and CEO Don Detmer, MD, in an article in the December 2006 

Physician leadership is a critical factor in the successful implementation of healthcare IT projects, which ensures that physicians like Wessel will remain at the forefront of clinical IT design and adoption. For this reason, the chief medical information officer (CMIO) has become a key executive in many healthcare organizations. The CMIO has been aptly described as the person “at the nexus of executive, medical, and technology leadership,” according to the November 2006 issue of 

Journal of the American Medical Informatics Association

, identified the ideal CMIO as someone who is: “credible as a good clinician and not viewed as a ‘techie doctor’ who is only knowledgeable about computers; an effective communicator across services and disciplines; an effective consensus builder; and knowledgeable of hospital operations.” Of the five prominent CMIOs interviewed for this study, four continue to provide part-time patient care. All had been involved in a clinical IT project prior to assuming their current roles, and every one of them possesses executive leadership skills and experience. Only one, however, had completed a full-time medical informatics training program.

Although the CMIO may be an organization’s most visible informatician, there are many other opportunities available to physicians with interest and expertise in informatics. “I think there’s a range of opportunity. There’s definitely an emerging role for clinicians who want to make it their primary career activity, who really want to transition,” says William Hersh, MD, Professor and Chair, Department of Medical Informatics and Clinical Epidemiology at 

But Hersh foresees a wider range of potential involvements: “Everything from the clinician who essentially is going to change his or her career so that informatics is their primary job responsibility to more intermediate liaison positions... where they’re still predominantly a practitioner but they have enough informatics skills that they can serve as liaison” between the clinical and IT departments.

Wessel agrees that a good introductory position for physicians interested in informatics is as a part-time liaison between clinicians and IT staff . He suggests that physicians who have extensive clinical experience will likely bring the most to such a position, since these clinicians are often best qualifi ed to communicate their colleagues’ needs to IT leaders and developers. The tradeoff , he cautions, is the need to balance clinicians’ expectations with what is actually available.

David Hall, MD, began in such a part-time IT liaison role, but soon found a transition to full-time informatics irresistible. Hall, an internist-pediatrician, left his practice to become Physician Informatics Specialist for 

 in Peoria, IL. He saw informatics as a field that, although still in its infancy, would ultimately change the way that healthcare is practiced. Says Hall, “To be part of this opportunity was something I couldn’t pass up. I knew I would regret it if I did.”

In his current position, Hall works to enhance the enterprise’s EMR system, develop standardized order sets in anticipation of a projected computerized provider order entry (CPOE) rollout, and analyzes data from OSF’s seven hospitals to craft quality improvement initiatives. He summarizes his activities as “providing clinical expertise to a very technical world.”

What skills do interested physicians need to successfully transition to a career in clinical informatics? According to Hersh, “Physician-IT leaders need… a baseline understanding of the technology, but that’s only a part of it. Th ey also need to have organizational skills, political skills. They must be able to work with people, and possess knowledge of informatics and what the major issues are in informatics— standards and interoperability of systems and other national initiatives.” Many physicians will likely find themselves inadequately prepared, however, since most of these skills are ignored in traditional medical education. Fortunately, help is available.

Wessel recommends involvement in AMIA, an organization dedicated to the development and application of biomedical and health informatics in support of patient care, teaching, research, and healthcare administration. AMIA offers a variety of educational resources and networking opportunities to its members. In fact, Wessel initially joined the organization so he could associate with other physicians who were also doing what he wanted to do. Membership helped him evaluate if a similar role would be a good fit for him. One particularly popular resource for new and potential physician informaticians is AMIA’s 

e. Hersh is one of the originators of the program, and is the course director of the “10x10” program at OHSU.

According to Hersh, “The course came about because the AMIA recognized that there are not enough clinician leaders in hospitals and other healthcare settings who can be that link between the clinical and the IT.” AMIA created the program with a goal of training 10,000 healthcare professionals in IT by the year 2010 (hence the term “10x10”). The courses, now also offered for credit by several other universities in partnership with AMIA, are conducted online, followed by a one-day, interactive, in-person session. 10 x 10 participants receive a broad introduction to informatics, including subjects such as personal health management; electronic and personal health records; health information exchange; standards and terminology; healthcare quality and error prevention; public health/population informatics; and translational bioinformatics. Participants are taught to develop solutions to problems in real-world settings (ideally their own) guided by established informatics principles.

