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A Word from the President: Will Medical School Graduates Be “Meaningful Users” of HIT?

AAMC Reporter: March 2011

AAMC President and CEO, Darrell G. Kirch, M.D.

Early last month, colleagues from several medical education associations, accreditation councils, licensure bodies, and certification boards joined me in a meeting with David Blumenthal, M.D., outgoing national coordinator for health information technology (HIT) in the Department of Health and Human Services. During the meeting, we discussed the various ways HIT is being incorporated into the training and assessment of health professionals. Reflecting on our conversation, I thought it would be appropriate to explore in this month’s column the questions academic medicine must answer in order to graduate meaningful users of HIT from our medical schools and residency programs.

Although the critical need for HIT training has been especially prominent in the national dialogue over the last two years, nearly 30 years ago the AAMC report Physicians for the Twenty-First Century called for doctors to be trained in “information sciences and computer technology.” Then, as now, the public expects that medical schools and teaching hospitals will produce physicians who are prepared to provide safe, competent, coordinated, and patient-centered care throughout their professional lives. Meaningful use of HIT is a critical success factor in accomplishing this mission. The conversation with Dr. Blumenthal helped crystallize four key questions we must address to achieve this vision.

• Have institutions assessed the true cost of implementing HIT? The cost of a fully integrated HIT system, complete with an interoperable electronic health record (EHR) system, is not limited to the sticker price of new equipment and technology. Rather, institutions will need to invest time and resources in retraining faculty who, in their careers, have become used to delivering care without EHRs or computer order entry systems. Physicians aged 35-60 are an especially important demographic because, not only are they the educators of today’s medical students, but they remain years away from retirement and are, like myself, “digital immigrants” born before the computer age.

Are institutions teaching users how to harness the full potential of HIT? In addition to painting a more holistic portrait of patients, the data contained in HIT systems—when properly captured, organized, and analyzed—can produce better community and population health outcomes. Tomorrow’s health professionals must be trained not only to think about the patient in front of them, but also to monitor patient populations through HIT tools (for example, using this technology to monitor the blood sugar levels of an entire cohort of diabetic patients). Eventually, the data contained in HIT systems could be used to study diseases and outcomes across institutions, regionally, and even nationally to uncover best practices, while maintaining and preserving the privacy that is foundational to trust in the physician-patient relationship.

• Are medical schools and teaching hospitals working to spread knowledge about HIT? As hubs of innovation, medical schools and teaching hospitals are at the cutting edge of patient care, research, and education. But are we reaching out to community physicians and other health professionals in our neighborhoods to spread the skills and best practices developed at our institutions? As the sponsors of over 50 percent of all continuing medical education hours offered in the United States, academic medical centers must leverage this position to disseminate knowledge to the wider community about HIT and its myriad uses.

• Are practice settings modifying their HIT systems and clinical environments in tandem for maximum impact? In addition to ensuring that an HIT system fits with the unique nature of an individual clinical environment, we must adopt a culture of continuous improvement and, when necessary, modify clinical workflow to take full advantage of technology. In allowing physicians to gather, filter, and organize patient information in new ways, HIT will be a driving force in creating new care models. Only when we examine the processes built up over time to develop team-based delivery models that better serve the patient will we reap the full benefit of HIT systems.

Just as technology has progressed from the 1980s, so too has our community’s thinking on HIT. Moving forward, the challenge will not be in simply imparting the necessary technical skills to medical students, who already are “digital natives,” but rather teaching them how to manage vast quantities of information. Our core focus must be on teaching a core skill set to make clinical decisions in an information-rich and dynamic environment. Core competencies, such as the ability to engage in self-directed learning over a lifetime, are critical no matter the latest technology.

Viewing HIT facility as a competency has important implications for medical education. Just as safety and quality cannot be “taught” in a single class or lecture, neither should HIT instruction be relegated to perfunctory demonstrations or seminars. Rather, HIT use should be woven throughout the continuum of medical education. Students must work with faculty who incorporate HIT systems into the delivery of care before they can be expected to do the same, and we are on the right track in this regard. A 2010 survey of the AAMC Group on Resident Affairs found that 80 percent of responding medical schools and teaching hospitals use computerized order entry in resident education, while nearly three-quarters make use of electronic medical records for physician notes.

Even as the definition of “meaningful use” evolves, academic medicine is at the forefront of the nation’s adoption of HIT—according to 2010 HIMSS Analytics data, 93 percent of AAMC-member teaching hospitals have adopted at least the basic components of electronic medical records (EMR), with a quarter of these institutions demonstrating more advanced EMR utilization. At the end of the day, we all envision, and are working diligently toward, a system in which HIT transforms care delivery, enriches the physician-patient relationship and, ultimately, leads to improved care and outcomes.

Darrell G. Kirch, M.D.
AAMC President and CEO