Lee Milligan, MD, chief medical information officer at Medford, Ore.-based Asante, shares insights on the impact of physician builders within his health system and how the programs help support the intersection of healthcare and information technology.
Responses have been lightly edited for clarity and length.
Question: How do you feel about physician builder programs in health systems?
Dr. Lee Milligan: I am a big fan of our physician builder program at Asante. We launched in 2014 and now have 11 physician builders from a variety of specialties: emergency medicine, family practice, cardiology, general surgery, hospitalist, pediatrics, etc. In my opinion, they have been critical to adoption, optimization and ongoing quality assurance efforts.
In their role, physician builders perform a variety of functions. At their core, they bring a willingness to collaborate with IT and our Epic analysts, bringing their real-world clinical and workflow expertise to bear. They receive analyst level training and certification through Epic and then they are granted security privileges to build within Epic. In our case, this has led to many instances of uniquely innovative and highly helpful build. In some examples, our builders have produced build so helpful that is has now been incorporated by all Epic customers within the foundation/model build.
Q: That sounds extremely innovative. What are the challenges you've faced in structuring your build this way?
LM: Like any program, there are good and challenging aspects. It takes a lot of effort to get the physician builder program off the ground. It could be a case study for applying [Dr. John] Kotter's or [Dr. Kurt] Lewin's change management theories. First, from a resource perspective, you must answer the following questions: how are we going to fund this? How much funding is necessary? What kind of funding is needed beyond financial? Second, selection of specific physician builders must be done with care. I've learned the hard way that technical enthusiasm or degrees in computer science don't always correlate to success. What's more important is: are they influential within their specialty domain? Are they collaborative? Are they logical in their thinking? Are they willing to understand and follow change management protocols? Are they good communicators?
Third, it is necessary to create documentation to support the effort. Implement policies, procedures around physician builders' level of responsibility and tiers of security clearance. Next, they must undergo training in Wisconsin and submit and pass several large projects to demonstrate their understanding. After they are certified, we partner them with one of our local Epic analysts to help guide them.
The advantages fall mainly into two large buckets: unique, relevant Epic build, which improves the end-user experience within a particular specialty, and engaged, collaborative and insightful physicians who elect to apportion some of their time to this intersection of healthcare and IT — making it better for them and everyone else. We are ridiculously lucky to have the team of physician builders that is currently in place.
Q: How do you determine what physician data is fit and unfit for use? What categories of data should hospitals consider?
LM: Surprisingly, the bulk of the work does not include software IT tools; rather it is a byproduct of a number operational process put in place to ensure the job gets done. For our physicians to be confident in the data, they need to have trust in the process that produced that data. This is accomplished through transparency and accountability.
Transparency allows the physician to understand how data is initially ingested, calculated and ultimately visualized. Transparency can take many forms, but at Asante, we have elected to bring physicians, nurses and other clinicians directly into the process — giving many of them a front row seat. For example, one of our ambulatory physicians chairs our Problem List Task Force. This committee consists of six ambulatory physicians and six hospital-based physicians who work together to create the policies, procedures and business rules around how the problem list is managed. This is critical as the problem list drives significant elements of real-time patient care as well as being the main source for registries — the starting database for many of today's reporting requirements.
On the accountability front, we have built a four-layered system to ensure execution. At the top, many members of our C-Suite populate the Data Governance Steering Committee — setting direction for our teams and focusing on both clinical and operational topics as well as finance. Next, we have the Data Governance Council, made up of director and vice president level leaders who were appointed by their C-Suite steering committee chief. Then, each specific domain has a data steward who reports to that director/VP. The data steward is an individual who understands the operational and/or clinical workflow and is best positioned to inform decisions on policy, procedure, etc. Lastly, we have the office of data governance that supports these efforts.
The combination of transparency and accountability has led to a steady cultural shift whereby clinicians now have more trust that the data quality is enough for its intended use and individual literacy around how that trust was earned.
Q: What are some of the benefits of using data analytics to measure physician performance?
LM: The triple aim of population health seeks to improve the health of a population, improve the experience of care and reduce the per capita costs of healthcare. Improvements in all these areas require accurate information— both to measure outcomes and process-related improvements along the journey. Without accurate data, you can't be sure that any efforts you're making are having an impact. However, this is a delicate dance with physicians.
Historically, physicians have been independent, trusted clinicians who bore the individual responsibility of patient care and outcomes on their shoulders alone. This is, fortunately, changing. Many times, they learned largely through anecdote, without the advantage of objective data to fully inform historical decision making. Now we are experiencing a tsunami of healthcare data and, frankly, it can be overwhelming.
It is critical that health systems formulate a thoughtful, well-orchestrated plan to bring physicians into the realm of analytics and not just throw every metric they can mine at the doctor. For a metric to get in front of a clinician, each health system must ensure that the metric is fit, relevant and actionable. Without these three factors, the provider either loses trust, doesn't care or is disenfranchised. This scenario, among others, contributes to burnout.
Q: What are a few health IT trends you want to learn more about?
LM: Cognitive computing. It feels like the hype cycle is rounding out, and soon we may be better positioned to see real value for CC in the healthcare space. To date, value has not fully materialized, in part, due to poor data quality combined with glorified and unrealistic expectation setting. I think as we take accountability for healthcare data and level set on viable goals, the ability to derive value in tangible and impactful ways will emerge. Domains that seem best poised to benefit include advanced imaging, oncology, health coaching and, with care, clinical diagnostics. Considering these possibilities brings out my inner nerd.
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