Thursday, February 03, 2005

Major medical center thrashes for clinical IT leadership

Major medical center in Philadelphia, Temple University, thrashes around for clinical IT leadership.

This ad, regarding a "a seven-year, enterprise-wide Information Technology strategic plan" for clinical IT and process redesign, was posted again on the job exchange area of the American Medical Informatics Association. It has many hallmarks of the lack of awareness of sociotechnical issues in clinical IT and of the role of Healthcare Informatics professionals in studying and preventing costly errors experienced by other medical centers, and of facilitating change.

"The ideal candidate will have a Bachelor’s degree; a Master’s is preferred [in what, exactly, is unclear-SS]. Significant IT skills [why don't I see "Medical Informatics" or clinical medicine training anywhere? - SS] with 8-10 years in managing a CIS Implementation Process in a large, complex academic medical center or multi-hospital health system is also required....The Director must have a demonstrated, successful track record in Operations Improvement, Clinical Work Redesign, Benchmarking and results monitoring as well as strong project management skills. The ability to conduct educational training and coaching on project management, change management and Operations Improvement analysis is also essential."

This position also has the hallmark of a "Director of Nothing" position, lacking executive presense and credibility with medical staff - especially tough medical specialists such as surgeons, invasive cardiologists, and the like:

The Operations Improvement Director/Clinical Work Redesign will provide support, leadership and guidance to all system entities’ OI Teams during the implementation process. He/she will serve as a Team Leader and Major Change Agent leading multiple Redesign Teams.

With a bachelor's or master's degree in field that is unspecified, such a person is likely going to have a very hard time convincing the medical staff of several major academic hospitals to acquiese to major work changes affecting how they practice medicine, for example. A summary of some of these issues is at the page "Ten critical rules about job structure and reporting for applied informatics positions", authored by me in 1998 or so.

My background was, for example, deemed unsuitable for this role when I inquired last year, despite the fact that I'd successfully led evaluation, acquisition and implementation of both vendor-acquired clinical IT (e.g., the Logician EMR), and personally led custom development of advanced subspecialty IT (e.g., in Invasive Cardiology), in large (1500 bed) multi-hospital medical centers. The rejection was on the basis of "not having enough clinical process redesign experience." Not even called for an interview; the rejection was paper-based.

Others with formal training and experience in Healthcare Informatics, with training and background similar to mine, were likely also rejected. This posting is a repeat on a primary site for NIH-program Informatics recruiting, namely, the website of the American Medical Informatics Association.

It is a sad phenomenon to watch this apparent thrashing, essentially reflecting an "informatics immaturity", over and over again throughout a period dating back at least 12 years in my case, when I was an NIH Postdoctoral Fellow in Medical Informatics. Perhaps I should not complain. The pioneers in clinical IT began noting these issues 30+ years ago.

It's also possible that resumes of those with formal Medical Informatics credentials scare the daylights out of some people in large medical centers -- for example, IT personnel with no clinical training or experience, and "Medical Instamaticists" (e.g., clinicians whose credentials in information technology amount to novice or intermediate-level tinkering as per this taxonomy of informatics skills).

The NIH has tried to introduce a cadre of specialists to make EMR implementation more efficient but even after more than a decade of dedicated funding for programs at some of the country's best universities, the word has not gotten out as well as it should have. In the end, patients (and taxpayers) pay the price for errors in clinical IT implementation - sometimes spectacularly so.

As Roy Poses' correspondent notes below regarding leadership of Independence Blue Cross of Pennsylvania:

"What you're seeing is typical of most businesses. This seems to me to be the result of some myopic views taught in B-schools; "you don't have to know 'THE' business, just how to run 'A' business." Similarly, some folks think just because they can "do anything," they can run a business. I'm trying to convince them that "it ain't necessarily so."

This myopia seems to permeate down far below the C-officer level in the so-called "healthcare system" in the U.S.

I hope I'm wrong, but the Internist-learned pattern detection algorithms in my grey matter sense a long and arduous implementation process at Temple. That public money may be spent on this seven-year project (Temple University is a state-funded school) is a real issue.

-- SS

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