HIStalk Quotes
An Exclusive Interview with Jim Morrow MD, North Fulton Family Medicine
posted 04/12/2007
Jim Morrow, MD (center)
Photo: Associated Press
I dialed Jim Morrow’s cell number and thought there had been a mistake. What was that crowd noise? Then, a recorded voice came on, informing me that I was calling Clemson’s #1 fan, who would be along shortly.
He joked about it when he came on the line, saying people always expect to hear a serious, deep-voiced doctor explaining in no-nonsense terms to leave a message. Like most doctors (but unlike us non-doctors whose careers are spent in fear of offending a boss or customer), Jim says exactly what he thinks.
Jim is one of the best known EMR advocates among office-based practicing physicians, thanks to recognition from HIMSS (Davies Award and Physician IT Leader of the Year). He’s clearly excited about the second phase of his professional life, working with electronic medical records systems as both a power-user and an industry evangelist.
Tell me about yourself and your medical practice.
I’m a family doctor and have been for 22 years. North Fulton Family Medicine has four locations, 10 doctors, and 10 PAs in Georgia. We do the whole gamut of family medicine – physicals, acute care, chronic care, and testing. I’ve used an EMR for 8 ½ years and have loved every minute of it.
You’ve won both the Davies Award and HIMSS Physician IT Leadership award. What was that like?
It was unbelievable, to tell you the truth. I was completely shocked that I would with the HIMSS Physician IT Leader of the Year award.
All I’ve done since 2004 is to try to get the next practice to go live with electronic records. I’ve been evangelizing about healthcare IT. I referred to myself last week as the Jimmy Swaggart of healthcare IT. Maybe you shouldn’t print that (laughs).
It takes that. You have to get people excited, you have to inform them, you have to let them know what’s going on. HIMSS recognized that with the award and it was shocking to me.
The Davies was really special. It was the icing on the cake for what we did with electronic records. Like a lot of people, I didn’t know about it until it came time to apply for it. It has given us a larger opportunity to introduce this whole subject to more people.
I realized that if I’m in an exam room with a diabetic, and if I can get them to watch their diet and do all the things they’re supposed to do, I can affect that one life. If I can talk to a group of doctors and administrators and any one of them implement electronic medical records, then I’ll impact thousands of lives. That’s special to me. I realized that’s why I’m here. To realize at 52 why you’re on this earth is a tremendous experience.
What will it take to get widespread physician adoption of EMRs?
Don’t ask me that. People don’t like the answer. A government mandate. That’s what it’s going to take.
Inertia is a very powerful force and that’s what we’re up against. Doctors are accustomed to doing things a certain way. They don’t see 7,000 people a year dying from medication errors and 98,000 from medical mistakes. They’re set in their ways and that’s how doctors are. In a lot of regards that’s a good thing, but in a lot of regards it’s not.
What about return on investment?
The bottom line is that it does not matter what your ROI is. I don’t know that I’ve ever heard a doctor or practice manager talking about how much they’ll make because they have a practice management system. It’s a cost of doing business if you want to get paid.
HIMSS had a chance to talk to David Brailer for an hour before he left office and he said healthcare IT is a cost of doing business. I’d love to tell you it’s my quote, but it's not. The good news is that when people implement healthcare IT, they’ll find a return. Implementation decisions determine whether it’s good or not so good. But even if it’s a pure cost, it’s a cost of doing business and the right thing to do.
We went from $110,000 a year for transcription to zero that we could put toward a computer. We saved $140,000 on other things. It’s hard to see because you spend it a little at a time. It’s not about $2, it’s about $2 times 30 people times 10 doctors times five days a week. That’s the way it works.
Would you accept a records system that costs you $5 each time you pull a chart and $4 to each time you take a phone call? That’s the one you’re using today. It’s about inertia.
Skeptical doctors might say you just like working with computers, so naturally you like EMRs.
I’m a computer guy. I’m a geek. But the problem with that theory is that these guys do things every day that they’re not crazy about doing to take better care of their patients. I hated doing flexible sigmoidoscopies, but patients needed them and I did them.
Healthcare IT has been shown time and time again to be a very good way to reduce errors and to make patient care better. Whether they like it or not is irrelevant if they’re going to continue to practice. In a single digit number of years, there will be a government mandate to use EMRS and interoperability and all of those things to be a Medicare doctor. You can’t afford not to be a Medicare doctor.
