Mark Weisman, MD, chief medical information officer at Salisbury, Md.-based Peninsula Regional Medical Center, discusses healthcare's need for interoperable IT systems and his best advice for aspiring CMIOs.
Responses are slightly edited for clarity and length.
Question: How did you become a CMIO? What is your background and what advice do you have for aspiring CMIOs?
Mark Weisman: The first moment I saw our "time of day for chart closure" report, I knew we had a problem and I felt compelled to help. This report showed the time of night our primary care providers were closing their charts, and over 50 percent of them were doing some chart work after 8p.m. I felt reasonably comfortable in the EHR and thought I could help our struggling providers.
Along with a team of trainers from IT, project managers, adult education specialists, other physicians and some leadership support, we set off to create the "Home for Dinner" program with the goal of achieving just what the name says. We identified best practices, educated providers on basic and advanced EHR functionality, looked for opportunities to improve our version of the EHR, identified unwanted alerts and completely revamped our provider onboarding and continuing education programs. I loved making a difference in the lives of my friends and colleagues and thought I could have a bigger impact on healthcare from a CMIO position than I could as a full-time clinician. I took on extra training through our EHR vendor and took some online classes as well.
My advice for aspiring CMIOs is to get involved in the programs at your current institution. Every system will have committees that review informatics issues, discuss alerts, help struggling providers or need clinical expertise to help with analytics. That’s the first step. Then, look to get more education in the areas you really enjoy.
Q: What is the vision for your team in 2019? How will you approach your role and meeting your goals?
MW: PRMC went live on Epic in November 2016, so they are relatively new and are experiencing the typical growing pains a system goes through with a new EHR. Due to significant concerns over burnout — nurse and physician — we are focusing on optimizing the EHR for our clinical staff and providers. We are aggressively going after alerts that fire on chart opening, alerts that fire on everyone rather than a targeted audience and alerts that are not achieving their intended goal.
Many providers became frustrated with the system shortly after go-live and disengaged from participating in optimization projects. My goal is to recruit them back because I can’t possibly be an expert in every one of their clinical areas and need them to help me make the system better. I need them to re-engage and identify the parts that aren’t working well for them and their colleagues. Most have started to re-engage just by inviting them to talk about their issues and listening to them. Providing them with some quick wins has given them hope and they are starting to come around. I plan to build on this success and ultimately have a physician-builder program where the providers are very hands on with optimization projects.
For nurses, we are tracking their total time spent in the EHR doing their documentation. We have initiatives to reduce their documentation burden, reduce their alerts, decrease the number of verbal orders they take and assist the nurse care managers with their unique workflows. Eventually, we hope to have them on mobile devices to do their documentation, and we will start that process this year. We also recognize that we do not have a very deep bench for nursing informatics and have a goal to improve that over the next two years.
Q: Where do you see the biggest need for innovation to improve the healthcare system in the future?
MW: I have an internal medicine background, so I naturally tend to look for the opportunities to improve the longitudinal care of our patients. The biggest need for innovation is around interoperability for all these disparate IT systems in a community. It is nearly impossible to care for a population of patients when you can only see a fraction of their care. Outside labs aren't interfaced with our EHR system — every specialist uses a different EHR in their office, which doesn't communicate with anything else in town.
Old records sit in data warehouses with minimal indexing, so they are available if you have the time and inclination to sift through mountains of data, but most people don’t do it, and the list goes on. I don't think the average person on the street knows how dysfunctional we are in healthcare. If they did, they would be scared.
Q: Which apps and technologies do you find most helpful, and which do you think will be passing fads?
MW: Artificial Intelligence has the potential to be the most helpful. Routine and mundane tasks are perfect for the computer to take over and should allow the providers to focus on more complex issues. Can a computer identify who is due for a screening procedure, order it based on a standing order, contact the patient to schedule the test, answer basic questions about the procedure, and return a normal result back to the patient? Absolutely. Can a computer assist with a complex diagnosis and provide a confirming or dissenting opinion? Yes. We need to take full advantage of this technology to provide better care for our patients.
As for fads, I think primitive home monitoring devices designed to prevent readmissions that only check blood pressure, pulse, weight and oxygen saturation will pass. It takes more than routine vital sign monitoring to keep high risk patients from being readmitted. I think these devices will be replaced with more sophisticated tools in the future that will be far more effective in changing the trajectory of this patient population. I also think it will be a long time before these monitoring devices will be able to outperform a home health nurse, pharmacist or social worker.
To learn more about clinical informatics and health IT, register for the Becker's Hospital Review 2nd Annual Health IT + Clinical Leadership Conference May 2-4, 2019 in Chicago. Click here to learn more and register.