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Master of Psychology

Gary Baldwin, for HealthLeaders Magazine, September 10, 2008
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By leveraging physician competitiveness—and device connectivity—Cardiology of Tulsa makes EMR headway.

Cardiology of Tulsa (OK) overturns many of the stereotypes about physician practice adoption of electronic medical record technology. The 15-physician group has been an early adopter despite some bad experiences. In 1997, the group failed at its first effort to adopt digital recordkeeping. Four years later, it tried again, taking considerable financial risk and investing $866,000 in clinical IT. With four offices in three cities and a busy hospital practice, the cardiology group needed a way to easily share files and streamline business operations, recalls Michael Spain, MD, president and chairman of the group practice, which includes no surgeons.

Now, not only has the group recouped its investment, it has helped develop a national cardiology database. Spain has become something of an IT proselytizer, addressing national conferences and hosting site visits. The group was honored by HIMSS in 2006 with the Davies Award, an annual prize that recognizes IT innovators. Physician groups "just need to get started," Spain says. "If you just get started and do something every day, you wake up five years later and you have something special on hand. We did not start out thinking we would win prizes or do consulting."

Although Spain has no technical background—something he says is not needed in a physician IT champion—he became the practice's leader in a project that has overcome numerous barriers. Understanding physician psychology is crucial to any successful conversion to digital recordkeeping, he asserts. Not only that: Vendors need to deliver software that correctly anticipates physician needs. "Once you make the commitment to be digital, you've got to solve many problems," he says.

Before Cardiology of Tulsa embarked on its second EMR journey in 2001, it took a vote of the entire practice. Spain wanted a unanimous vote before proceeding, and got one. "We gave every single physician in the practice the ability to blackball the project," he recalls. And while the practice benefited from the unanimity, it could not simply bank on the enthusiasm to sustain the implementation indefinitely. "We said physicians could receive high value from the first patient encounter when using the EMR," he says. "We didn't say, ‘Come back in three years.' Physicians are extremely loaded down and under lots of stress already. You have to recognize their nature and how they think, work, and act."

That meant playing off the members' highly competitive natures. Cardiology of Tulsa brought physicians over to the new system one by one, systematically offering training and installing high-speed connectivity at members' homes before beginning. "The physicians had a process to go through to go live," Spain recalls. "Before long, we had a showdown at the OK Corral. Two physicians said they were too busy to train." Rather than criticize the two doctors, Spain dispatched Nancy Nelson, the group's administrator, to console them. After lending a sympathetic ear, she advised that Spain would announce that they would be the first to miss the go-live schedule. "They both came in the following Saturday to do the training," Spain recalls. "They were not going to be the first to publicly fail."

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