AAMC Reporter: May 2009

Viewpoint: "Health Care IT — 'The Opportunity for Schools of Medicine'"

James M. Walker, M.D., F.A.C.P., chief health information officer, Geisinger Health System; director, EHR Safety Institute

The growing importance of information technology to health care has been highlighted recently by the commitment of $20 billion in the American Recovery Reinvestment Act (ARRA) of 2009 to support the implementation and meaningful use of electronic health records (EHR).

America's medical educators are challenged by section 3015 of Title XIII of the ARRA to submit strategic plans to the secretary of the U.S. Department of Health and Human Services that integrate "certified EHR technology into the clinical education of health professionals to reduce medical errors, increase access to prevention, reduce chronic diseases, and enhance health care quality."

This will be a daunting task for several reasons. Many schools of medicine may not have access to clinical settings that make effective use of EHRs across the full continuum of care. Health care informatics (the art and science of understanding and fulfilling the information needs of health care stakeholders) is itself a discipline still in the process of formation. Finally, difficulty in demonstrating the benefits of EHRs—in improved care processes or patient outcomes—suggests that EHR implementation alone is not an adequate goal for health care reform.

As schools of medicine increase their commitment to advancing the practice and study of health care informatics, they will need to pay careful attention to the specific contexts in which EHRs are being shown to contribute to improved care processes and patient outcomes.

From Tasks to Processes

Reflecting the structure of health care in general, EHRs have primarily been designed and used to support isolated tasks, such as order entry, rather than more integrated processes such as order management. The result has been that EHRs do not support the kind of teamwork among physicians, pharmacists, and nurses that is necessary for the safe and timely administration of the right medications to the right patient—and other care processes.

As I posited in an article I wrote with my colleague Pascale Carayon, Ph.D., a professor in the department of industrial and systems engineering at the University of Wisconsin-Madison, for a recent issue of the journal Health Affairs, the challenge to health IT is to implement and optimize EHRs that support value-added (highquality, high-efficiency) care processes, rather than isolated tasks. To meet this challenge, Geisinger Health System and other organizations are repurposing their EHRs to support integrated care processes that optimize the contribution of every member of the health care team—including patients, doctors, nurses, educators, and case managers—across the full continuum of care. This approach results in care that is genuinely patientcentered, in which the patient's needs are anticipated and met across time and space. It also results in significant improvements in acute and chronic care processes as well as improved patient outcomes, as shown in a 2007 report co-authored by several of my Geisinger colleagues and appearing in the journal Annals of Surgery.

Meaningful Use of EHRs

What does all this suggest about how medical educators can contribute to the meaningful use of EHRs to improve health care?

First, medical schools can play a critical role in investigating the role of care-process improvement (and management) in improving health care.

Second, they can play a similar role in investigating the role of EHRs (and health IT in general) in supporting care-process improvement.

Third, they can train physicians to participate in and lead the development of value-added care-process supported by EHRs.

Of course, not all physicians will become process engineers or health care informatics specialists. Nonetheless, all physicians will need to be knowledgeable users of processes and EHRs. And many different kinds of physicians—executives, clinical leaders, and informatics experts—will need to work cooperatively with other representatives of the health care team to develop value-added care processes and the EHRs that will support them.

Finally, medical schools will need to partner with organizations that are implementing improved care processes supported by EHRs. These partnerships will give medical students and graduate trainees access to care settings in which they can learn best practices. Additionally, the partnerships will provide real-world settings in which researchers can cooperate with working clinicians to identify next-generation practices.

Editor's Note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members.