Physicians' Roles in Implementing Health IT

The depth and breadth of health IT offerings for physicians - especially those in solo and small practice - can be overwhelming. Often, physicians delegate the selection, training, and integration of new tech tools to their administrators or staff.

But that may not be the best choice, according to Michael Zaroukian, a primary-care physician as well as vice president and chief medical information officer for Sparrow Health System, one of Michigan's largest health systems. Using the selection of an EHR as an example, Zaroukian told Physicians Practice that physicians must ask one crucial question from the outset: Do they want an EHR or do they feel they are compelled to have one?

"Physicians need to come up with their own reasons why using an EHR in their delivery of care is important to their goals for patient care quality, safety, efficiency, and value.  Practices should ensure that EHRs are not implemented in a manner that shifts work that staff can appropriately do to physicians, but rather to validate and implement EHR work flows that allow staff to function at the top of their licenses to support the physician in team-based care," he said.

Zaroukian will deliver the Physicians’ IT Symposium opening keynote, "Diverse Roles of Physicians in Health IT," scheduled for Sunday, April 12, from 8:15- to 9:15 a.m. CT at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Chicago.

He recently spoke to Physicians Practice to share his insight on the various ways physicians can be involved with health IT innovations.

Physicians Practice: What should a physician's role be in selecting health IT for the office?

Michael Zaroukian: Engagement of physicians is critical in part because, as crucial members of the care team, they need to interact with the system, with their colleagues, and with their patients in a way that is effective, efficient, safe, and ensures high quality. If they are not engaged in the selection process, then they've missed a huge opportunity to weigh in on how to best leverage EHR configuration options with desired patient care work flows. So it is really very important to be able to imagine with the EHR you are considering - whether you are considering your first one or changing to a new one -how you will leverage its layout, its features and functionality, and its personalization options, to help make sure it can fit with what you want to do and how you like to work.

You should strongly consider following what the vendor already knows to be established best practices from other similar customers – specialty, size, and types of healthcare professionals – and try to follow those best practices that are suitable to your practice while still being able … to personalize the EHR experience to match your own personal content and work flow preferences, for everything from clinical documentation to order entry, use of voice recognition, and interoperability with other EHRs. 

PP: How can managers and administrators get physician buy-in when it comes to practice technology?

MZ: Since time is one of the scarcest and most precious assets to physicians, it can be difficult to convince them of the importance of taking time to actively participate in health IT product selection, work flow validation, user acceptance testing, and preparation for go-live. When this happens, it is important to remind them that if they don't have time to help make sure the practice chooses the right system with the right functionalities and work flows to support its goals for quality, efficiency, and safety, it will be harder and more expensive to do so later, especially if they eventually have to replace the system.  

When it comes to appropriate EHR selection and a smooth implementation and go-live experience, physician engagement is not a "nice to have," it's a must.

PP: What advice do you have for your peers - physicians - to keep up with technology?

MZ: If I were to leave my current practice and go out into solo practice, the first question I'd ask myself is: Is there a trusted partner out there whose shoulders I can stand on to support my general computing and network infrastructure needs, and to help me implement, optimize, and maintain the EHR and practice management system I select? This would mean finding an information technology infrastructure partner with a proven track record, whether it is an IT company that does this kind of work for health practices, or a health system that has a community outreach program that provides IT infrastructure support along with an EHR solution they can offer.

At Sparrow, we have the ability for physicians in small, medium, and even large practices to use our experience, expertise, and assistance to purchase, implement, and use our EHR and practice management system, often at deeply discounted rates made possible by Stark exceptions and Anti-Kickback [Statute] safe harbors that enable EHR donation.  With shared clinical data, much of the interoperability challenge goes away and all the expertise and technical resources to implement the system are locally available from a trusted partner. At the same time, the practice management data remain private to the practice, protecting and promoting their continued independence.

Another approach for those providers and practices who want to have their EHR and supporting IT systems housed and supported remotely would be to consider contracting with one of the cloud-based EHR solutions. This raises its own set of issues and tradeoffs to consider but has been an effective approach for practices that do not have an EHR community outreach program to connect to or prefer to implement a solution that is completely separate from a local hospital system.