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Vivek Kundra: Training Physicians To Use EMRs Is The Key To Adoption

I attended the 29th annual Management of Change (MOC) Conference with Dr. Val.  The conference is sponsored by the American Council for Technology and the Industry Advisory Council.  MOC brings together government and industry leaders to share knowledge, collaborate, and develop actionable technology management strategies.  As a physician, attending this conference for the first time, I assumed a great deal of the conference topics would be over my head and in very “techie” terms. My hope was to get a glimpse of some of the technology solutions the government was considering as they relate to health care IT.

Vivek Kundra, first Chief Information Officer of the United States, addressed the audience early in the day in language that even a doc could understand. He spoke about the need to simplify government, and connect people to solutions, instead of “endless bureaucracies.” The same of course goes for medicine. How great would it be to connect our patients to systems that actually had interoperable medical data?

I was able to catch up with Mr. Kundra after his talk for a few minutes and ask him how technological simplification would apply to physicians such as myself, operating in a haphazard infrastructure with varying PAC systems, EMR’s and paper charts. He said the key would not only be investing in technology, but investing in training healthcare personnel to master new technologies. He acknowledged that different generations of physicians would embrace technology differently, but ultimately, if a physician says he “can do a better job on paper” then we have a problem.

I was very impressed by Mr. Kundra’s answer namely because it was so insightful for a man who’s expertise lies primarily in the technology field. He does not come from a healthcare background, and yet had hit the nail on the head. There has been so much talk about HIT being the “key” to cost savings and the next “breakthrough” in medicine. With very little discussion on how physicians feel about it. For some docs – particularly those that come from an older generation – the thought is quite terrifying. They are happy with their paper charts and manual dictations. Health technology is almost viewed as an impediment to those set in their ways, and accustomed to a system that has worked for them and their patients for years. This upheaval will not come without it’s challenges even after we find the best technologies for the tasks at hand. It will be imperative for government leaders to understand that the mission of HIT implementation may be just as difficult as finding the technology solutions they are currently seeking.

As Mr. Kundra and his team embark on this huge task, it will be important for physicians and health care personnel to engage with the government and serve as a guide for what docs need from technology, and what will and will not work for our patients. I hope next year’s conference is attended by more physicians such as myself and Dr. Val.


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9 Responses to “Vivek Kundra: Training Physicians To Use EMRs Is The Key To Adoption”

  1. Jay Bhatt says:

    Excellent piece. The point is certainly an important one considering health IT and having standards as well as everyone speaking the same language.

  2. Jamie P. Morano, MD, MPH says:

    Yes, indeed! Thanks, Geeta, for this great commentary.

    I just returned from a semi-annual business meeting of our local community hospital in Rockville, MD held on June 2, 2009; apparently federal stimulus package money is being generated to help this hospital system with HIT infrastructure. It would be important to know if these stimulus HIT investments are interoperable between each recipient? Let's hope the records will be accessible for more than the 6 months that are currently allowed with our current EMR system!

    For other HIT folks out there, can we somehow modify our VA system (or other privately owned systems such as Dartmouth-Hitchcock or Vanderbilt) that work very well and are already field-tested? From “Health Affairs”, HIT systems are currently being piloted by the US Government and in Massachusetts, but the key is making these financially feasible for hospitals and private practices. And you're right, if the HIT systems are subsidized, it will be crucial to make sure that the medical staff is both willing and able to document via these systems appropriately.

    A dream for me would be a free-access Google-like system of health office/hospital records based on the Outlook model (with VA-like security) in which physician practices could add/modify the system to their needs but also somehow be automatically updated by the government systems in terms of compliance with diagnostic codes and formularies!

  3. Monica says:

    A very interesting article. I personally feel that despite the challenges and the initial opposition, eventually the concept will have a good chance of getting mass acceptance, more so as recent generations of doctors are very computer savy. It will increase convenience, add accountability, create more order and easier sharing of information as with any other IT based solution.
    It would be exciting to watch as IT hits the health field.

  4. Dr. Neeta Venepalli says:

    Unless the government finds a way to reward physicians for switching to health technology instead of paper charting, it won't happen. This could be in the form of subsidies or tax refunds for clinics/hospitals or a reward system with regards to insurance costs. Otherwise, what incentive is there for doctors to switch to more expensive computer systems that require even MORE time to learn to use (for them and their staff), regardless of the ultimate payout? I welcome Mr. Kundra's suggestions on how to make the esoterics of HIT accessible, practical, and cost effective. Until then, paper charting is here to day.

  5. Jay Bhatt says:

    Excellent piece. The point is certainly an important one considering health IT and having standards as well as everyone speaking the same language.

  6. Jamie P. Morano, MD, MPH says:

    Yes, indeed! Thanks, Geeta, for this great commentary.

    I just returned from a semi-annual business meeting of our local community hospital in Rockville, MD held on June 2, 2009; apparently federal stimulus package money is being generated to help this hospital system with HIT infrastructure. It would be important to know if these stimulus HIT investments are interoperable between each recipient? Let's hope the records will be accessible for more than the 6 months that are currently allowed with our current EMR system!

    For other HIT folks out there, can we somehow modify our VA system (or other privately owned systems such as Dartmouth-Hitchcock or Vanderbilt) that work very well and are already field-tested? From “Health Affairs”, HIT systems are currently being piloted by the US Government and in Massachusetts, but the key is making these financially feasible for hospitals and private practices. And you're right, if the HIT systems are subsidized, it will be crucial to make sure that the medical staff is both willing and able to document via these systems appropriately.

    A dream for me would be a free-access Google-like system of health office/hospital records based on the Outlook model (with VA-like security) in which physician practices could add/modify the system to their needs but also somehow be automatically updated by the government systems in terms of compliance with diagnostic codes and formularies!

  7. Monica says:

    A very interesting article. I personally feel that despite the challenges and the initial opposition, eventually the concept will have a good chance of getting mass acceptance, more so as recent generations of doctors are very computer savy. It will increase convenience, add accountability, create more order and easier sharing of information as with any other IT based solution.
    It would be exciting to watch as IT hits the health field.

  8. Dr. Neeta Venepalli says:

    Unless the government finds a way to reward physicians for switching to health technology instead of paper charting, it won't happen. This could be in the form of subsidies or tax refunds for clinics/hospitals or a reward system with regards to insurance costs. Otherwise, what incentive is there for doctors to switch to more expensive computer systems that require even MORE time to learn to use (for them and their staff), regardless of the ultimate payout? I welcome Mr. Kundra's suggestions on how to make the esoterics of HIT accessible, practical, and cost effective. Until then, paper charting is here to day.

  9. Craig Gordon, MD MBA says:

    I agree health care IT COULD yield improvements in medical care (less medical errors, less duplicate testing, better information for physicians to act on) but health care IT is just in its infancy. Multiple problems exist including: health care IT that can accessed by community physicians, hospitals, and acamdemic centers; affordability; the fact that within healthcare there are multiple specialties, each with their own demands; the fact that the data needs to be entered in a fast, accurate, and yet detailed manner; and the fact that it is hard to template what physicians do. While I am an advocate of further research to developing and delivering health care IT, we should approach this process slowly, intelligently in order to work out bugs, ensure physician use and confidentiality, and to avoid huge IT mistakes that the government has a track record for (e.g. FBI database as just one example). In deed this effort should be led by private companies with the government assisting and consulting and ensuring confidentiality and common standards.

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