The National Library of Medicine sponsors a week-long biomedical informatics course each spring and fall at the 

Marine Biological Laboratory at Woods Hole, MA

. This course is an excellent resource for physicians seeking to increase their knowledge and understanding of the field of medical informatics, as well as to meet and interact with other professionals in the field. Course participants receive an intensive introduction to all areas of clinical

informatics, taught by internationally recognized faculty from across the country.

 routinely cite its influence on their professional careers and on their involvement in a broad range of activities related to medical informatics. The 

Association of Medical Directors of Information Systems

 is another professional organization specifically for physicians interested in and responsible for healthcare IT. This

organization also offers symposia, a listserv, an online journal, online presentations, and networking opportunities. In addition some specialty organizations, such as the 

 (ACP), sponsor online informatics-related resources for their members.

Clinicians seeking more extensive training may be interested in a certifi cate or masters degree program in medical informatics or public health informatics. Increasing numbers of these programs are available in part or almost completely online, making them accessible to working professionals. Tanu Pandey, MD, practiced internal

medicine for fi ve years before enrolling in the Masters in Public Health Informatics program at the 

. She chose the program, offered online, as a “route to expand my skills into public health, health

policy and administration, and clinical informatics.” Pandey, who “loves clinical practice too much to leave it completely,” says that enrolling in the program “was an awesome decision.” And although she doesn’t currently have any specific job in mind, she hopes her preparation will allow her to eventually combine her passion for clinical practice with her interest in IT.

Where can one find the ideal informatics job? Prospective candidates may want to start in their own backyards and explore opportunities at their current institutions. Hersh suggests resources such as 

. He also notes that headhunting firms are starting to either specialize in this area or add it to their repertoire, and

predicts that this trend will grow. Are there difficulties that a physician might anticipate when leaving clinical

practice for a job in informatics? The prospect of leaving the bedside represents a difficult dilemma for most physicians. Wessel was no exception. He took comfort from the 

’s (AMA) book, Leaving the Bedside, which helped him realize, “I wasn’t the only physician considering this.”

Wessel also mentions the ambiguous role in which informaticians may be viewed. “Other physicians may no longer see you as one of them, and IT professionals may view you as a person with authority but without any IT knowledge.” Hall found that he had to adjust to working within a “completely different workflow and environment” than when he practiced clinical medicine. “It’s definitely more of a business lifestyle than a physician

lifestyle. It’s quite different from what I had envisioned myself doing, for sure.” Hall offers the following advice to physicians considering making the move to IT: “Much of what I did in internal medicine involved delayed gratifi cation, such as reducing a patient’s risk of a myocardial infarction.Informatics is along those lines. You have to keep an eye on its promise for the future and where you’re heading.”

My interest in computing began with an introductory BASIC programming course I took in college. Then, as a resident in internal medicine, I renewed my interest in computing with an early Texas Instruments hobbyist computer. That was followed by a string of machines as the technology and prices improved. By the time I began practice as a nephrologist, I was familiar with the early electronic records systems then being used in the care of dialysis patients. I began writing simple database applications to help me manage my own patients, and started extending the system that was available in our dialysis unit. I attended some database programming seminars and continued developing simple EMRs.

When the Internet “happened,” I became an early adopter, by creating a 

 with links to online patient education material. Although I participated in the information systems committees of the integrated delivery system with which I was affiliated, I wanted to further expand my involvement in clinical informatics. For me, a career shift into academics was the best way to accomplish this.

I left private practice four years ago for my current position as a full-time faculty member in the Department of Medicine at the University of Illinois College of Medicine at Peoria. Here I have had ample opportunities to expand my interest and training in informatics by developing projects within the department and with the hospital and medical school. At the same time, I’m able to teach principles of clinical information management to residents and students, continue clinical practice, and develop a research program. With funding from the Agency for Healthcare Research and Quality, my colleague, Dr. Jim Graumlich, and I are evaluating the ability of health information technology to facilitate information transfer between physicians, pharmacists, and patients at transitions of care. For me, this has been the perfect position at this point in my career. I couldn’t be happier.

