Craig Joseph, MD, interim chief medical information officer at Mountain View, Calif.-based El Camino Hospital and CMO of IT service provider for EHR enterprise software company Avaap in Edison, N.J., discusses future healthcare innovation. Dr. Joseph shares insights on physicians' excitement surrounding EHR technology innovation, including ambient listening devices and incorporation of usability principles.
Responses are lightly edited for clarity and length.
Question: How did you become a CMIO? What is your background?
Dr. Craig Joseph: My undergraduate degree is in computer science, so looking back, I was doomed from the beginning. I majored in computer science because I thought it was fun, but I was always planning to become a physician. I practiced primary care pediatrics for eight years, but the siren song of connecting clinical practice with technology became too great for me to ignore. I accepted a job working for EHR vendor Epic in Madison, Wis., and it's been healthcare IT since then.
Q: Where do you see the biggest need for innovation to improve the healthcare system in the future?
CJ: While we need innovation, and disruption, in virtually all areas of healthcare, I'm a big believer in doing the basics before getting too fancy. A friend once told me, 'You want to be innovative? Try executing. That would be pretty innovative.' While he's sarcastic like me, what I took from him was this: We have science and decades of experience that can lead us to success in healthcare IT, but often, I see people ignore all of that and try to figure it out on their own. As an example, I think it's innovative to incorporate usability principles into our EHR software and configuration options. It shouldn't be innovative, because these principles are now well established, yet I've seen lots of organizations ask their end users how something should look or function even though for many of the questions, we already have the answers.
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?
CJ: Physicians are more excited about ambient listening devices than anything I've seen in my career. The idea that physicians will be able to ask, 'What was Bob's last ejection fraction?' or, 'Have we ever tried Betty on an ACE inhibitor?' is astounding. Soon these devices will be listening for documentation points or potential orders during office visits, all of which can be queued up for the physician to act on when he or she is ready. This is the future that clinicians have been waiting for. This is the technology that the EHR has been lacking.
Q: How do you feel about physician builder programs in hospital systems? What are the advantages, or disadvantages, to putting one in place?
CJ: I recently wrote a blog post for KLAS Research about how survey data has shown that physicians of a given specialty are happier with their EHR if they have a physician builder from their specialty at the organization. Contrary to stereotypes, most physicians embrace technology; they just want technology that works for them, and not vice versa. Giving some physicians extra behind-the-scenes training and access to their EHR configuration tools is a huge enterprise win. The power to create documentation templates and order sets, while straightforward to most IT analysts, is eye opening to practicing physicians. It frees them to create tools they would never have asked for or knew that they needed.
Q: In regards to physician personalization, what advice would you offer to other hospital CMIOs looking to improve physician happiness when it comes to the EHR?
CJ: EHR personalization is one of the key methods that we know can make physicians more efficient and more proficient as they do their work. Sending out tip sheets won't move the needle. While it's not difficult to personalize the EHR, overcoming inertia is difficult. I've found that personal outreach is essential. Having physician champions or other involved physicians 'testifying' about how 30 to 60 minutes of personalization saves them 15 to 30 minutes every single day can convince even the non-believers. The final step is to have other clinicians sit elbow-to-elbow for an hour and help the physicians do the personalization right then and there. That way, inertia is finally overcome.
Dr. Joseph has an extensive background as a pediatrician and former Epic employee. In his roles as Avaap CMO and interim CMIO at El Camino Hospital, Dr. Joseph spends his time helping hospitals and health systems learn how to configure their EHR for greater physician efficiency and satisfaction. Connect with him on Twitter @CraigJoseph or www.avaap.com/contact.
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