Robert Budman, MD, chief medical information officer at Atlanta-based Piedmont Healthcare, discusses his responsibilities as CMIO and why he considers himself as the "parent of the EHR" at the health system.
Responses have been lightly edited for clarity and length.
Question: 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?
Dr. Robert Budman: I foresee great potential for Amazon or Google voice recognition technologies in healthcare, but most of that still seems to be in the formative stage and garnering a lot of headlines. However, companies like Nuance and M*Modal are currently using voice recognition technology with various algorithms and artificial intelligence embedded in EHRs. For example, we currently use Nuance's Dragon Medical One coupled with Dragon Medical Advisor to drive thoroughness and specificity of documentation in our providers' notes.
On top of that, I previewed Nuance's in-room assistant that can help take notes, search the chart and place orders while listening to the physician-patient interaction. It holds great promise and will only grow in its abilities and usefulness. Cost, implementation, training and support beyond just the development of the tools all are likely to push this as a mainstream product many years into the future.
Q: Which apps and technologies do you find most helpful, and which do you think will be passing fads?
RB: I think there are some fitness and tracking apps that will remain helpful for a small percentage of people who stick with them. Unfortunately, what we tend to see is that many people stop using the apps after a few or several uses. The reminder apps are quite nice, but the recurring notifications can be an annoyance and lead to some users turning off the notifications, thus obviating the utility of the reminder. The multitude of services, of all types, under the umbrella of telehealth holds great promise as the concept of easily connecting to a healthcare provider on demand from a PC or smartphone at a low visit cost, without having to travel, and relatively quickly is a fairly unbeatable combination.
Q: What do you consider your No. 1 priority as CMIO? How do you ensure you're successful?
RB: I see myself as the parent of the EHR and the clinical focus of IT, but I am a partner or colleague with the clinical staff at the frontlines. So, as a parent I'm responsible analogously for the nurturing and growth of information technology services to a mature, responsible, ethical and successful adult. I like to brag about our deployment just as I like to brag about my children's successes. I also must hover over it and protect it and try not to spoil it too much.
There are many ways to measure success with plenty of subjectivity, too. I try to stay on top of projects, communicate widely, stay open minded and change when necessary. I also try to be collegial and engage stakeholders as necessary and keep up with the myriad of innovations and clinical successes across the industry.
Q: How has your role as CMIO evolved over the past two to three years? How have your responsibilities changed since you took on the role?
RB: That's a loaded question and probably morphs not just with the overall industry but is intrinsically tied to the organizational structure and culture the CMIO works within. In my opinion, years ago the CMIO was deeply involved in rolling out new installations of EHRs, building content and meeting meaningful use and other regulatory requirements. Now, I think there is much more work for some integrating multiple technologies, developing policy, protocol and workflow, and grasping at the moonbeams of optimization. I say that because optimization is what you define it as and is a greatly overused word in my opinion.
I prefer to direct improvement strategies and projects to specific aims like standardization of documentation templates for better clinical communication and reporting, tackling change management to put in new clinical workflows — directed at better clinical outcomes, improving metrics like throughput, length of stay, or cost savings — or possibly de-installing old equipment and software and replacing it with the shiniest new toy on the market. Also, we may have more responsibilities in terms of budgets, contract decisions and managing people and resources, not to mention organizational growth by adding new physicians, practices and acute care facilities.
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