Earlier this year the troubled rollout of an electronic health record system at Athens Regional Medical Center in Georgia made the news when it was quickly followed by the resignation of the hospital’s CEO and president, as well as the CIO. News reports suggested that one of the reasons the implementation went so poorly was a lack of clinician input.
When it comes to EHR implementation, physician engagement “is really difficult,” says David Beuther, MD, the chief medical officer at National Jewish Medical and Research Center in Denver. “Which is a reason why hospital executives don’t do it. But there should be ownership of the issue on both the physician and executive side in terms of getting it to happen, and a CMIO is in a good position to see both both sides.”
While he believes that a successful implementation is unlikely without physician engagement at some level, there are reasons why it’s difficult to get that engagement. “Physicians are busy and aren’t inherently trained to be systems thinkers,” he said. “And they’re more likely to be all about what’s in it for them and their patients.”
Consequently, physician engagement is often reactive and “hyperlocal,” Beuther said, which makes it more difficult to make good decisions because the input received from physicians may at first not even be that valuable.
To make matters worse, there’s a well documented “morale problem” among physicians today as they deal with a changing healthcare environment, and this “overlays physician engagement,” said Beuther. “Reimbursement, income and autonomy are all decreasing and physicians aren’t terribly happy and they don’t have the emotional reserve they used to have to handle change.”
Having strong physician leaders is one way to get good physician engagement, he said, but this could be problematic if they simply aren’t available. “We don’t really train our physicians to be leaders,” Beuther said. “I think it’s starting to change and from medical school on up it should be part of the curriculum. At our organization we’ve actually had to grow our own physician leaders by selecting those that we believe have the necessary raw material and mentoring them and giving them the leadership training that will grow them into leadership positions.”
In the trenches
Beuther is a practicing pulmonologist and spends at least three half days a week in clinic and believes that experience is critical to physician engagement and adoption.
“I’m down there in the trenches with them,” he explained. “So I’m there enough so that if a system or a workflow isn’t working I’m experiencing it the same time they are and usually it’s hurting me just like it’s hurting them.”
It also allows him to sniff out problems before they become particularly disruptive, he said, since physicians are unlikely to bring up issues before they become completely unbearable, “and then they get really angry and things become less productive.”
The point is, Beuther said, that his grassroots level perspective gives him enough credibility to explain to physicians why certain decisions are made. “I have built a certain level of trust that decisions are being made for good reasons and I can get key thought leaders in the clinic to understand that there is some rationale behind these decisions that are being made.”
One issue, he said, is not to allow that level of trust to dissuade physicians from engaging in the first place because they trust that the CMIO totally understands what physicians are going through. “You don’t want to have them beg them for input,” he said.
In the end when it comes to physician engagement a successful CMIO is an “influencer,” Beuther said. “You can’t really force people to do something—it’s much easier just telling people what to do. But once you’ve been able to influence someone, then you’ve really won the game.
“And one of those influencing skills is being there in the trenches, and being a colleague and convincing them they should do something,” he said. “I spend a lot of time listening and crafting messages and I don’t think I could do that well if I was up in an ivory tower just sending emails to people.”