Connecting the dots.

Escaping from chronic information overload is my constant challenge. Most often, hundreds of bits of information soar by before I can even nail a bit or two. But oh so rarely, the dots line up in perfect order, ready to be connected.

For about three minutes, the dots lined up for the HMT editors as we compiled HMT e-News for March. It was an epiphany moment. We covered Rand Health's latest report, indicating that Americans receive 54.9 percent of the healthcare they need, regardless of age, gender, race, income or insurance status. How dismal. We covered a survey of 110 Northwest Permanente physicians, in which 80 percent said they ignore automated clinical alerts if they are running behind schedule--and 84 percent said they always run behind schedule. How disheartening.

We covered a CIO article by Susannah Patton on the functionalities within CPOE systems, and the inherent foibles that can sink them from the onset, like uncontained pop-ups and alerts that drive physicians nuts. How insightful. We remembered Mike McBride's story in HMT, January 2006, featuring the New York Heart Center's adoption of an EMR. Physicians there initially thought using the system would slow them down, and that perception sustained itself, even as they tried the new system. Only when administrative staff actually timed them using the old, manual processes versus the new, automated processes--and proved both processes to be equal in duration--did physicians change their attitudes. How enlightening.

Here's the point and the epiphany: The clinical technology behind EMRs, CPOE, e-prescribing and clinical decision support probably has reached its pinnacle. In terms of functionalities delivered, these technologies may deliver everything short of a Broadway show to those who purchase them. But purchase isn't adoption, and it's not results, either. Just as adoption was a major issue eight or 10 years ago, when most of these technologies were immature, apparently adoption continues to be a significant challenge today.

Is it understandable that physicians ignore clinical alerts when they are rushed? Yes, it is. Is it understandable that physicians who believe the technology will slow them down resist adopting it? Yes, it is. Who wouldn't like to be in that position--where we can use the IT tools we want and reject others we don't want, based on our perceptions, or ignore some tools because we are too rushed to let them interfere? In real life, in real work settings, few of us have that luxury.

In the business of delivering healthcare services, physicians are the mission-critical players--and physicians remain the only professional bloc that can sink a technology in a heartbeat. The issue isn't whether that should be or shouldn't be. It's true. The issue is, how should vendors and senior healthcare executives accommodate it, learn from it, plan for it and alleviate it?

Therein lies the final dot to be connected--customization. Tweaking a system to fit the preferences, work styles and even idiosyncrasies of its end-users remains the only logical answer. Time and again, HMT has presented case histories of real organizations that have customized, personalized and tweaked new systems, sometimes for years, to spill forth with exactly the functionality--and only the functionality--that their physician end-users have okayed and accepted.

Here is the preferred order of things: 1) purchase; 2) tweak; 3) adopt; 4) deliver the remaining 45 percent of healthcare services. Then the promise of technology will have teeth.