The doctor is in

Systems integrators are hiring chief medical officers not to administer to ailing employees but to serve as information technology experts as companies chase a bigger share of the growing health care IT market.The electronic health records business alone is expected to grow 13.5 percent in the next four years and to top $4.85 billion by 2015, according to a study by Kalorama Information, a publisher of medical market research in Rockville, Md."The market is just happening now," said Michele Kang, vice president and general manager of health solutions at Northrop Grumman Corp. "I think it's going to be a very exciting place to be for the next few years."Two of the largest integrators, Northrop Grumman and Computer Sciences Corp., recently added CMOs.CSC hired Dr. Robert Wah in January. "My interest and expectation is to provide a practicing physician's viewpoint," Wah said. A physician's input leads to medical IT systems that doctors will find useful, he said."When we talk about places like the Centers for Disease Control [and Prevention], which is managing huge volumes of information in their biosurveillance work or all of the work they do to monitor the health of the country, that's where large megaproject [integrators] like CSC can be very helpful," said Wah, who has worked with large health information exchange networks at the Defense and Health and Human Services departments.Wah said he foresees the creation of a nationwide health information system that is interoperable but not integrated. "We don't have to have the same system for everybody," he said. Rather, it will be better to have systems that meet unique requirements and can exchange information with other systems.DOD's Armed Forces Health Longitudinal Technology Application is one such system. AHLTA supports 9.1 million military personnel and their families, 70 hospitals, 450 medical clinics and 400 dental clinics worldwide. The State Department and DOD are testing whether AHLTA would be an appropriate system for the diplomatic corps.Northrop Grumman, which manages AHLTA, hired Dr. Harry Greenspun as CMO in February.Greenspun said health information exchanges and electronic health record systems affect AHLTA. "If you look at the care provided to military personnel, over 50 percent of that care happens outside a military facility. So there is a need for exchanging data between the military and private health systems," he said."As health care has advanced, the need for integrating the different types of systems in place has gotten greater and greater," said Greenspun, a cardiac anesthesiologist and former chief resident at Johns Hopkins University Medical Center.Microsoft Corp. and DOD are involved in a cooperative research and development agreement to develop a prototype medical data warehouse and the analytical tools for easy but secure access to military patient health data and records in the AHLTA clinical data repository.Medical doctors are a good choice for CMOs because it's important to have someone who can understand the different facets of medicine. "That is what's driving a lot of [the hiring of] CMOs into our systems integrators," Greenspun said.It's challenging even for a veteran physician to attend a company meeting on electronic health records, visit a pharmaceutical company to see how record systems might be integrated into drug records and then confer with the Centers for Medicare and Medicaid Services or the CDC on public health issues, he said. "These are very, very broad areas of subject matter," Greenspun said.BearingPoint Inc.'s Health Services unit hired Dr. Michael Cowan, a former two-star admiral and Navy surgeon general, in October 2005. As CMO, his job is to strengthen the company's public health consulting capabilities and provide innovative leadership."We are well behind other comparable Western nations" in using health care group information technology, Cowan said. "There are lots of reasons for that. It's not because doctors are Luddites. It's not because they don't want to use the latest technology."Cowan said the United States has been slow to adopt a national health records system because of the high cost involved, the extreme reluctance of doctors in small practices to adopt electronic health records and concerns about privacy and data loss.But such fears are unfounded, Cowan said. "It's not like successfully getting into a relational database where you can then suck everything out. Large-scale identity theft would be very, very difficult," he said. "We can build all the securities and safety into [the system] right up-front."Dr. Kevin Fickensher, executive vice president of health care transformation at Perot Systems, agreed."Having been a physician for 30 years now, I can tell you that I feel a lot more comfortable with the security and privacy of electronic records than I do with paper records," he said. There are far fewer controls on paper records and no foolproof way to track who has accessed them, he added.Fickensher, who went into consulting after a stint as CMO at WebMD, an online medical information Web site, said many contractors devote too much attention to health care technology and not enough attention to the people and processes that technology affects.Perot's approach to health care IT services could be described as holistic, focusing equally on all three aspects. "We believe that our capabilities on the transformational front are quite good," he said. DOD and the Veterans Affairs Department are interested in the Perot approach, he added."In the discussions we've had with the federal agencies, [what we've learned] is that, like many of the health care systems, they have come to the conclusion that having a partner they can work with over the longer term is the much more successful approach than parsing out and doing these six-month or nine-month projects," Fickensher said.