Cleveland Clinic CIO: Tools are the biggest barrier to IT-driven medical care

This medical doctor and CIO puts technology at the heart of patient care.

By driving adoption of information technology, Dr. C. Martin Harris keeps the Cleveland Clinic on the cutting edge of medicine. The clinic's CIO and chairman of its IT division, Harris shares his vision for how technology is redefining healthcare for patients and caregivers alike at conferences nationwide. He is board-certified in internal medicine, is a member of the American Medical Informatics Association and the Healthcare Information and Management Systems Society, and has served as a health technology adviser to President Obama. Here, he offers his diagnosis of the state of healthcare IT.

You've said there's a need to introduce IT "right into the heart of the practice of medicine." What does that ideally look like? Think about all the participants in the healthcare system. That begins with the patient but includes all the care providers -- doctors, nurses, allied health professionals. It also includes the administrative aspect of healthcare, such as schedulers, registrars, insurance providers. And when I say "into the heart of medicine," what I'm imagining is that there's a time when anyone involved in that cycle will have access to the information they need to make the right decision about that patient as part of the patient-care process or something that facilitates that care process, such as getting a bill paid.

How close is the Cleveland Clinic to that ideal? In the direct patient-care portion, we're pretty far down the road. All of our physicians use the electronic medical record when caring for patients. We have over 500,000 patients who use a patient portal that we call MyChart to access the exact same information as their physicians. It's been framed differently to be more consumer-friendly, but they're looking at the same results their physicians look at. All our registrars use a system that's part of that electronic medical record, and we use an insurance management system that's part of that system.

Is today's healthcare system close to that ideal? My sense is we're about 30% toward that goal overall. There's a national program that's federally funded known as the "meaningful use" program that's driving the adoption of this technology in the practice of medicine very aggressively. You'll see numbers that show higher rates of adoption of physician and hospital technologies. But when I say 30%, I mean fully functional, not just that you've acquired it or are implementing it, but that you've actually fully implemented it and are getting rid of other things. For example, when patients don't have to call the office to make an appointment or renew an existing prescription or physicians can communicate with patients online.

You've said that technology will redefine the practice of medicine. How will that happen? Imagine you need an appointment to see a physician. Today, the average American would be thinking about where they would physically go to see that physician. Tomorrow, you will have choices about how you would like that appointment. You could have that appointment occur from the comfort of your own home with something that would look like a Skype or FaceTime session. You'd see a healthcare provider, you'd provide some real physiological information, they'd see you and, in certain cases, with home appliances, they could look in your ears or mouth. That [appliance is] something the average American would have in their homes, like a thermometer today.

Another way of redefining it is we'll be able to use the power of big data analytics to think about the entire population of patients with a particular problem and identify those patients who have chosen not to have a visit. Tomorrow we should be able to use this technology to actively reach out to them on their smartphones and engage them when it's most appropriate.

Where is medical care in terms of that redefinition? You're beginning to see a lot of interest in this area. You see more and more stories related to [the use of big data], but we are still very early, in our infancy, in terms of our applying analytic tools in the way I described it.

What's been the most important IT advancement to move healthcare closer to that redefinition? It really is the changing attitude of patients/consumers. When we started in 2003, the patient was very skeptical. But consumers have swung out into the front, and they are helping drive this transformation by the rate of their adoption and their ability to engage this information.

What are the biggest barriers to IT-driven medical care? I would call it the activation hurdle. A lot of people think it must be limited by technology or the patient, but you have to reach a certain level of functionality to be truly valuable to all parties. If you go online and the only thing you can do is see test results, it's a minimal value for both the physician and the patient. When you have a tool where you can share all the information and you can use that tool to alert both the physician and patient to something that needs to happen, that's a shared experience. As we grow that functionality, we'll see the adoption climb very quickly for everyone in the healthcare system and you will see the barriers go away.

How have consumer demands around technology changed your IT strategy? The biggest impact is still in front of us. When you look at the generation of smartphones on the market now, they're really the first-generation handheld computer. I can imagine in short order, in 18 months, you'll really have a computer in your hands. And when you do that, there will be a lot more we can do, and it will change what we mean by healthcare access for patients and providers. That will allow us to fundamentally redesign. It changes how you deliver and influences what you deliver.

-- Interview by Computerworld contributing writer Mary K. Pratt (marykpratt@verizon.net

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