Opening Comment: Dr. Sands, with your impressive background in the Medical Informatics field, we are fortunate to have you doing this interview. Thank you for taking the time to share with our audience.
A: It's a pleasure, Stephen.
Q1: Can you describe your current roles with Harvard Medical School and as Cisco System's new Director of Medical Informatics? How will you shape these organizations strategies and objectives into the future?
A: I have been on the faculty of Harvard Medical School for many years, where I continue to teach residents and students about medicine and health information technology and collaborate on some research projects. The job at Cisco is new. In this role, I provide both internal and external health IT leadership, build relationships with customers and other organizations, and help partners transform their clinical and business practices using IT. I also maintain a part-time internal medicine practice at Beth Israel Deaconess Medical Center in Boston.
Q2: Can you provide specific examples how the clinical environment can be transformed by technology?
A: Electronic medical records, computerized physician order entry, electronic communication, clinical decision support, patient access to their records, just to name a few.
Q3: From an overall perspective, what are the steps required to implement these IT solutions for clinicians, patients, and provider organizations?
A: Not a simple answer. In general, this requires an organization (or practice) that is committed to transforming clinical care processes. Key members of the organization must be committed to the project, including administration and key clinical leaders. Organizations must pursue a careful analysis of current workflow and pain points. Then they must select a system with adequate attention to the company itself, site visits including user interviews, demonstrations, and attention to system stability, performance, expandability, and usability.
Q4: What are your perspectives on the future direction of technology in the clinical environment?
A: Currently, we have an unsafe environment for patients (medical errors are common and costly), and both patient and physician satisfaction is flagging. Ultimately, physicians should be rewarded based on quality of care delivered and patient satisfaction, and not just quantity. We should get continuous feedback on how we're doing and we will strive to improve. Technology such as electronic health records with integrated clinical decision support can help us improve the safety and quality of care we deliver. Ordering tests and medications through intelligent computer systems will be compulsory. These systems will inform clinical decisions by incorporating information about patient health problems, medications, allergies, and increasingly genomic data. Through e-communication with colleagues and patients we will improve the therapeutic relationships we have with our patients and provide comfort to them. Patients will have continuous access to their health records and health care teams whenever and wherever they need them. As we age and become infirm, home monitoring will help us maintain our health and prevent illness. Technology will enable these transformations and many more.
Q5: What specific challenges/barriers did you experience and the resulting lessons and useful tips from your work as: Chief Medical officer and VP for Clinical Strategies at Zix Corporation, Clinical Systems Integration Architect at Beth Israel Deaconess Medical Center in Boston?
Q6: Overall, what are the top opportunities and threats for the medical ecosystem and how they can be managed using people, process, and technology?
A: I will limit this to US and Canada:
Q7: Looking back over your career, what three stories and resulting lessons can you share that were most pivotal?
A: When I started my training in health IT, one of my mentors made me spend time with personnel in all parts of our hospital. This included nurses, physicians, pharmacists, ward secretaries, radiology technicians, laboratory technologists, and others. I was angry, because I didn't understand why I had to do this. I met with dozens of people and learned how they did their jobs, how they interact with the hospital computing system, what needs were being met, and which weren't. In retrospect, this was an extremely valuable experience.
Another experience involved e-mail. I was doing a project in computer-assisted discharge planning. I realized that communication, often via e-mail, was a crucial part of this. I hypothesized that e-mail was important for clinical work in the medical center. My teacher disagreed and felt that most of it was social. This prompted me to study the use of e-mail in our institution, and I found that at the time most was clinically oriented.
Finally, when I took over leadership of our electronic medical record project I established a committee with roles and responsibilities, established a culture of customer service, set goals for system utilization, and monitored data every quarter and how well we were achieving these goals. This turned out to be valuable because it made us more focused and directed. We developed esprit de corps and pride of ownership. It resulted in excellent results as we were able to track our progress.
Closing Comment: Danny, again, thank you for sharing your deep insights, talent and experiences with our audience.
A: My pleasure, Stephen.
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