Center Voices
Hospitals, Physicians and Information Technology
By Bill Johnson
Two trends are emerging relative to physicians’ use of information technology (IT) and IT’s impact on physician-hospital relationships. First, physicians are becoming more active users of hospital-based clinical IT systems, and secondly, they are installing and using clinical IT systems more in their own offices. Boards should be prepared to address the implications of both trends.
In the past, the close relationship between hospitals and physicians has centered on clinical processes and related issues, medical staff bylaws and clinical equipment purchases. When it came to clinical IT systems, physicians were, and often still are, passive users of the systems that hospitals installed.
For example, today, most physicians continue to handwrite or call in their patient orders to the hospital. A nurse or a member of the clerical staff then enters the orders into the computer. In many hospitals, clerical staff also print lab test results and transcribed reports available online and then give the printed reports to physicians for their review.
Now, more hospitals are installing clinical IT systems that will require physicians to become active users. Two such key systems affecting physicians are the electronic medical record (EMR) and computerized physician order entry (CPOE). An EMR displays a patient’s medical record in an online, electronic format that physicians access via computer. In CPOE systems, physicians, rather than nurses or clerks, enter their own patient orders.
Although at a slower pace, physicians have begun to install clinical IT systems in their own offices. Their slower pace can be attributed to high costs. Experts estimate that it costs a medical practice $100,000 per physician to implement an EMR, while 89 percent of the economic benefits accrue to others, such as insurers. Nevertheless, physicians recognize the noneconomic benefits of EMRs, such as better access to patients’ medical information and improved patient care and safety.
Another IT-related issue that will make an impact on hospitals, their boards and physicians centers on geographic sharing of patient information. The Office of the National Coordinator for Health Information Technology (ONCHIT) is a federal organization whose mission is to promote development of an “interoperable health information technology infrastructure”—that is, a set of technologies, standards, applications, systems, values and laws that support exchange of information among health care providers. ONCHIT will be a major force behind the establishment of Regional Health Information Organizations (RHIOs). RHIOs are intended to promote the exchange of patient information among health care providers in a given geographical area.
What do these trends mean to hospitals, and how should boards be prepared to react? Six implications warrant trustees’ attention:
- Physicians’ more active use of hospital IT will require increased board support for hospital IT policies and resources. However, while some physicians will advocate increased use of IT, others will resist this trend. The board will need to support hospital administration’s policies, such as requiring physicians to enter their orders online using a CPOE system. Paying physicians to enter their orders online may be one cost of CPOE. Boards should also be prepared to support additional IT staff to assist physicians with technology problems and questions.
- As physicians increasingly use hospital IT, they will demand upgrades to the technology. Just as they now want the latest 64-slice CAT scan, so too will they want new and improved IT systems. Boards should expect more IT costs.
- Decreased physician reliance on hard copy medical records will increase the hospital’s vulnerability to unauthorized access to the clinical information contained in those records. For example, hackers could break into a hospital’s computer network and retrieve clinical information contained in an EMR. From this perspective, paper-based medical records are actually safer; in order to retrieve information from them, someone has to physically gain access to the paper record.
Also, hospitals must now have good disaster recovery procedures for computer systems that store electronic records. If a hospital’s computers are destroyed by fire, for example, the hospital must be able to restore the information contained in them. This means the hospital must create backups of computerized records that will allow them to be restored if a disaster occurs. Boards will need to pay more attention to hospital IT disaster recovery strategies, as well as to what measures are employed to protect confidentiality and integrity of patient information.
• Increased adoption of clinical IT in physicians’ offices will strengthen pressures to share information between hospitals and doctors’ offices. Boards should be concerned about security risks associated with opening a hospital’s information systems to nonhospital IT systems. Also, ownership of shared information and lack of interoperability between disparate systems attempting to exchange information are both issues that call for board review.
• As physicians begin to purchase clinical IT systems for use in their offices, many are likely to seek financial, technical and logistical support from hospitals. Boards should be prepared to address these requests.
• External organizations—federal and state government and nonprofit entities—will exert pressure on both physicians and hospitals to participate in RHIOs. This may be a temporary phenomenon, but it is likely to be a topic on many boards’ agendas at some point during the next several years. Requirements to exchange information with other RHIO IT systems will also increase pressure to upgrade existing hospital systems. Secure exchange of information will be an issue here as well.
Boards need to recognize and address issues associated with increasing physician use of clinical IT. Boards that understand and provide guidance to their hospitals on these issues will strengthen their hospital’s ability to create policies and allocate needed resources.
Bill Johnson is a senior manager for Long Beach, Calif.-based First Consulting Group. He can be reached by e-mail at wcjohnso@fcg.com.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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