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Richard P. Mansour, M.D. CMIO and VP, product innovation, Eclipsys

Board certifi ed in internal medicine, oncology and hematology, Dr. Rick Mansour is CMIO and VP of product innovation at Eclipsys. He is currently an as- sociate professor of clinical medicine at the Feist-Weiller Cancer Center. Dr. Mansour is founding partner of Vital Software and participated in the development of its oncology products prior to selling the company. He has worked on developing browser-based medical software prototypes for the pocket PC, prescription writing software and browser-based software for clini- cal research. His Web-based structured documentation software that incorporates SNOMED CT, automated ICD-9 coding, E&M coding and Medicare compli- ance rules checking was integrated into the Sunrise Clinical Manager design for physician documentation.

Paul Bleicher, M.D. CMO, Humedica

Paul Bleicher is chief medical offi cer of Humedica. Prior to Humedica, he was the founder and chairman of Phase Forward, where he grew the organization from concept to a publicly traded company providing integrated clinical-trial data-management software and safety solutions for the biopharmaceutical industry. Previously, he had led clinical trials at a biotechnol- ogy company and clinical research organization. Dr. Bleicher received his M.D., Ph.D. from the University of Rochester and his BS from Rensselaer Polytechnic Institute. He trained in internal medicine and der- matology, did a post-doctoral fellowship at Harvard and began his career as a physician/investigator and assistant professor at Massachusetts General Hospital and Harvard Medical School.

What is the most difficult challenge of CPOE implementation?

John Santmann, M.D. President and CEO, Wellsoft

Dr. John Santmann founded Wellsoft in 1988 to provide real-world software solutions in emergency medicine. He completed his undergraduate degree with honors at Johns Hopkins University in 1977 and graduated from Washington University Medical School in 1982. His emergency medicine residency was completed in 1987 at Norfolk General Hospital, and he has practiced emergency medicine in various hospitals in San Francisco, St. Louis, and throughout New Jersey. Dr. Santmann’s desire to merge his inter- est in computers with emergency medicine to improve patient care has inspired him to devote his energies full time to Wellsoft Corporation.

He has two patent applications pending, one related to structured documentation and a second related to the automated abstraction of electronic medical records for construction of data cubes for advanced analytics. What is the most difficult challenge of ICD-10 implementation?

Machines adapt without complaint. Humans, well, that is an entirely different story. The clinical and busi- ness community using ICD-9 has developed a “keen eye” or pattern recognition based on this coding system. It will take some time for these highly trained and ef- fi cient people to develop the new pattern recognition for the ICD-10 coding system. Computer systems can do it with the turn of a switch and without complaint. We need to design our software to ease the transition and fl atten the learning curve for this more complex coding structure.

Often, project teams for CPOE implementation focus on the technology and process, but they miss the critical importance of the end user. Clinical teams have to be able to give meaningful feedback on the usability of the system during the selection process, and the process must be built with fl exibility to accommodate post-implementation modifi cations. Furthermore, there must be careful attention given to optimal work fl ow, whereby user training and incentives are well aligned with organizational goals.

Successful implementation typically is accom- plished when incentives are more “carrots” than “sticks.” The clinical team should be given action- able insight into the cost and quality of their care of patients through quick, easy-to-use analytics and re- porting. When users perceive value, they will become regular users of the tool and be willing to overlook the minor annoyances that come with any new software and process improvement.

What is the most diffi cult challenge related to sys- tems interoperability?

The main challenge to achieving better interoper- ability has been a lack of clear direction and, for some vendors, confl icting motivations. For years, many vendors have not seen interoperability as a devel- opment priority, partly due to marketing strategies that promote a single-vendor solution. Today, many vendors have their own version of HL7 v2 messages that do not conform to the HL7 standard. I see this changing.

Up until now, it was not always clear which stan- dards to use for a given purpose. The meaningful-use requirements help solve this problem. In the future,

Continued on page 8 HEALTH MANAGEMENT TECHNOLOGY September 2010 7

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