Can you be a good doctor if you refuse to use computers?
I think you can, but you’ll never be as good as you could be if you used computers.
I used to think I was a great doctor until I started using electronic records and realized I wasn’t. Now I’m a great doctor because I do things I couldn’t do before.
Someone told me they immunize 100% of patients who are eligible for pneumonia vaccine. I said, no you don’t, you offer it to 100% of the people who come to your office. You don’t offer it to those who don’t come to your office, but who are still your patients. You can with a computer.
When Zelnorm got pulled off the market a couple of weeks ago, I saw a blurb about it on the Internet. I sent an e-mail to the office and had them start pulling records and sending notices. A lot of people wouldn’t have known that. With a computerized system, you can call those patients, tell them to stop taking Zelnorm, and come in to talk about an alternative.
Is our healthcare system too broken to fix with computers?
Absolutely not. I don’t think that at all. The people in the system have the best intentions. These are people who care deeply about their patients’ well being. The vast majority of doctors went into medicine for exactly the right reasons. Those who didn’t have been grossly disappointed. They want to practice the best medicine they can.
I’m afraid it will take a government mandate because they won’t let us continue at this rate, like the airline industry’s equivalent of a major crash every day. Two years ago, I only got to talk about why you should use an EMR. Now, I get asked how to do it, not why. That’s a huge difference.
Is there a stereotype that it’s older doctors who are reluctant to use computers?
It’s a stereotype, but it’s not accurate. Our system has five doctors. The youngest one said he didn’t go to school to ride a keyboard. We said, you can still use the transcription module, but we’re not paying for it. He left and went down the street to join another group. Now they have an EMR.
I’ve learned very definitely that you have to take a hard line with implementation and make it mandatory. If you do it, you’ll love it and never go back. If not, you can go back to what you’ve been doing, at least for now. You can’t have some people on and some people off in the long run. The same system won’t work.
Is electronic prescribing a slam dunk?
No. If you have an EMR, e-prescribing is a slam dunk because it’s just a mouse click. If you have paper records and have to go from the exam room, tell the patient you’re logging in trying to send information to their pharmacy, I don’t think so.
When you have an EMR, it’s seamless and wonderful. We’re on the verge of being able to get notification back that not only did the prescription reach the pharmacy, but that the patient actually picked it up. It happens all the time that patients don’t take what you prescribe and you can’t figure out why they’re not getting better.
What will be the intersection of electronic medical records and personal health records?
I’m not sure what format it will take. I know it won’t be a CD you carry around, and I hope it’s not a thumb drive you carry around. The only way a PHR is any good to anybody is if it’s a virtual PHR, accessible anywhere in the world on the Internet. If we do that and you can update it as the patient and note that the patient has made that change, or when I change medication, that will be incredibly useful.
We have an online portal, which is a patient’s PHR as it relates to our practice. It tracks labs, meds, vital signs, and date of visits. I have a family that goes to Park City, Utah every year for skiing and usually someone gets hurt. The patriarch of the family went to the ED for altitude sickness. He didn’t know one of his meds, so the only choice was to go 30 miles back to the hotel at 11 at night, except he told them that they could get on the Internet and find out.
If you have to carry anything, I don’t care what it is, and present it and have it updated, you won’t do it. You also won’t do it unless all the doctors are using healthcare IT. You aren’t going to go to somebody’s website and go look at a PHR.
The system will have to be something like Napster, where you can go to the network and tell them to give you what they’ve got. If I’m in the office seeing a patient, I can Google you, basically, and see what’s out there. Then, we don’t need rooms full of servers like some people in government think we need. It will be in my office and your office and the cardiologist’s office. If we don’t do it that way, it’s not going to be useful at all.
I can tell you what will pay for that. Take every office in the country and find out how much money we spend Monday mornings from 8:00 until noon under this scenario. You went to the ER this weekend and they told you to see me Monday morning. What meds did you get? I’ve got those right here. What about the blood count and X-ray? They said I have pneumonia. That’s not particularly helpful. I’ll just repeat the blood count and X-ray to see how it looks. Unnecessary radiation aside, that extra blood count and X-ray would pay for it.