’s Editorial Board. He is also Assistant Professor of clinical medicine and Program Director at the Department of Medicine, University of Illinois College of Medicine in Peoria, IL.

Most physicians choose clinical medicine because they want to make a positive impact on patients' health. Tom Wessel, MD, is no exception. And that's the reason he left the bedside.

Sounding Board: Career Makeover: Medicine Moves to IT

Health information technology (IT) is evolving rapidly. Big changes are on the way, including pay for performance (P4P), ePrescribing, ubiquitous electronic health records (EHRs), and computerized physician order entry (CPOE), interoperable patient data that can move from provider to provider effortlessly over high-speed Internet connections, and a new breed of personal health record that will scour the Internet for patient-centric health information. Who will guide this process? The individuals on this list are likely to have a major influence over the direction of healthcare IT over the next few years.

 Microsoft is committed to entering the health IT arena. Ballmer recently told Health Informatics, “We’re very serious about health, not just providing doctors with a word processor, but also very interested in the business of health, and we’re very committed to it.” Microsoft recently acquired 

, a health IT company that aggregates clinical information across disparate platforms. Microsoft has also unveiled its 

, which is a schema for permitting the interoperability of patient data across systems. Microsoft may also be interested in the home health market and 

medical devices that facilitate information transfer

 between patients at home and physicians, offices, or hospitals.

 Chairman of the Board, Intel Corporation

Barrett is a member of the highly influential 

, Barrett has been outspoken in his criticism of American healthcare for being too expensive, too inefficient, and too error-prone. He has called for wider adoption of IT to lower costs and improve quality in healthcare. Significantly, Intel has joined with 

, and other partners to fund a non-profit institute to develop a personal health record (PHR), named 

. Dossia, according to a December 6, 2006 press release, will be an independent system that will “give individuals access to complete medical information whenever and wherever they need it.” Dossia may revolutionize the PHR market because it is not only a repository for personal health data, but also an aggregator of personal health data that can gather health information from various sources and store it within secured databases.

 Medical Director of Clinical and Quality Analysis, Partners Healthcare System

Dr. Bates has played a pivotal part in academic health informatics, championing the role of EHRs and computerized decision support in improving patient safety. He serves on the Executive Committee of the Center of Information Technology Leadership at 

. He is co-director of the Program in Clinical Effectiveness at the 

 covers such areas as prevention of adverse drug events, improving clinical effectiveness, and implementation of clinical guidelines through the adoption of EHRs and decision support.

 Vice President of Google, Head of Google Health

 Bosworth, one of the pioneers of XML technology, is Vice President of Engineering at Google and now heads

 wields immense influence and power in IT, and while the company’s exact strategy in the health IT space may still be evolving, it is clear that healthcare is too big for Google to ignore. Google may choose to be a provider of medical information (competing with 

), a purveyor of PHRs (as alluded to in this 

), or an aggregator of personal health information. Bosworth is committed to improving the quality and relevance of health information searches in Google. Refer to our May 2007 Cover Story, “

Director, Agency for Healthcare Research and Quality (AHRQ)

, which has become the government vehicle for distributing grants for the development of health IT infrastructure. Most government money available to offset the cost of purchasing health IT has been funneled through AHRQ. AHRQ has been pivotal in developing strategies and funding research that addresses how health IT can make healthcare safer and more efficient.

Crane is a mathematician who has led teams that created software for electronic medical records (EMRs), ePrescribing, physician education, and Web-based medication sales. He is at the center of 

National ePrescribing Patient Safety Initiative

 (NEPSI) efforts to provide every physician in the US with free ePrescribing software (eRXnow). It allows physicians to prescribe electronically through the SureScripts Network and access benefit information through the RxHub network.

