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The United States healthcare system is going to become digitized. By allotting nearly $20 billion for health information technology, President Obama has set in motion a fundamental change to our entire healthcare system that many experts agree has been a long time coming. The period we're in now is that nebulous time after a bill has become law, but before any tangible change takes place when all the blogs and message boards come alive with opinions, hypotheses, and predictions about what this infusion of cash will mean in practical terms for the country's hospitals and physician practices.

Is HIT enough to fix our broken system of care? Are electronic health records mature enough for a deployment of this scale? What about interoperability issues? What about standards? All important questions. But perhaps not the right questions, says Peter Basch, MD, a clinical leader for EHR implementation at MedStar Health, a community-based network of eight hospitals and other healthcare services in the Baltimore/Washington region.

"We're chasing a target and that target is technology adoption. But you have to realize that once you've adopted that technology, you're basically embracing a care neutral and a safety neutral and a quality neutral tool. Without understanding how to use that tool to achieve the administration's goal of reforming and improving our healthcare system, we stand very little chance for improvement," he says.

Basch offers up this example: Would simply giving every high school student a computer automatically improve test scores? Probably not. But if you put computers in the hands of motivated students who have good teachers and a good teaching plan with a solid strategy for how to use this technology to achieve their goals, well, then you stand a chance for improvement.

"One thing that has always vexed me is that as this stimulus bill got closer and closer to being announced, we started seeing an increasing number of disparate studies. One showing that HIT has no value, then the next one tells us HIT has negative value, and the next one shows HIT has positive value," says Basch. "My thought is, stop staring at your feet and look forward."

The bottom line, says Basch, is that HIT is not magic. Yes, digitizing our existing system can lead to improved outcomes, but how much good can it really do in a healthcare system as disjointed as ours? "No matter how sophisticated the technology, if it's being used in a broken infrastructure, it will just make bad processes happen more quickly. To see mediocre or hopefully better HIT optimize quality, safety and effectiveness, health IT has to be implemented in a healthcare system that is far less broken than the one we have today," he says.

So where does that leave us? Basch says lawmakers should not just be looking at adoption of HIT, but should be placing just as much importance on revamping the payment system. "An EMR can do no more than support the business processes of the health system. If the system contains fully aligned payment incentives that lead to participants doing well by doing good, then maybe health IT can realize its full potential," says Basch.

For CIOs who are working on the frontlines of this movement, your job now is to be in constant communication with your hospital's clinicians to find out what kind of technology would really make a difference in the quality of care they offer, says Basch. "Of course, we all want to be paying close attention to the definition of meaningful use. Beyond that I would hope that health systems will move beyond looking at HIT as just a project, but look at these implementations for what they can accomplish," he says.

The technology is never going to be perfect. And the "experts" could probably spend from now until eternity debating the virtues of EMRs. Maybe now our time would be better spent concentrating less on simply increasing adoption numbers, and more on fixing what's broken in our healthcare system.

Physician leadership is a big topic at this year's AMGA annual conference, which kicked off with an all-day pre-conference workshop on "How to Groom the Next Generation of Physician Leaders."

The first session featured J. Gregory Stovall, MD, senior vice president of medical affairs at Trinity Mother Frances Hospitals and Clinics in Texas, who described physician leadership development using a gardening/farming analogy. He outlined four basic steps:

Creating fertile soil. Creating a culture of leadership in an organization is essential to growing physician leadership opportunities, Stovall said. Trinity began by rewriting bylaws to require the president of the organization to be a physician and boards to reserve seats for physicians. It also prioritized financial support, creating compensation models based on annual performance reviews and bonuses for all vice president level positions and higher. "I can't stress enough the importance of the annual reviews," Stovall said.

Planting good seeds. In this case, seeds are physician leaders, and "planting" refers to the recruitment process. Stovall partnered with the other presenter on the session, David Cornett, regional vice president for Cejka Search, to identify leadership potential, in addition to clinical skills, when recruiting new doctors. They used behavioral interviewing skills to dig into candidates' previous leadership experiences.

Watering and fertilizing. Recruiting physicians with leadership potential is not enough. That potential has to be nurtured and developed, and Trinity does this through a variety of on-site training programs. There are more examples later in the day of facilities working to educate physicians about the business aspects of healthcare.

Harvesting. By harvesting, Stovall means optimizing the return on investment. Solid physician leaders often increase revenue through new or expanded service lines or enhanced reputation and recognition, but they can also significantly reduce costs by spearheading quality improvement initiatives or reducing turnover (for both physicians and support employees).

Harvesting is obviously the stage that organizational leaders are most excited about, but to optimize a physician leader's ROI, it's important to start with the organization's culture, and cultivate leadership throughout the growth process, Stovall said.