PHYSICIAN EMR ADOPTION IN AN ACADEMIC SETTING

Abstract

Mark Hulse, Chief Information Officer at Moffitt Cancer Center wondered out loud as he stared at the results of the survey used to determine organizational readiness for change. Much about this implementation seemed to be different from his prior experiences: the academic setting, the physician led leadership structure, the regulatory requirements driving change, and the government incentives to reduce the financial burden of implementation. Hulse’s decision of how to proceed was influenced by a number of issues. First, electronic clinical documentation was implemented but very few physicians had adopted the technology, as it was more cumbersome then their current process. Attempts to push adoption had resulted in considerable frustration from the physicians. Second, the organization was running out of time. To earn government incentives for meaningful use (approximately $6 million), certain aspects of the electronic records had to be in place in six months. The project was plodding along, but it was feasible to continue with the current path and implement just enough to meet the requirements for year 1. But after the initial year, the next phase would be Computerized Provider Order Entry, requiring even further adoption and significant clinical workflow changes. The risks would continue to compound making it challenging to hit stage 1 in time to achieve any incentives. Both Hulse and Dr. Phil Smith, the Chief Medical Information Officer, believed there was another alternative. The organization needed to change its view from an IT driven project to an institutional change in clinical and operational workflows. But, that would entail a much longer process and would require the organization to forgo the significant financial incentives. Would the executive leadership even entertain such an idea? Hulse and Smith stared at each other; they both knew neither proposition was without great risk. They were already receiving angry emails from physicians and the executive team was anxious, to say the least. Hulse sighed, “This is not going to be an easy decision to make.”