An interview with AMDIS Award winner Richard Schreiber

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 - Richard Schreiber, MD

At this year’s annual Physician-Computer Connection Symposium of the Association of Medical Directors of Information Systems (AMDIS), Richard Schreiber, MD, was recognized as one of two recipients of the AMDIS Award for excellence and outstanding achievement in applied medical informatics.

“It feels really nice to be recognized by one’s colleagues for hard work well done,” said Schreiber, who serves as chief medical informatics officer at Holy Spirit Hospital in Camp Hill, Penn. “That’s what it represents for me and for the institution where I work.” Schreiber recently took some time to talk about his journey as a CMIO.

How did you make the transition into the CMIO world?

I’m an internist professionally and I’ve always been intrigued by the science, the mystery and detective work involved in assessing a patient’s status. In modern medicine we try to figure what’s going on with a patient so that we can help cure them, or at least ameliorate their suffering. To do this we need lots and lots of data in order to make inferences and deductions in terms of diagnosis. So internal medicine is really data driven.

Right from day one of my medical school days and in practicing I thought that I needed access to information that had to be at my fingertips. And it had to interpretable—not just readable but understandable—and there needed to be a way of amassing a large amount of data in a small amount of space and time. I’ve always been kind of a squeaky wheel about how to make that happen.

And that just naturally flows into what we now know is the job of a CMIO. One of the many things we do is transforming data into information and I think I was kind of thinking about the role of CMIO even before I knew what it meant.

So I was intrigued when those positions started to become available. And for me personally, it culminated in a trip I took in 2005 to New York City to do some due diligence and look at one hospital’s EMR. On the way back I was talking to my CMO and I told him that in order to really make this happen [at our institution] he would need someone to represent the physicians and advocate to them and for them, and that I wanted to be that person. And he looked at me and said, “Good, I was hoping you would say that.” And that’s how I go the job.

Where are you on that journey today?

When I started we were barely computerized. You could look up labs, and we were ahead of the game in that we had a PACS, but relatively speaking our hospital was really kind of behind the eight ball in comparison to our local competitors.

We quickly chose a vendor and implemented in record time, and by 2007 we were live with the first portion of an EMR. We went to CPOE six months later and were the first community hospital in South Central Pennsylvania to have that. Now we are ready to attest for Meaningful Use Stage 2, we are at Stage 6 in HIMSS, and two years in a row we’ve been named most wired. I think that says how far and how fast we’ve come in the last eight years.

What are some of the challenges you face going forward?

What I would really like to do is get out from under the thumb of Meaningful Use. In many ways Meaningful Use is very good—it pushes everyone in the country forward, and that’s a good thing, and a lot of the things we are being asked to do are good things. But it has become so constricting that we don’t have time to do the things we want to do to really make a system hum—to optimize what we already have. We have a great system that works, and it has a lot of information in it, but we could really make it better.

For example, I would really like to have time to focus on improving clinical decision support so that it would allow the electronic record to do things a physician is going to do anyway. If I order a certain drug, for example, I’m going to order certain tests as a follow-up. If it’s an antibiotic I’ll order kidney tests. I’d like to be able to order that automatically and I could try to build [that functionality] but it’s kind of clunky right now and I need the right kind of analytics personnel to make it happen more smoothly. But there’s so much time spent on things like Meaningful Use that I don’t have my analytics people available to do the things I’d really like to do.

I’m also pessimistic that we are going to be able to optimize our system in the way that we really want to in the future. We have a profound shortage of healthcare IT workers and at the same time we’re seeing reimbursements and profit margins being reduced. Healthcare dollars are becoming scarcer and my job might become basically fighting for personnel and money.

What kind of a role does an organization like AMDIS play in the CMIO community?

There are maybe 2,000 CMIOs across the country and they are an intimidatingly smart bunch of people. There is an incredible amount of knowledge and experience out there and I learn so much from the AMDIS ListServ, or by talking to people individually and by phone, or meeting them at conventions. It’s a real brain trust and everyone always seems more than happy to help each other. I’m very happy to be a part of it.