reprinted from Issue 22, Spring 2016 of Frontiers of Medicine (PDF)
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Equal parts diplomat and air traffic controller, J. Ben Davoren, MD, PhD, associate chief of staff for clinical informatics at the San Francisco Veterans Affairs Medical Center (SFVAMC), has guided IT innovation locally and nationally for over 15 years.
"The most important thing is the credibility of leadership," said Davoren, who is fond of pithy sayings. "You need to eat your own dog food." As a hematologist-oncologist, he experiences first-hand the flaws and opportunities in the SFVAMC's electronic health record (EHR) system, and works to improve it.
The VA was way ahead of other health care organizations, creating an EHR in the mid-1990s. It also draws on homegrown innovations pioneered at its roughly 150 sites nationally. For example, Davoren led a VA-wide process to identify "best of breed" technology to optimize medication doses for veterans taking the blood thinner warfarin – a finicky drug requiring constant monitoring and adjustment. He and his team identified the 10 best computer applications nationally, developed a scorecard to compare them, and selected the best one. The winning program allows a patient's entire clinical team to efficiently share tasks such as reminder calls and follow-up tests. Davoren's group spent months demo-ing the application for end users and tweaking it in response to comments.
"It's essential for clinical staff to articulate their needs and provide meaningful feedback to [software] developers," said Davoren. "Health care processes are complex, and require a lot of stakeholder input. It can't be a technology-based strategy; it has to be about how technology might be useful in improving the work that's being done."
At the SFVAMC, Davoren also led the introduction of tablets; among other uses, clinicians can now show patients their CT scans at the bedside. "The patient has been quite isolated from his or her own information," said Davoren. "They get it later, if at all. Having it available to them for decision- making is really useful, and you get questions from the patient and family members that they might not have otherwise asked."
For decades, he has led "Ten with Ben" sessions with clinicians and trainees, teaching them IT tips and tricks. He also champions developing contingency plans for when – not if – the computer systems go down. Davoren is excited about a new version of the EHR the VA is scheduled to roll out in the near future, which will better support systems improvement rather than just a one-patient-at-a-time approach.
"There's very little in IT implementation that's related to technology," said Davoren. "It's almost all about relationships. Informatics is a contact sport – people don't want to change what they're doing unless it's their idea, so you have to get out there, press the flesh, and say, 'Let's figure out how to make this the best it can be for you.'"