, which seeks to mobilize the purchasing power of large employers to create breakthroughs in the safety and cost effectiveness of American healthcare. The Leapfrog Group has established an initial agenda of “

,” hospital quality and safety practices that include CPOE, evidence-based hospital referrals (referring patients to hospitals with the most and best experience in treating specific disease entities), staffing of ICUs with specialty trained intensivists, and implementing 30 

National Quality Forum-endorsed safe practices

Kevin Hutchinson is a member of the AHIC and is CEO of 

, which, as the network that electronically connects physicians and clinicians to pharmacies and makes ePrescribing practical, has been key to the recent success of ePrescribing in the US. SureScripts is one of the partners with 

Dr. Kibbe is the founding director of the 

, where he serves as a senior advisor. Now he is a health IT consultant with the Kibbe Group and is one of the co-developers of the 

 (CCR), which allows the interoperable exchange of patient information between providers and across platforms and EHR vendors. Kibbe is an 

influential health IT strategist and visionary

 who has the creativity to build new solutions to old problems in health IT.

 National Coordinator for Health Information Technology

: Dr. Kolodner previously served as Chief Health Informatics Officer for the 

; and in 2006 replaced Dr. David Brailer in the pivotal position of National Coordinator for Health Information Technology. The 

 (ONC) is charged with developing and implementing a strategy to move healthcare into the IT age. Kolodner plans to follow the aggressive agenda set by Brailer to push the development of interoperable standards in health IT, push for the 

 (NHIN), and continue to push for physicians and hospitals to adopt EHRs.

 Chairman, Certifi cation Commission on Health IT (CCHIT)

 Leavitt is the driving force behind the 

. CCHIT was formed to operationalize Dr. David Brailer’s idea that the certification of EHRs would speed adoption by physicians and other healthcare professionals. In 2006, CCHIT completed its first round of certifi cation of ambulatory EHRs and in 2007 will begin certifying inpatient EHRs. Key to the process of certification are issues of functionality, privacy, security, and interoperability. Both inpatient and outpatient EHRs must be certified in a juried testing process. CCHIT workgroups establish both criteria and scripts for testing the EHRs, which influences vendor development through a “roadmap” process that delineates what functionality will be tested annually over the next three testing cycles.

: Secretary of the Department of Health and Human Services (HHS)

 Leavitt wields enormous power over healthcare expenditures through the huge Medicare and Medicaid programs. His budget accounts for nearly 25% of federal expenditures and has 67,000 employees. According to the 

 website, Leavitt is “intensely focused on making healthcare more transparent in quality and price...” Leavitt has committed the HHS and Centers for Medicare and Medicaid Services (CMS; www.cms.hhs.gov) to using health IT to lower healthcare costs and reduce medical errors. Leavitt is a strong proponent of P4P as a tool to reduce healthcare costs. On the HHS site, Leavitt indicates his intention “to link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health.” Leavitt also serves as Chair of AHIC. Through the HHS, Leavitt is responsible for major initiatives in health IT, including AHIC, ONC, government P4P, and the 

President and CEO of Health Information Management Systems Society (HIMSS)

, a powerful organization that now has more than 15,000 individual members and more than 240 corporate members that employ more than 1,000,000 workers. The winter annual meeting of HIMSS has emerged as the most important industry trade show where deals are made and new products rolled out. HIMSS has extended its reach and influence beyond vendors and now attracts clinicians, CMOs (Chief Marketing Officers), CIOs (Chief Information Officers), CNOs (Chief Networking Officers), and CMIOs (Chief Medical Informatics Officers) to its hugely successful annual meetings. Not only has HIMSS emerged as a vendor trade organization, but also as an organization that has significant efforts in education, professional development, and health IT advocacy.

, arguably the most successful developer of EHRs and CPOE. Cerner continues to grow at a rapid pace and has signifi cant market penetration in both the US and internationally. In my opinion, Cerner has set the bar high for inpatient EHRs.

 Managing Partner, National Health Information Infrastructure (NHII) Advisors

National Health Information Infrastructure

 Director for HHS. He has had considerable influence in molding the strategy behind the NHIN and now is a healthcare consultant and founder

. eHealthtrust is a new idea in EHRs that proposes to store patient data in protected health data banks, allowing patients to access their records but also making the data available for research and public health uses on a 

Daniel B. Hier, MD, MBA, is Professor of Neurology and Rehabilitation at the University of Illinois at Chicago, where he is Physician Practice Director for the Neuroscience Center. He is the Physician Editor of 

 and Associate Editor for Education for AAN.com for the American Academy of Neurology. He serves as Vice Chair for the EHR Workgroup for the AAN.

