Only a man of Bill Bria’s vision, passion and good humor could describe with equal enthusiasm the power of health information technology, the lessons he learned from his physician father, and the relevance of a favorite Saturday Night Live skit—and manage to connect them all in the process.
A critical care pulmonologist, and currently the Chief Medical Information Officer (CMIO) for the Tampa, FL-based Shriners Hospital System, with 22 hospitals nationwide, Bria has been at the forefront of medical information systems for nearly 30 years.
He remembers with relish the first time he got computerized information about patients, back when he was an intern at a large academic medical center. “Tracking patients’ laboratory information was a daily chore,” he recalls. “Understanding the delta—the change from yesterday’s values or last week’s—was very important, because that might be your one opportunity to identify an old problem that recurred or a new one.”
“We had a very unsophisticated system, but it did result in a computer printout that put asterisks in a vertical gradient that would help you compare lab values.”
“It was a revelation. We were delighted. I could have one single printout that would show me the trend for the entire duration of a patient’s hospitalization and outpatient care.”
Bria recalls thinking, “This is good stuff.”
“This Is Medicine”
During the 1980s, as a pulmonary specialist and pulmonary director of the medical ICU at Baystate Medical Center in Springfield, MA, Bria began to pursue his interest in developing health IT systems, eventually becoming the organization’s first—perhaps the nation’s first—CMIO.
Recruited in 1991 by the University of Michigan in Ann Arbor, where he spent 16 years, his interest and expertise grew. As co-director of the medical ICU and medical director of information systems, he oversaw a decade-long process of integrating clinical information systems that included decision support.
Bria has a very clear and simple message for physicians and organizations that are still thinking about adopting health IT systems. “This is medicine,” he says. “It’s not geeky medicine. It’s not ‘sort of ’ medicine. It’s not being imposed on you by payers or regulators. It’s not a technical trick or automating of paper. Medical informatics is medicine. It’s that simple.”
Recapturing “The Romance of Being A Doctor”
Asked to name the single biggest benefit of health IT, Bria says, “Communication.” And by this he means not just enhanced communication among the members of a care team, but better communication between physicians and their patients. “When the patient sees the same information as the physician, they can engage in a meaningful conversation. And that results in better care.”
And for Bria, the opportunity to have “meaningful conversations” with patients is what being a doctor is all about. “Growing up, I saw all the romance of being a doctor,” he says. “My father was beloved by his patients. He was integrated into their lives and they considered him part of their families. And that kind of trust is built on communication.”
He recognizes that change can be challenging, but he’s been through enough implementation scenarios at enough organizations to know that setting up and learning to use electronic health records and other forms of health IT is eminently doable.
“But the change itself is not the focus,” he urges. “The focus should be on the demonstrable benefits that a properly implemented and utilized health IT environment can provide.” One of those benefits, he says, is the ability to care for populations of patients.
Researching Your Own Practice
“These instruments allow us to use information to become our own researchers about our own practices,” he says. “I might see that only 50 percent of my patients with diabetes have their HbA1c levels under control, and I can ask, ‘What am I doing or not doing consistently?’ We can look at outcomes, treatment patterns, and consider whether we are truly practicing state-of-the-art medicine.”
Contrary to the concerns that some physicians hold—that health IT just introduces another layer of complexity into work that is already increasingly challenging—Bria sees information technology as a tool that helps physicians reclaim the joy in their work.
“Doctors often feel too busy, tired, or besieged by the tyranny of volume,” he observes. “Some worry that IT will ‘de-skill’ them—by giving them alerts and prompts to follow. And that would be the worst thing we could do as a profession. But that’s not what we’re doing. We’re actually returning to our roots of using our knowledge to build caring relationships.”
Continuous Refinement, Like Medicine Itself
Bria has observed first-hand the progress in health IT during the past decades, from his first printout of lab results, to today’s sophisticated systems that provide comprehensive patient data, clinical decision support, and communication tools. Still, he believes, the technology is in its infancy.
“We are in the ‘Theodoric of York’ era of informatics,” he says, referring to the Saturday Night Live skit in which a medieval barber/doctor played by Steve Martin opines on how far medicine had come: “We used to believe that illness was brought on by demonic possession, but now we know that it is really an imbalance of bodily humors perhaps caused by a toad or small dwarf living in the stomach.”
Bria knows the technology will evolve, growing more useful and flexible as a tool to support new models of care and strong physician/patient relationships. “Everything we do in medicine is under continuous refinement, and the same is true for informatics,” he says. “Supporting and developing this tool is part of our sacred trust with our patients.”
He is delighted that the American Board of Medical Specialties recently approved a board certification program in clinical informatics. “This shows that, within our profession, this discipline’s time has come. This is now an official, established, respected part of medicine. ”
Bria smiles. “I can’t tell you how happy that makes me.”