Cerner fights cultural resistance to IT

This is Part II of an interview with Cerner Corp. President E.H. "Trace" Devanny conducted recently by Health-IT World editor-in-chief John Dodge. Part I in the April 20 edition focused on Cerner's losing out on lucrative National Health Service contracts in the United Kingdom. This installment focuses on how Cerner views cultural resistance to IT in healthcare.

Q: What are the biggest challenges for Cerner?

A: It's not the technology. It's the cultural transformation that must occur in the clinical environment to deploy these systems. We were born in the clinical laboratory and now Millennium has grown to 55 applications. We believe there has been a tipping point (in which) clinicians have begun to consider IT strategic (for) managing patient safety and care-quality issues. All that can be affected by first-rate IT systems that deliver the right information to the right place at the right time, allowing a clinician to write an order at the point of service.

Q: Does the most resistance come from physicians?

A: Physicians are very smart people (here) and provide the best care anywhere in the world. But they're not God. They have a huge challenge trying to remember the idiosyncrasies of the individual patient. You can't expect them to know all the allergies and things they must know to treat a patient safely. What we have done delivering the information to the bedside through Millennium is allow them access to not only extended knowledge, but to alerts and information in real-time about the patient. Current X-rays, tests, lab results, and medications are all available at the touch of a button at bedside.

Q: Is there a danger of information overload at the bedside? How do physicians process all the information available to them?

A: Is it information overload? Absolutely not. Think about how they had to do it in the past. They've had to deliver care without benefit of a complete medical record. They're really shooting from the hip because they don't have all the current information. What do they do if they don't have all the current info? They run another battery of tests or film. All those create a huge amount of waste and redundancy. If you make a mistake, you could be talking to a lawyer.

It's not information overload if you can envision walking through North of Anytown USA hospital with a wireless device and a list of patients. Click on a patient and up comes all the relevant information. If you want to look over the X-rays, you can do that. If you want to look at meds, you can do that. And it gives you a template to better chronicle the care.

Q: How much will doctors have to change work habits from the way they do things now when the clinical information systems are widely implemented?

A: Physicians want better data. It's a tough culture hill to climb, (but) try to take (technology) away from those who are using (IT).

Probably less than 15 percent of physicians in the world have engaged in some form of entering orders. That will change because that's the only way you're going to get the right info to the right place at the right time.

Q: How do you change the minds of the most resistant, intractable, technology-averse physicians?

A: You probably don't. It's a generational thing. Often, democracy is not your friend. You've got to have strong leadership both at the CEO and the clinical level to drive change into an organization. We don't think you'll ever turn the herd completely. But we think that over the next five years well over 50 percent (of physicians) will be entering their orders in some fashion to deliver a better outcome.

Q: Do you believe that IT will lower the cost of medicine?

A: It's well known that the paper-based record is incomplete and not an accurate portrayal of a patient. There's pieces ripped out, entries that were never made, and pieces that are lost. It's the same with radiology. You see people running across a parking lot with a whole load of exams because physicians need to see them before patients come in for the day. They fall off in the road. Nurses are writing on their hands and on their smocks. If you have an electronic record, you enter it one time.

Q: How many paperless hospitals are there in the U.S. now?

A: There are very few. We have a couple. We have one in Kuala Lumpur in Malaysia and at the Mayo Clinic in Jacksonville.

Q: We get bombarded with press releases about how IT saves time and money. But we rarely see solid evidence about how IT improves outcomes. We think IT improves outcomes, but how can be sure?

A: We have some great proof points on that. Banner Health in Phoenix will tell you they've been able to reduce adverse drug events, and we have data on that. The University of Illinois Hospital at Chicago is taking a good portion of their clinical population into a paperless environment (and producing) better outcomes. (IT users) also have been able to attract and retain a much better quality of resident in the very competitive Chicago marketplace. When you realize how stiffly competitive the marketplace is for physicians and nurses, you want every advantage you can get.

(Also), the Centers for Medicare and Medicaid Services is very much on record that they'll be measuring outcomes. HIPAA is very much a part of the landscape. How do you manage those critical manual processes today and become compliant? You can't do it.

Q: Are they teaching IT in medical school?

A: Not entirely. The University of Kansas School of Nursing has embraced Cerner's nursing product. Every nursing student is trained on a Cerner system, which we think is the best, of course. (But the fact is) they're being trained on an IT product so they're expecting to use it in their careers.

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