Health information technology (IT) is evolving rapidly. Big changes are on the way, including pay for performance (P4P), ePrescribing, ubiquitous electronic health records (EHRs), and computerized...

Who Will Change the Course of Health Information Technology?

The topic of health information technology (IT) seems to be popping up everywhere nowadays. No longer the

province of healthcare and tech-focused websites, it has recently made prominent appearances in the pages of

high-profile, widely read publications like 

s, and has been featured numerous times on popular news outlets such as CNN and MSNBC. Once the presidential campaigns start heating up (and yes, they will get much hotter), health IT will likely get even more air time. Given all this massive media exposure and attendant hyperbole, and in light of some of the grandiose claims made regarding the capabilities and promise of healthcare IT, one could be forgiven for asking the question: Is health IT all hype?

One person who certainly doesn’t think so is Kevin Hutchinson, a guy who knows a thing or two about health IT. Hutchinson is an active member of the American Health Information Community (AHIC) and serves as president and CEO of SureScripts, an innovative outfit based in Alexandria, VA, which has made it its mission to “facilitate the electronic transmission of prescription information between physicians and pharmacists” and “improve the overall quality, safety, and efficiency of the prescribing process.”

When Hutchinson moved to Alexandria, VA, three years ago, he had an interesting experience: about 10 minutes after he installed his telephone and fax machine, he started receiving faxes. Tons of them. Only it wasn’t like the Seinfeld episode where Elaine was getting bombarded with restaurant menus. There was nothing comical about what Hutchinson discovered when he began sorting through the laboratory results, prescription refill requests, discharge summary reports, and other crucial medical documents that were being sent to him instead of to physicians’ offices.

After some investigating, Hutchinson learned that the fax number assigned to him was previously registered to a nearby practice. The catch? Th e physician’s office, it turns out, changed the number three years earlier. The pharmacies that were still using the (supposedly) defunct number had received several notices that the number had changed; however, their speed-dial settings still contained the old number and continued to send prescriptions to a business address and not a doctor. “I couldn’t believe it,” said Hutchinson in an interview with MDNG. “We’re talking three years. It really opened my eyes.”

The whole ordeal could have been avoided, said Hutchinson, if ePrescribing systems had been put into practice by the physicians and pharmacists involved. ePrescribing—or as Hutchinson prefers to call it, “the automation of the prescribing process”&mdash;works to fix the errors often caused by manual entry while facilitating the “interaction between physicians and pharmacists” that plays such a crucial role in the process. With this technology, healthcare professionals have the potential to reduce the number of adverse drug events that occur and achieve significant improvements in workflow. And of course, there’s the financial issue. One study suggests that adoption of ePrescribing technology could save as much as $27 billion in healthcare costs domestically.

What’s even more promising is that health IT, including ePrescribing, seems to be gaining in popularity among both

physicians and patients. Results from a survey announced at the “Health IT: Unlocking the Potential” summit suggest three times as many Americans favor healthcare providers who use electronic medical records (EMRs) over those who do not, and more than four times as many Americans prefer insurance carriers who have entered the digital age. The study, commissioned by Kaiser Permanente, also shows that 72% of American adults view a computer system as more efficient than a paper one when it comes to managing medical records, and—perhaps even more importantly&mdash;73% believe that the benefits offered by EMRs outweigh the potential privacy risks.

During an address at the recent Government Health IT conference in Washington, DC, Robert Kolodner, MD, national coordinator for health IT, stated that the quest for health IT adoption has “made more progress in the last three years than we had in the last decade, or maybe two decades,” adding that we are now at “the tipping point.”

In a statement reported on the Healthcare IT News website, Andy Stern, president of Service Employees International Union (SEIU), said that health IT “can transform healthcare for the benefi t of those who deliver it and those who need it.” SEIU recently joined forces with two other advocacy organizations, AARP and Business Roundtable, to present a case to Congress for further support of health IT adoption. Not only can health IT serve as a “building block” to healthcare reform, but it can result in significant savings, according to Stern, who cited a 2005 RAND study that estimated the potential efficiency savings at more than $77 billion.

