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Time Capsule: Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift

August 17, 2012 Time Capsule 5 Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in October 2007.

Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift
By Mr. HIStalk


Hospitals suddenly want to align themselves with private practice physicians. They don’t want to buy their practices in that fashionable and fabulously unsuccessful trend of a few years back, but they recognize the need to at least keep the war cold.

Much of the desired hand-holding is, by definition, electronic. RHIOs, referrals, integration of office systems with hospital systems — all require expertise beyond what doctors have available. It’s junior league IT in the doc’s office, hospitals figure — a cakewalk for the crackerjack IT team they’ve assembled.

What sometimes knocks the idea off the tracks is someone holding the CIO title who doesn’t really buy into the concept of enterprise computing, which includes connecting outside the organization.

CIOs are, by and large, reasonable and polite people. However, many of them know nothing about physician practices. They have their hands full already, falling further and woefully behind under a tsunami of unfunded IT demand from inside the hospital walls.

CIOs are trained to keep hospital department heads happy, and rightly so. Not doing so is a career-limiting strategy. Throwing a bunch of whiny and uncooperative doctors into the mix isn’t likely to increase the level of unrestrained joy among the technophiles.

Doctors have unreasonable demands, at least as observed from hospital IT departments. They abhor standards in any form, medical or technical. They don’t work in a polite business culture, so they are alarmingly prone to say exactly what they think, with an extra helping of sarcasm and contempt laid on top of what may well be a shaky intellectual platform. Anything that costs them money is an abhorrent attempt to pick their pockets, starve their children, and insult their intelligence.

Hospital executive leaders understand that doctors distrust hospitals and everyone who works in them. The feeling is generally mutual. However, the market is limited for doctors without hospital privileges and hospitals without admitting doctors, so cooler heads prevail and technology peace pipes must be smoked. That means turfing the whole thing off to the CIO to make it happen.

Some CIOs are as stubborn in their unwavering paradigms as their doctor counterparts. IT systems must be purchased from big, reputable vendors with publicly scrutinizable financials. Extra points are awarded if the company also sells hospital systems, runs on familiar hardware, is used by similarly unimaginative hospitals, is priced high enough to avoid suspicion, and has a cadre of glad-handing suited minions to soothe concerns that the product might be anything but the best.

That’s how CIOs buy hospital systems. Since the goal is getting access to doctor data and tying them to the hospital by giving them free systems, the CIO gets to pick the gift themselves since they have to support it afterward.

Physicians don’t use EMRs all that much, but consider this: utilization hasn’t improved much since hospitals got involved. Whatever they’re buying for doctors isn’t inflecting that magic tipping point. Free isn’t cheap enough if it’s something you don’t want (think “free kittens”).

Most physician practices are small. They want systems that are simple and that save them time (time is all they have to sell, after all). They aren’t about to use the CIO-friendly systems that hospitals want to provide them at no cost if those systems don’t fit their small business. If it takes more of their time, the “no cost” part of the pitch isn’t convincing.

The track record of CIOs in choosing systems that doctors will use in their offices isn’t any better than that of choosing systems they’ll use in the hospital. Lesson learned: let the doctors pick the systems you insist on giving them for free.

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Currently there are "5 comments" on this Article:

  1. That’s how CIOs buy hospital systems. Since the goal is getting access to doctor data and tying them to the hospital by giving them free systems, the CIO gets to pick the gift themselves since they have to support it afterward.

  2. small physician practices do not consider the long term in making decisions (especially on technology) they believe the total cost of an EHR should be less than or equal to a bare bones dell PC’s especially since everything is on the cloud these days.
    they have no idea what cloud truly is and most have brother-in-laws or a spouse as an IT guru that don’t care enough to educate them. they will choose a a home grown unheard off EHR or a free EMR that is cheaper by 5 bucks than a decent reputable brand name EHR ( somehow saving $5 today is worth much more than the cost redoing EHR in a year)
    what most of them need is another education.

  3. The current approaches toward implementing EHR systems that mostly add to physician burdens at the point of care will soon implode as the payment system evolves to reward enlightened, quality-minded physicians (i.e. value rather than volume). However, in the short term we will continue to see a majority of systems being installed in ambulatory care that are mostly tools to manage billing information in an industry-centric fashion. These deservedly earn resentment from physician looking for patient-centric tools that enhance rather than intrude on the doctor-patient relationship.
    Soon the fee for service gravy train will slow, and the systems will no longer be able to afford the hubris that value can be forced into the doctor-patient relationship from the outside. Given the proper leadership and vision, the necessary process changes and use of technologies will eventually grow from within and outward. This industry is largely living in an ugly house of administratively-focused, proprietary cards and self-serving, closed systems that are about to be blown away by more open systems and practice designs that increase productivity and value from a physician’s and patient’s perspective. The successes will typically originate in the trenches and then overtake the boardrooms and I.T. departments in spite of their well-intended but misguided oppositions.

  4. Such a tug of war. The real answer is teamwork.

    The CIO brings knowledge, experience and strategic IT thinking to the practice. The CIO needs to be a consultant to the docs during this process.

    The Doc has needs for their workflows and processes. They are the primary user and their desires and preferences are critical to usability and adoption. Afterall the best EHR in the world is useless if the docs aren’t using it.

    The decision has to support and respect the docs needs AND fit into the strategic (long-term) plan for the orgaization. This includes data movement between the docs and the hospitals and the (hopefully soon) HIE’s.

  5. I could not agree more with the need for teamwork. Living in both the clinical and the Health IT world, I never cease to be amazed at how solutions and approaches that make perfect sense in one world are complete nonsense in the other.
    The real successes will incrementally come from the patient-centric clinical world perspective, with guidance from IT. As long as the hubris continues of attempting to use IT as a tool to control the doctor-patient relationship and the money flow, the resistance at the point of care and the obstacles to efficiency and true quality will persist.

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