Deloitte's Harry Greenspun: Larger practice docs 'disconnected' from IT drivers

A new study from the Deloitte Center for Health Solutions unveiled this week concluded that only one-fourth of physicians are on track to meet Stage 1 of Meaningful Use. In an interview with FierceHealthIT at the Healthcare Information and Management Systems Society's annual conference in Las Vegas this week, Harry Greenspun, M.D., (pictured) senior advisor for healthcare transformation and technology with the consulting firm, said the most concerning finding, though, was the "disconnect" of doctors in larger practices versus the inability to accomplish more for physicians in smaller practices. Ultimately, he said, the issue is not one of usability, but rather of shifting focus.

FierceHealthIT: What study findings most surprised you?

Greenspun: The most concerning thing was that the docs in the larger groups disconnected from what's driving a lot of this stuff. Of course that's why they're in those larger groups, right? So they've got layers of management to help them. What's going on now between Meaningful Use and ICD-10 and healthcare reform requires so much physician engagement, and these larger groups are relatively disengaged from some of these critical things that are making a difference in making it happen.

The flip side of that is that the docs in the smaller groups and the solo practices are up on everything, but of course they don't have the resources to act on it. You've got this dichotomy of bigger groups able to do stuff and smaller groups that can't, and in the meantime you've got groups and populations that are left out.

FHIT: Why do you think that the physicians who have more time are more disengaged?

Greenspun: As you go into smaller and smaller businesses, the doc who's delivering care is also the one who's running the business, so they're going to be much closer to everything. At a large group, you've got layers and layers of management--a CIO, a CTO, all these different resources--while at a small practice they've got Bob with a ponytail and a screwdriver who installs a new printer, and that's the extent of their technical resources.

FHIT: What does it tell you that lack of staffing resources was the biggest barrier for hospitals implementing health IT according to the HIMSS annual survey, while costs were the primary concern for HIT implementation for your respondents?

Greenspun: It's hard to disentangle some of those things. I think the bigger issue is what it's not: it's not around usability. It's really about yet another thing they've got to pay for, and how they can achieve return on investment. I think the big thing this industry needs to focus on is helping organizations improve the workflows, improve their processes and actually use these technologies to create greater efficiencies and better profitability, as opposed to it being just another thing they've got to buy.

FHIT: So how do you think that situation can be remedied?

Greenspun: It's a mixed bag. There have been a lot of bets placed on lowering costs with IT, when in fact, it's more about the opportunity to lower costs. Certainly when done well, and if you transform an organization you can lower costs. But I think the bigger issues are quality and safety. Those are going to be bigger drivers now that we have penalties for readmissions and other quality measures that are being rewarded. You're going to see other ways of getting ROI on these systems beyond just with the efficiencies with the docs.

No one said it's easy.

How can solo practitioners realistically take advantage of IT in the same manner as larger systems with more resources?

Greenspun: There are a lot of barriers going back to my ponytail Bob story. But solo practitioners aren't exactly people working out of a cave. These are very sophisticated practices. You go into an office and you see new technologies and cool stuff. No one's afraid of technology; it's an information technology and a transformation issue. It's a workflow change.

Editor's note: This interview has been edited for length and clarity.

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