The benefits of health IT adoption extend far beyond just cost savings, however. Innovative thinkers are proposing other ways in which health IT can significantly improve patient care.

• In Maryland, the Community Health Integrated Partnership is working on an initiative to establish an EHR system and integrate it with an existing automated registration, scheduling, and billing system that serves the uninsured.

• In Michigan, urban teenagers using a Web-based asthma program reported fewer symptoms and missed fewer school days than students who were utilizing more traditional methods of monitoring and education.

• Oregon Health & Science University launched a $7 million federally funded pilot project to determine whether

monitoring technology can help detect earlier signs of Alzheimer’s disease.

With what seems to be overwhelming support from both patients and physicians thanks to the success of selected programs, the potential of forward-thinking initiatives, and projections of future successes, the case for health IT adoption should be a slam-dunk. But not everyone is sold on the idea. Data from two surveys conducted by Health Industry Insights suggest that some physicians feel that incentives are hard to come by and are not necessarily high on the list of concerns for payers. The first survey suggested that a majority of managed care companies are not providing physicians with financial incentives to adopt IT systems that are needed to track quality health data for pay-for-performance (P4P) initiatives. Only 37% of payers surveyed reported offering physicians financial incentives to deploy IT systems, despite the fact that “IT systems, including electronic health records and electronic access to clinical guidelines, are the most effective ways to collect and track the patient data.”

The second survey suggested that “many payers don’t actively invest in or sponsor physician IT adoption and many more don’t incorporate it as a P4P incentive,” and that “despite the industry standard that physician IT adoption is critical to better outcomes, payers ranked it fifth in a list of seven factors required for successful P4P programs.”

Fortunately, there are some groups and organizations that rank health IT adoption much higher among their priorities. The National ePrescribing Patient Safety Initiative (NEPSI), a national program launched earlier this year in response to the staggering number of medical errors that plague the healthcare system, provides US physicians with free, Web-based electronic prescribing software. The goal of NEPSI is to facilitate the use of ePrescribing software by every physician’s office and pharmacy in the US, and, subsequently, eliminate thousands of injuries and deaths caused by prescription errors.

Physicians who are reluctant to send records electronically to healthcare providers in other states for fear of breaking privacy laws can take comfort in the fact that the State Alliance for e-Health likely will develop legislative language to provide healthcare professionals safe harbor from violating state laws. “The alliance’s Health Information Protection Task Force recommended that the group develop language as part of an initiative to increase the electronic transmission of patient information between providers in different states,” according to Government Health IT.

It’s a Poor Musician Who Blames His Instrument

Physicians who mistrust the reliability and effectiveness of current technologies and physicians who are uncertain of their abilities to successfully implement new technology are major barriers to health IT adoption. Because of these and other reasons, many physicians still haven’t fully embraced the health IT revolution. According to Hutchinson, some instances aren't so much a refusal to integrate as much as a lack of education on how to best navigate certain systems. “A lot of the time, it’s a problem of awareness,” said Hutchinson. “A lot of physicians out there are filing electronically, but then they’re still faxing ePrescribing orders.” In some cases, physicians simply have not been educated on the correct way to navigate the technology in order to achieve optimal results.

To that end, the Centers for Medicare and Medicaid Services (CMS) is doing its part to assist physicians in the adoption and implementation of EHRs and care management practices with the launch of the Doctor’s Office Quality IT University website. A free education tool designed to help small-to-medium-sized physician practices adopt health IT, the program provides self-paced lessons and tools for the adoption of EHRs and care management practices.

Steve Lieber, president and CEO of the Healthcare Information and Management Systems Society (HIMSS), reiterated Hutchinson’s sentiments when discussing the results of a survey in an interview with iHealthbeat.org. “The focus now is on technologies that help practitioners do their job more effectively, more efficiently,” said Leiber, who also expressed that health IT dialogue has become more “focused” and “tactical,” shifting from “discussions of what we might be able to do” to “things we must do.”

The topic of health information technology (IT) seems to be popping up everywhere nowadays. No longer the province of healthcare and tech-focused websites, it has recently made prominent...

July 2007 | Oncology Live®