Monday, August 06, 2007

Hospital IT: Amateurs welcome?

In my prior post "Leadership Position in Health Informatics: MD's Need Not Apply?" early this year, I pointed out in some detail the confusion in many healthcare organizations about medical informatics and the expertise needed for best EHR implementation. I mentioned that sometimes the thinking on this topic within healthcare organizations seemed bizarre, as in Superman comics:

In the Bizarro world, a cube-shaped planet known as "Htrae" ("Earth" spelled backwards), society is ruled by the Bizarro Code, which states "Us do opposite of all Earthly things! Us hate beauty! Us love ugliness! Is big crime to make anything perfect on Bizarro World!". In one episode, for example, a salesman is doing a brisk trade selling "Bizarro bonds. Guaranteed to lose money for you". Later in this episode, the mayor appoints Bizarro #1 to investigate a crime, "Because you are stupider than the entire Bizarro police force put together". This is intended and taken as a great compliment.

I periodically receive solicitations for health IT positions from recruiters at large hospitals.

Here's just the latest two, quite typical of what I receive on a regular basis. Keep in mind that I completed an NIH postdoc in clinical IT, have been a CMIO (Chief Medical Informatics Officer) in a 1000+ bed regional medical center reporting the the Sr. VP for Medical Affairs, been a Group Director of informatics in a multinational pharma overseeing a staff of 50, and am now a professor of informatics and IT (for the second time in my career):

#1, from the largest medical center in the Philadelphia suburbs:

Systems Analyst

Physician Practices Ambulatory EMR systems experience required.

Full-time, including support call rotation

You’ll implement and support clinical systems for Physician Offices for one of the busiest hospitals in the Delaware Valley.

  • Familiarity with Eclipsys Sunrise Clinical Manager and/or Ambulatory Care Manager and Misys Vision would be assets
  • Experience with project management, electronic medical records, help desk and implementing process changes
  • Troubleshooting, problem resolution and creative thinking a plus

"A plus?" Wow. Troubleshooting, problem resolution and creative thinking can probably can come in handy when dealing with clinical IT project management, doctors, process change, and EMR's, especially when doing Help Desk support as a lowly Systems Analyst.



Manager of Clinical Support Systems, CPOE, Clinical Manager in CA Hospital.

The successful candidate will have a clinical background (nurse, but not essential) and really know the ancillaries and understand their strategic importance to the execution of all the “in vogue” IT projects like EMR and CPOE. The successful candidate in this role will be very smart and take extreme pride in delivering results!

Why in the name of heaven would anyone seriously think of sending me a JD for a manager-level position, at least two levels below my previous hospital and pharma positions? I also received a personal phone call from this recruiter as well as an email - this was not computer-generated spam.

As in my earlier posting mentioned above, do I see a preference for a nurse again, and that a clinical background is really not essential? Or does the hiring manager mean any clinical background is OK - even perhaps - gasp - a physician? I imagine it also could be useful in such a role to be "very smart" and take pride in one's work.

Infrequently indeed do I see requirements for formal healthcare informatics or IT training. (In some ads, only a bachelor's in IT is called for.)

These ads probably do result in hiring of clinical IT personnel, who clinicians increasingly depend on for tools essential to clinical care (if only in the sense that clinicians are ordered to use them).

I would not enjoy imagining what would occur if neurosurgeons were hired in the same way.

To these organizations, I give the following free advice. Paraphrasing Dr. William Hersh at OHSU's Dept. of Medical Informatics & Epidemiology, "It's unwise spending millions on Electronic Medical Records without investing thousands in Medical Informatics expertise."

Any takers?

-- SS


Richard Fogoros said...

Admittedly I, an MD who is not an IT professional, could be off base here. But please consider the following possible explanation for why physicians are not being welcomed with open arms to directorships of medical informatics.

In an era of covert healthcare rationing, controlling physician behavior is job one. (This is because most covert rationing must occur at the bedside.) There are many ways to control physician behavior, most of which require seizing control of the doctor's professional viability. In any case, a very promising method for getting doctors to behave in advantageous ways is to collect large volumes of clinical data, massage it via computers, and announce conclusions that, logically applied, will require physicians to alter their clinical behaviors. A prominent form of this behavior modification is P4P.

If covert rationing were not the prime directive, such methodologies would no doubt be incredibly useful (and physicians could be trusted to direct medical informatics programs). This is because the data could simply be followed to wherever it might lead, to the ultimate benefit of patients' outcomes. However, since covert rationing is the prime directive, and since sometimes the best clinical outcomes are achieved by more expensive instead of less expensive therapy (implantable defibrillators being just one obvious example), to get the results you're looking for sometimes you're going to need medical informatics people who are, well, malleable.

My guess is that the executives who are hiring these medical informatics directors believe nurses to be a good compromise. That is, nurses have clinical experience, but by training and tradition are used to taking orders, even when those orders are obviously blockheaded. Doctors, on the other hand, are often seen by these executives as entirely unreasonable and intractable.

I do not mean to disparage nurses here. In my personal experience they very often have ethical standards that are far superior to most doctors. Indeed, I think the executives may be mistaken in their assessment of the tractability of doctors vs. nurses.

I'm just trying to find a logical explanation for your observation that physicians need not apply for these postitions. I do NOT believe that avoiding physicians is an oversight, or inexplicable, or illogical. I think it is very deliberate, well-thought-out, and entirely compatible with the real goals of these executives.

Keep up the good work.

- DrRich

MedInformaticsMD said...

Readers should visit DrRich's site at .