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A Doctor's IT Prescription

Joe Cantlupe, for HealthLeaders Media, April 15, 2010

David Blumenthal, MD, has spent countless hours over his career using paper—writing down procedures, medication prescriptions, and evaluating x-rays.

Through the years, he resisted technology. In fact, the 61-year-old National Coordinator for Health Information Technology for HHS says his wife still runs the computers at home.

"My wife actually thinks it's a huge failure in vetting that I have this job," he joked about his overall skills.

He spoke a few weeks ago to members of the Patient Centered Primary Care Collaborative about how he was forced by peer pressure to embrace technology and for that, he's a better physician. His message is instructive to physicians everywhere, especially those who are resistant to change.

"Information is the lifeblood of medicine," Blumenthal said. "Any clinician is only as good as the information they have available to make decisions. The best way to circulate that information is electronic health information systems."

Whether it's electronic health information systems, or electronic medical reporting systems, physicians are caught in an electronic vortex. As Blumenthal sees it, changing information technologies is a must for physicians as well as hospitals and other providers to maintain proper healthcare delivery.

As the nation develops IT programs, there are physicians who will resist the change. Blumenthal's path is instructive to other physicians. He was someone who didn't necessarily shun technology, but he didn't embrace it either.

"I come to this insight as a clinician, I don't come as a technology aficionado, I was like many of my colleagues practicing primary care at Massachusetts General Hospital, happily using paper for most of my career," he said. "I liked my prescription pad, I was very comfortable with it. I liked those x-rays that I wrote out in triplicate. I was not looking for change."

It wasn't the bosses or the institution that made Blumenthal change. It was something inside him–the competitive spirit to keep up with people younger than himself.

"Gradually, with a lot of help from support systems, I came to see it was making me a better doctor," Blumenthal said.

Over time, Blumenthal says he could see the day-to-day difference technology made in his practice, as the memory of pen and pad became further distant.

"I knew the results of those biopsy moles when my patient would come in unable to find a dermatologist to get hold of the pathology report; it would be there in my computer. I knew the results of the mammograms. I knew the results of the blood tests. I was no longer scrambling through a paper record looking for specialists inevitably lost in the world of paper. I knew the medicine patients were on; if I had questions, I can contact them in the mail," Blumenthal added.

A singular incident stood out in his mind about the need for technology and how important it is for him as a physician. "I tried to discharge a patient from the hospital, and the patient had a urinary tract infection," he said.

Blumenthal looked at the computer and saw in "bright red letters"—a description of an allergic reaction. As he spoke, you get a feeling he was pretty shaken when it happened. Blumenthal said he avoided a "potential complication."

Since being named to the post by President Obama a year ago, Blumenthal has been assigned to lead implementation of a nationwide interoperable privacy-protected health information technology infrastructure as called for under the American Recovery and Reinvestment Act. Prior to his appointment, he served as physician and director of the Institute for Health Policy at the Massachusetts General Hospital/Partners HealthCare System.

Blumenthal is a leader in the health IT movement, but he understands the barriers to technology that doctors face. Changes in technology involve a change in outlook. For physicians who have been in practice a long time, it may not be easy. As for Blumenthal, he says he has used an electronic record to care for patients the past 10 of his "30 plus years" in primary care.