The first day of my Princeternship was right after the North Shore-LIJ Health System upgraded its electronic health record system. An electronic health record (EHR) is a systematic collection of data over a large range of potential fields for the patients in a particular system. Some fields include: medical history, medication and allergies, immunization, and social history. The HITECH Act, a part of the American Recovery and Reinvestment Act of 2009, introduced incentives in the form of bonuses for physicians who switched from traditional paper-based records to EHR as well as penalties in the form of decreased reimbursements for those who do not by 2015. In addition to using EHR, physicians must fulfill “Meaningful Use” criteria and certain other measures before qualifying for rewards.
My Princeternship host, Dr. Mitchell Adler ’73, is the Chief Medical Informatics Officer for the ambulatory network of the North Shore-LIJ Health System. His role is to oversee the administration of the EHR system in this network by working with physicians to set up an electronic health record for their patients and ensuring smooth transitions when changes occur in the technology or policy. In my time shadowing him, I attended an ethics meeting, as well as several meetings to discuss the status of the software implementation and meetings with health care providers to help them switch to an EHR system. I also spent some time shadowing Dr. Adler at the clinic.
On my first day, I accompanied my host as he attended meetings revolving around the implementation of EHR. Some physicians and nurses found that with the upgrade, they had to change the workflows in their practices to accommodate certain changes. Dr. Adler also met with the group managing the IT end of the EHR implementation in order to ensure a smooth transition. Other meetings Dr. Adler attended were focused on making the EHR software more compatible with a medical field’s particular needs. For instance, we met with pediatric oncologists and learned that in order to transition fully to EHR, the software would have to support various treatment flowcharts and road-maps that are used in this field.
I attended another meeting on my second day which was different in subject from the previous meetings. The pediatric department was in the process of switching to EHR, so Dr. Adler, an attorney, and several members of the health system met to discuss the issue of confidentiality in adolescent medical records. According to New York state law, from the ages 12-18 a child is given the autonomy to keep certain treatments or medications confidential from his or her parents although the child is their dependent. This raises potential issues, and with a new health record format, it would be important to ensure that this information is protected. The meeting was centered on the issues of who should have access to this confidential information and how to protect the information from falling into the wrong hands.
On my last day at the Princeternship, my host and I spent the first half of the day in meetings and the second half at the clinic. In the morning, Dr. Adler held a Physician Advisory Group meeting in order to receive feedback from and discuss changes with physicians. Afterwards, we attended a data governance meeting that was focused on developing higher level data management and collection guidelines. Part of Dr. Adler’s responsibilities is to spend time at a clinic where residents see patients. After the residents see each of their patients, they discuss the case with Dr. Adler, who advises the residents and co-signs their reports. While at the clinic, Dr. Adler can also observe the EHR in use and answer questions that users may have.
My three days with Dr. Adler were valuable in exposing me to health care administration and the intersection of health care and IT. As Dr. Adler was previously a primary care physician, I had a chance to understand more about both clinical work and his current role as a CMIO. I would recommend this Princeternship to anyone who is interested in learning about health care and EHR, as Dr. Adler is knowledgeable about many intersecting fields such as medicine, IT, and public health policy. I would like to thank Dr. Adler for making this such a meaningful experience.