Siemens health services president calls IT benefits “unassailable”

Editor's note: Janet Dillione is president of the health services division of Siemens Medical Solutions, one of the world's largest medical technology companies. She has something in common with Donna Sollenberger, CEO of University of Wisconsin Hospitals and Clinics - both recently were named among the Top 25 women in healthcare by Modern Healthcare magazine.

Below are some excerpts from a recent WTN interview with Dillione.

WTN: With respect to medical information technology, does a vendor like Siemens play any role in helping a client CIO with change management. In other words, getting doctors and nurses to use technology like electronic medical records?

Dillione: Siemens does play a role in that it's a requested by the customer. I think the question is a great one, and it's actually one of the key aspects to any clinical implementation. The need to get the end users engaged in a very deep way is probably the biggest difference on the clinical side than it was on the revenue cycle side over the years, but typically what will happen is either the customer will engage Siemens as part of the overall project implementation, or sometimes the customer will choose to go to what I will call a trusted partner, someone they've used before to help on other significant implementations.

It could be that someone you would go to would be a typical big four, or it could be some other boutique firm, again, that either the chief medical officer or the chief nursing officer or the CEO has some comfort or history with. We either do it, or we're more than willing to work with someone else in doing it. WTN: Do you consider this a way to differentiate yourself in the market?

Dillione: I think that providing a full solution, which includes these types of services, is important for any of what I would call the big players. I don't know that it's a differentiator as much as an entry requirement, so to speak, because these are tremendously complex projects. Time and time again, the change-management component has proven to be, and I would also say the governance model of the project, have proven to be the key ingredients for success. So, differentiation, no. I think it's a requirement to play in the game.

WTN: What are the best kinds of approaches you've seen in getting physicians to use electronic medical records?

Dillione: I would actually start with the fact that I believe that the doctor usage is quickly becoming a non-issue. As newer physicians roll into the ranks, and you can't say the quote, unquote more seasoned physicians don't use it, but typically when you think about it, the residents coming up today are of the Google era, and most of them have been using mobile devices since high school, if not before that. So they are very comfortable with technology, and expect it when they get into it.

The model that I see having the best success is when you have what I would call internal champions, and they have to be influential physicians. They have to be the ones that others view as leaders. They are either department chairs or their heads of the service, and they have to be part of your steering committee or whatever you name it, and they have to be seen using that technology.

It's much more powerful to have a physician show his peer than somebody from the IT area trying to teach someone how to use it. So that consistently has proven to be the best way.

WTN: What is biggest challenge for effective patient data exchange - technology interoperability issues between health facilities, or varying medical records handling procedures between health facilities and between states?

Dillione: On the first one, I would say it's the lack of data standards. So each time you do one, you're almost doing a custom implementation. You spend an enormous amount of energy just cross walking data between the trading partners, so I think that's the first thing I would have said. I don't think that the technology, itself, is as significant an issue. I think the technology is out there to get it done.

I would say that number two, or potentially number one sometimes, would be privacy and security - the either real or perceived urgency to solve those issues. Sometimes, you can get a little cynical and say, “Well, whoever thought the paper record was so secure because it would be pretty easy to grab one and walk away with it,” but there is this idea that something electronic, because of the famous hacker story, something electronic is less secure. It's very difficult to get through some of those privacy and security issues.

I was just in Germany last week and they have a national referendum to get to a common EHR across the country, and it's a key issue in Europe as well. It was a key issue in Asia when they tried to do it, so everyone is wrestling with this privacy and security issue.

WTN: Is it more a matter of perception than reality?

Dillione: I think that perception, clearly, has a good bit to do with it. I do think there is technology there to provide the right privacy and security. I think that there are also clinicians who have some fears about these records being exposed on something as open as the Internet.

I think the primary care offices would not have the technology that you would want them to have to be a secure node on a clinical-sharing network, so there you can argue that the technology does become a problem. If we can start getting the technology in, with the capital issues and other things, I do think the technology exists. And there we're left with dealing with the perception.

WTN: Is a national, or even a regional patient data exchange system really achievable, or should we be content to accommodate patient data exchange within communities or within states?

Dillione: The first thing to recognize is that most healthcare in the U.S. happens within 20 miles of someone's home, and that's the one key characteristic of healthcare. It remains predominantly a local delivery system. Having said that, I think first if we can solve these issues on the regional level, then the national level becomes doable.

I think that at a logical level, as the technology person, yes, everything is possible. But I think some of these other issues like standards and implementation protocols, business models, where's the funding, where's the capital, data security and privacy, will be more easily solved on a regional level. And if we can come up with one on a regional level that proves repeatable, then we can get to that national implementation.

WTN: To speed adoption, should payers/insurers, who stand to benefit most from the efficiencies made possible by health IT, be required by the government to step up and help the providers make the necessary investments? Or would this create more problems than it solves such as more costs being passed to healthcare consumers?

Dillione: There are probably some very smart economists who have pondered this question. I don't know that it's that simple. You could argue that no matter where the cost is shifted, it will be shifted someplace else. I think that clearly there is an enormous amount of available money in the system if we can solve some of these waste and productivity issues.

We have customers and there are instances where providers have worked with their payers and either through increased reimbursement or some decreased cost somewhere else, both parties have found a way to make technology a benefit to both. Locally, payers and providers have found ways to do it and will continue to look for those ways. Whether or not it's something that we could say nationally that all payers must or all providers must, I think that will probably prove to be a little more problematic.

WTN: We're several years into looking at health IT as one of the answers to reducing medical errors and controlling costs. At this stage, is there any doubt in your mind that information technology can make a significant difference in these areas?

Dillione: I don't know how you can argue against the fact that information technology provides the clinical benefits. I think that the data is resounding on things like e-prescribing, on things like bar coding of medications and patients. I think on the efficiencies of drug delivery and order times to patients when there is automated order entry, I think the data is unassailable. And I think that every instance of every implementation, you have an outcome that demonstrates the benefits of IT.

The ones [data sets] that are the most poignant for me, anyway, and the ones that I remember the most are whenever anyone does an implementation of bar coding on meds and patient identification and the processing and the reduction of medication errors. We have many, many, many of those in our own customer base and I think on this one, I am technology agnostic. As a patient, I would look for some place that did it.

Related stories

• DHC 2007: Barriers to electronic data exchange include the law

• DHC 2007: Without fuller IT adoption, health costs might drain America's wealth

• Hayden says technology creates magic moment for healthcare delivery

• Digital Healthcare Conference 2007: Mounting obstacles for health IT

• Darrell Pruitt: Careful with that electronic health record, Mr. Leavitt