I interviewed Robert Connely of Novo Innovations awhile back and I know you’ve worked with them. What have you learned about integration challenges and solutions and where do RHIOs fit in?
I learned it’s not as hard as we’re making it. Robert’s a genius. We’re trying to be sure that every little player gets a piece of something and it’s not that hard. The Napster analogy comes from Robert’s design. I’ll see you on the grid. It’s like playing Crazy 8s. The timely delivery of this information is what we need, Right now, we don’t have that.
Novo is innovative, there’s no question about it. Robert is doing huge things at a fraction of what other people do it for. Implementation is in minutes. If somebody goes to Northside, I’ve got everything I need Monday morning through Novo. It’s absolutely remarkable.
What about the idea of a Nationwide Health Information Network?
We’ve absolutely got to have it. I just hope it doesn’t get lost in the conglomerate of government and hope it doesn’t get bogged down with the idea that we have to have information stored in some new place. The information is already stored.
The ambulatory EMR vendor landscape is changing. How do you see vendors and products shaking out?
I think the consolidation that we’ve started to see will continue for awhile. There won’t be this huge number of EMR vendors in the end. The purchases will continue.
Honestly, it’s probably good for the entire movement. These systems are very robust, require a lot of support, and they’re very immature. They require a lot of growth. Even if you have a system, it doesn’t take long to realize that they can’t do everything. There’s not one that does everything you need it to do.
You’re a CCHIT commissioner. How would you assess ambulatory EMR certification?
I think it’s made a tremendous difference, but the best is yet to come. Certification does provide potential buyers with the peace of mind that the system they’re considering will do what‘s necessary.
You started a consulting business. What kind of work are you doing?
When I started doing speaking a couple of years ago, I realized there was a great opportunity to impact patients’ lives that way. Just purely from a business standpoint, it became evident last year that I needed to have separate tax ID and so forth. That’s not particularly interesting, but the truth.
It’s something that I thoroughly enjoy and it’s revitalized my career. Hopefully, I’m making a difference. I’m a family doctor, not a consultant. When I’m consulting with people, I’m a family doctor because that’s what I am.
I believe wholeheartedly that healthcare IT changes lives every day, which is why we went into medicine. It’s been a lot of fun. It hasn’t replaced income, but it has given me an opportunity to do more in the field than I would have been able to do without it.
Any final thoughts?
I’m having a ball. The reason is because I honestly believe I’m making a difference. If I’m not, I don’t want to know it, because I like thinking I am.
comments (6)
1. Anonymous left...
04/13/2007 4:58 am
Interesting interview. Other than government mandate, another approach
would be to get practice insurance rebates for usage of an EMR. Of course
the EMR should have certain patient safety rules or features embedded in
the software. This could be a way that insurance companies can offer
incentive, and with the complaint of practice insurance being so high, the
savings from insurance payment could pay for the new EMR.
2. PezMan left...
04/13/2007 8:57 am
Great interview! The transcription savings alone would be huge if
practices switch to pre-completed notes for those very routine cases or
even voice recognition software. Most practices spend over $100K a year in
transcription costs and most Ambulatory EMR solutions are on a monthly cost
basis with RHO offerings. Things are getting easier to do and with
certifications, peace of mind is greater for physicians to jump on board.
This guy would be an EXCELLENT speaker to have come and speak in your
organization to your physicians.
3. Ann Onymous left...
04/13/2007 2:49 pm
Nice article, but I wuuld like to know if Dr. Morrow has a PC in each exam
room or does he bring a notebook PC with him to each exam room? Does he use
a tablet? He said he replaced transcription costs. Does he use voice
recognition, or does the system he use build a narrative from the care that
he documents?
4. Anonymous left...
04/19/2007 10:02 am
I am a patient of Dr. Morrow's and I can answer the last post. The
practice does have a PC in each exam room and I have never seen Dr. Morrow
bring a TabletPC in the room although I am sure that is an option he could
use with a wireless network.
5. Anonymous left...
05/14/2007 7:06 pm
During the interview there was mention of a vendor named Novo. Does anyone
know anything about them other than what I can see on their website?
6. Jeffery pace left...
06/24/2007 4:21 pm
Dr. Morrow is without a doubt one of the best Doctors practicing today. If
you are looking for a personal Doctor who will listen to you and spend time
with you Dr.Morrow is your man.
