Art Papier, MD, CEO of diagnostic clinical decision support system company VisualDx, and practicing dermatologist at University of Rochester (N.Y.) Medicine, discusses his 30 years of experience in medical informatics and shares advice for CMIOs.
Responses have been lightly edited for clarity and length.
Question: What do you consider a CMIO's No. 1 priority should be? How can they ensure success?
Dr. Art Papier: CMIOs have a very difficult job because there are so many competing priorities. On the one hand, they have to make sure the EHR is a success in the eyes of their users. And at the same time, they have to concern themselves with security of the network, EHR uptime and all the imperatives of upgrades and technical issues. There is always a backlog of work to be done.
CMIOs can ensure success by focusing on clinical workflow and engaging and listening to the physicians very carefully. In medicine in general, if you focus on what is good for the patient you usually end up doing the right thing. Unfortunately, too much of what the industry does is for the business of healthcare, not for what drives quality, safety and excellence in the exam room.
Q: How did you become CEO of VisualDx? What is your background and why did you set out to start this company?
AP: I'm a physician that has been involved in medical informatics since the 1980s. I had the great fortune to meet Larry Weed, MD, the founder of the Problem Oriented Medical Record and SOAP notes, during medical school. [Dr. Weed] told me in 1984 that medicine relied too much on the human brain, that complex systems require tools to augment the brain, and infected me with his passion to change the system. His critique of the inherent problems in medical education and care delivery from the 1970s is as relevant today as it was back then.
After working for [Dr. Weed], I ended up in dermatology and brought together his ideas around problem orientation, patient work-up questionnaires and visualization. We started VisualDx at the beginning of graphical displays. We just don't think people want textbooks online. Decision support needs to be highly visual.
Q: How do you feel about the use of voice recognition technology, such as Amazon’s 'Alexa' and Google Assistant, in healthcare? Is there a place for its use within the EHR?
AP: Alexa, Google Assistant and Siri will for sure all play a role with people in their homes. We have already built Siri into our new app for patients, Aysa. The idea is that people will be able to talk into their phone or assistant and describe their symptoms. Aysa will be able to guide and teach them and ask them the right questions. Who wouldn't want a copilot for their health?
The use of these tools in the EHR by the professional is a little more difficult due to patient confidentiality. It remains to be seen whether clinicians can maintain patient privacy while speaking into a device in a clinic with other people nearby.
Q: Where do you see the biggest need for innovation to improve clinical informatics in healthcare systems in the future?
AP: Everyone is talking about artificial intelligence and machine learning. Certainly, deep learning of imagery will move expertise into the hands of non-experts. Image recognition is going to make the patient and professional smarter and will augment our brains in ways unimaginable from just a few years ago.
There is tremendous hype along the lines of man vs. machine and AI replacing doctors. These are typical attention-grabbing headlines but not real. As long as there is grayness, ambiguity and great unknowns in medicine, the informatics equation will be 'brain + computer > computer.' In the near term, we should think of these tools augmenting what we do, not replacing us.
The greatest need for innovation centers around integrated systems and platforms. There will be too many applications and too many competing products in the marketplace. There will be difficulty integrating disparate tools into workflow and keeping it simple enough for professionals to be trained on and use daily.
It seems that the greatest innovation will be a unified platform to keep it simple and easy, and able to unload what the brain is poor at, and to optimize what the brain is good at. Highways have universal road signs, stop signs are red and octagonal … What are the universal design idioms that will ease understanding and communication in medicine? We need common formats to innovate on top of. [Substitutable medical applications and reusable technologies criteria] on [fast healthcare interoperability resources] is a start, but we have to go further.
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