The Next Exponential Leap

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Symposium on Health Information Technology - July 2006  


By Philip Suarez, MD, Guest Editor  

When Ignaz Philipp Semmelweis, MD, shocked the medical world in the late 1840s by demanding that his staff wash their hands, he introduced the concept of infectious disease. Sadly, the world was not ready for that message. He was repeatedly ridiculed by other physicians of the time, and patients even spat upon him for insinuating that they were "dirty."

Dr. Semmelweis lost several teaching positions because of his "outrageous" claims that sick people actually were making healthy people sick as well. To prove the point, he intentionally cut himself with an infected scalpel used at an autopsy. The world began to take note only after he died from "puerperal fever."

Medicine has gone through many such exponential leaps throughout the ages. We sit in awe at how each such step has improved the care we provide to other human beings.

No less awe-inspiring is the current tsunami of technological advancements rocking the medical world. The mastery of these and future technologies will provide the next exponential leap in the quality of medicine practiced by physicians worldwide.

As with any dramatic change, there are, regrettably, many who refuse to recognize the importance and the impact of that change. As physicians in Dr. Semmelweis' time scoffed at the idea of infectious disease, many of our colleagues today long for the days when flipping through the foot-high Physicians' Desk Reference ( PDR ) and scribbling barely legible orders on paper were considered standard of care.

In a virtual blink of an eye, the days of the microprint PDR , hand-written orders, x-ray films sliding around a desk, and stacks of text books will seem as archaic as leeches and the filthy lab coats of Dr. Semmelweis' mentors. The challenge we face is to make the learning curve for these new technologies as short, painless, and affordable as possible. The technological future is inevitable; resistance is futile.

The most compelling reason for this inevitability is the dramatic improvement in the quality of medicine when new technologies are adopted.

The hurdles are many. Concerns of physicians are real. Seemingly endless questions must be answered: Will this slow me down? How much will it cost? Who will pay for it? Will my system's designer survive? Will my system "talk" with other systems I depend upon?

In 1999, a bombshell hit the medical community when the Institute of Medicine published To Err Is Human: Building a Safer Health System . We can debate the accuracies of the numbers all we want, but there is one undeniable truth: We can do better. There is not a physician in Texas who can look into the mirror and honestly say that he or she is perfect and has never erred.

One thing is certain: The federal government has taken this 1999 report seriously and, as evidenced by President Bush's State of the Union address in 2004, will mandate the electronic age for physicians. Like it or not, with a carrot or a stick, it's coming to each of our offices and hospitals.

I would urge every physician who thinks this is simply going to go away to reconsider. Incorporating new technologies can be done in cost-effective and efficient ways, and the Texas Medical Association will continue to vigorously support physicians in this endeavor.

The initial hurdle is simply to make the decision. Like weight loss and smoking cessation, the first step to the electronic medical office is to decide to actually take that first step.

As you'll read in this issue, Christopher Crow, MD, from Plano, accomplished the unthinkable. He went from being a computer neophyte to mastering the "art" of the electronic office in just a few years. The most astounding revelation for Dr. Crow? He believes he and his partners are practicing better medicine for his patients because of these efforts.

The learning curve will be there, no doubt. But without exception, each physician or group that has gone down the other side of that curve will attest to the fact that it's easier with electronic medical record (EMR) systems than paper ones and they are far more efficient today than yesterday.

While becoming 100-percent electronic is surely a daunting task for any physician or group, might I suggest baby steps at first? How does one eat an elephant? Why, one bite at a time, of course.

There is no question that patient demand, along with government regulation, is driving this move to the electronic world. Electronic communication with their physicians is very high on this list of our American consumers, er … patients. 

Online Communication  

So, just start by creating an electronic system to allow your patients to communicate with your office online. It's really simpler than you think, and it's the first step to take into this world.

Your TMA has issued guidelines to help direct you. While chair of the TMA Council on Communication, I helped create guidelines for communicating with patients online.  The details of these guidelines can be seen on the TMA Web site. The essential points include the following:

  • Online communication must be conducted over a secure network, not standard Internet e-mail.
  • The physician must take reasonable steps to authenticate the identity of the person who receives the online communication.
  • A printed record of the online communication must be contained in the patient's permanent medical record.
  • Highly sensitive subject matter (e.g., results of HIV testing) should not be dealt with online.
  • Online communication is not appropriate for emergencies.
  • Most important, the use of online communication between the physician and patient is appropriate only after the traditional physician-patient relationship is established.

To learn more about electronic communication with patients and how you can incorporate technology into your practice, log on to the TMA Web site at Click on Practice Management and then Technology.

While there appear to be countless options to accomplish this task, I personally use the TMA-endorsed Medem system, available at Not only does the Medem network fulfill all of the TMA guidelines, but it also offers a completely integrated HIPAA and e-risk compliant, secure messaging system.

The Medem network offers your practice more than this, but for your first baby step I suggest you consider this option. I was amazed at how my patients' eyes lit up at the thought of accomplishing routine communications (prescription refill, appointment request, simple follow-up questions) online as opposed to the tangled, frustrating, eternal nightmare of our phone and traditional paper systems.

Remember, your (and your patients') most precious commodity is time. Online communications go a long way to demonstrate your recognition and respect of that fact. 

Electronic Medical Records  

Taking the further inevitable steps into the EMR world is far more daunting and risky. The objections by physicians are very real and numerous: Who will pay for this? How can I be sure that the system I choose will survive? Will my chosen system interact with the hospital and other colleagues? Will my patients' privacy be protected?

In recognition of these substantial concerns and objections, but also realizing the inevitability of all of this, the Certification Commission for Healthcare Information Technology (CCHIT) was created. CCHIT ( is a joint project of three leading HIT industry associations (the American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology).

The goals of CCHIT fit our needs exactly:

  • Reduce the risk of HIT investment by physicians and other providers,
  • Ensure interoperability (compatibility) of HIT products,
  • Assure payers and purchasers providing incentives for EHR adoption that the return on investment will be improved quality, and
  • Protect the privacy of patients' personal health information.

Concurrent with the publication of this edition of Texas Medicine , CCHIT will begin publishing a list of certified products and their developers. It would be prudent to look to CCHIT for further guidance on this topic before investing in any system.      

TMA also is helping physicians make the move to EMRs. Thanks to a $1 million grant from the Physicians' Foundation for Health Systems Excellence, TMA formed the Health Information Technology Department within its Division of Membership Development and Physician Services. This new department will create and coalesce existing and planned TMA health information technology activities (both grant and non-grant funded).

While reading this issue of Texas Medicine , do not lose sight of this most important point: Our privilege and calling is the care of other human beings. We bring this issue to you with great enthusiasm because we are convinced that by mastering these new technologies, your patients and the people of Texas will be better cared for because of our collective effort.  

Dr. Suarez is an obstetrician-gynecologist in Victoria and a member of the  Texas Medicine Editorial Board.  

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