A Doctor's IT Prescription

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.

Blumenthal hopes to convince physicians on the fence change as a result of the American Recovery and Reinvestment Act of 2009, which includes billions of dollars in Medicare and Medicaid incentive payments to providers and hospitals for the "meaningful use" of certified IT products. Electronic medical records (EMR) need to be from a certified vendor. Providers need to meet the meaningful use requirements for EMRs as outlined in the HITECH portion of the act to claim their share of the incentive payments.

Change is difficult. Blumenthal referred to Surgeon General Regina Benjamin, a former primary care physician in a small town in Alabama who lost her paper records to Hurricane Katrina. When her small clinic was ruined, Benjamin laid out medical charts to dry out following the storm, according to the Huffington Post.

It was only the "second" time that her paper records were destroyed that Benjamin decided to go electronic, Blumenthal said, only half joking. "And her 78-year-old nurse became extremely proficient," he added.

At the conference, Robert Austin, MD, listened to what Blumenthal had to say, and said he wasn't sure what lies ahead. Austin, a Texas physician, told Blumenthal he has been in practice for 40 years, and wasn't necessarily resistant to the idea of change, "but to the voluminous process of change."

Austin noted that if a physician had a practice with an "office of 2,000 patients, and charts that are overflowing and falling on the floor," but no assistance, "one may think at that point it is time to get out of practice."

"We [can] lose some valuable practioners," Austin added. "Do we vigorously respond to this problem that is impacting our most needy patients?"

"We are trying to make those resources and supports available within the limits of our funding and legislative authorities," Blumenthal responded. "We are trying to blanket the country with supports, technology support."

Blumenthal posed questions for physicians who are sitting on the fence. It was one of those cut-and-save moments.

"Am I going to stay in my practice? If I stay in practice is an electronic health record in my future? If it is in your future, is there a better time than now when I have the federal government willing to make $44,000 or $63,000 available in extra payments to me?"

"Is that the transition that different from the tough challenges throughout my career? Do I want to stay at the top of my game?"

"All those calculations should be part of that decision," Blumenthal said. "We're certainly hoping that when all those things line up, the decision will be made to go forward—as hard as that may be."

For many physicians, the prospect of embracing the new health information technology is like a patient taking some new medicine. Blumenthal is betting that most take it–like he did.

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