Go tech go: Championing new health IT

Gavin Parisi, MD, doesn't consider himself a computer geek. But he is definitely into technology.

So when he took a job as an emergency physician at Banner Estrella and Banner Good Samaritan medical centers in Phoenix, he was excited that the hospitals were already paperless and planning an electronic documentation system.

When implementation began, Dr. Parisi volunteered to become the "physician champion."

"We needed a voice to be able to communicate with the IT people to see how [physicians] wanted to design things. I decided that's what I would be the best at," he said.

Experts agree physician champions are a key component to any tech implementation project. And, like Dr. Parisi, many physicians can assume this role just by asking. The champion need not even be the most tech-savvy physician on staff.

The responsibilities can include more than being an advocate. After Dr. Parisi assumed his champion role, he soon found himself attending high-level meetings, answering about 20 extra e-mails a day and designing training programs to help speed implementation. He still had his regular duties in the emergency department.

"It was like having another full-time job," Dr. Parisi said. "Once you are the focus person you become the focus for praise and for people who want to vent. If someone wants to be angry about something, they come to you."

Physicians who are prepared for the task can find it a rewarding experience and a source of new respect from colleagues and superiors. But a physician who underestimates the job can quickly feel overwhelmed.

What's in it for me?

Serving as physician champion is "being the doctor who is convinced this product is a good idea and needs to convince others that it is," said James Slawson, MD, family and community medicine doctor at the Medical College of Wisconsin. Dr. Slawson was the physician champion when his practice implemented new charge-capture software.

Rosemarie Nelson, a Syracuse, N.Y.-based consultant for the MGMA Health Care Consulting Group, said a physician often becomes the de facto champion simply by being the one who is already using the technology, or who is gung ho about it and wants to get others excited as well. But that person may not be the best champion, she said.

Convincing others that a technology solution will make their lives easier takes a lot more than singing a product's praises, experts say. And a techie physician might have a hard time convincing non-techie colleagues that the solution really will make their lives easier, eventually.

Nelson suggests co-champions -- one techie and one non-techie.

"The champion has to identify for the other physician, 'What's in it for me?' " Nelson said. Tech-reluctant physicians are more likely to believe product praises from someone who also is just learning to use it. But a tech-savvy physician is more likely to understand the product, know how it works and be able to answer questions along the way, she said.

Because physicians can anticipate these questions from colleagues, they are better suited to the champion role than is an IT person or a high-level administrator, Dr. Slawson said.

"There are a fair number of people willing to train physicians on computer systems, but for some reason, physicians are skeptical of people other than physicians who are training them," said Dr. Parisi. "For example, if a nurse is teaching me anything medical, there is a little bit of skepticism of, 'Do I know a little more about this than the person teaching me?' "

Carrying the message out

Knowing firsthand how physicians work is key to another role physician champions sometimes take on -- liaison between the medical staff and the vendor.

Mark Baker, MD, an emergency physician at the Kapi'olani Medical Center at Pali Momi, Hawaii, was the physician champion when his hospital implemented an electronic medical record system. Throughout the implementation, Dr. Baker spent a lot of time listening to department representatives share concerns. He met regularly with the vendor to discuss those concerns and other questions.

Dr. Baker said the communication was key because there was no way he, let alone a vendor, could know all the issues a physician from another discipline would have.

Marc Chasin, MD, executive medical director of quality and clinical informatics at Good Samaritan Hospital in Suffern, N.Y., said negotiating skills are a must.

When Dr. Chasin's hospital was implementing an EMR, he became the point person between physicians and the administration. Much of the job became choosing his battles.

"You hold onto your convictions and know they are valid but also know there are a lot of people involved in that decision. You have to be willing to compromise," he said.

Dr. Slawson said the physician champion must pull viewpoints and interests from colleagues into a common goal that can be presented to the administration.

For Dr. Baker, communication with other departments also helped him determine the preparedness or willingness of physicians to be trained. Because he went through the training first, he could determine how much each physician would bring to the table.

It doesn't stop with installation

Dr. Parisi was asked to collaborate on training manuals and programs, and by default became the in-house trainer. He regularly conducts classes for new employees and created a Web site with answers to questions he was asked multiple times. He also uses the site to posts videos he creates that walk users through a specific process.

He said the videos serve as a refresher for people who have gone through the formal training, which is several hours long.

Dr. Parisi, like many physician champions, learned fairly quickly that the often time-consuming demands of this role would mean a change to his daily routine.

Some physicians aren't prepared for the extra workload and can resent the time it takes from patient care.

Nelson said groups and hospitals must be prepared to compensate champions financially, by making arrangements to cover clinical responsibilities, or both.

"My group was very receptive to the fact that I needed to work less in the department and had to be compensated for [the IT work] because it is a tremendous workload," said Dr. Parisi. He asked for a reduction to his clinical schedule and for a stipend, both of which he received.

Nelson said it's common for practices and hospitals to reduce the clinical workload for physician champions, especially during implementation. And at the very least, doctors on a fee-for-service pay structure should be compensated for reduction in pay necessitated by the diversion of time.

"You can't expect that person to take home less money," she said.

On average, she said, physician champions need to reduce their workloads about 50% during implementation. After implementation, administrative duties can take 25% -- or more -- of his or her workweek. "It usually isn't less than that."

The eventual hand-off

Nelson said it's important that a practice or hospital have a consistent point person during the implementation, but once the system is up and running, some of the champion's work can be transitioned to someone else, not necessarily a physician.

The torch can be passed to a physician assistant, nurse or even a practice manager, she said. But it's important that the replacement be up to the job. Otherwise, physicians struggling with the technology will continue to seek out the original champion.

Even though demands are less after implementation, accountability is key, Dr. Chasin said.

"If a doctor comes to me with questions or concerns, I try to get as quick a follow-up as possible, even if it's just a note saying I haven't forgotten about it," he said.

Dr. Parisi said if no one is there to continue helping physicians get better at using the systems, it's easy for them to go back to the original way of doing things.

"The philosophy of being upbeat and positive works in any industry," he said. "That positive attitude says, 'I am here and will support you and you will do well.' "