For the CIO of Partners Healthcare, fixing recurrent slowdowns and outages to the electronic medical records system was a major test of leadership

All systems go down at some point.

So John Glaser, CIO of Partners Healthcare System Inc., wasn't particularly worried when the electronic medical record (EMR) system used by more than 6,000 doctors and nurses affiliated with Partners started experiencing brief outages in late July. After all, since the start of 2004 the EMR system had experienced anywhere from two to six short disruptions a month -- slowdowns or outages lasting from a couple of minutes to several hours. Inconvenient, yes, but not the end of the world. There was no reason to suggest that this was any different.

But the disruptions got worse -- the outages occurring with greater frequency. The automated alerts Glaser receives when his systems are strained poured in. Doctors called and e-mailed with complaints. Partners administrators let him know that a lot of people were irritated. In every crisis there is a point at which the notion that this is just a bad week gives way to the recognition that you are treading on thin ice.

By early August, Glaser says, "we realized we were in trouble."

Between then and mid-September, Partners' EMR system slowed or shut down 25 times, often for hours at a time. Each disruption affected every doctor on the system; they could not gain access to their patients' medical records, and at times clinics were forced to turn patients away untreated. The IS department faced heat on all sides -- from the doctors whose work was disrupted and from Partners' administration who feared a medical mutiny over the EMR system.

"When we moved from being a single-sourced company to a multivendor model, it became clear we needed an expert who knew all the vendors, was out in the marketplace all the time, and was well-versed in contracts and negotiations," Ascenzo says. "The result is that the prices we are getting are always competitive, and the quality of the work has improved."

Dr. Mark Eisenberg, a doctor at Partners' Charlestown Healthcare Center, couldn't access his patients' medical records for 45 minutes during one of these slowdowns. "It is a real problem if we have no record to look at when we see a patient," Eisenberg says. "There are real concerns about care if you can't see lab results or what medications someone is taking."

Partners is Boston's largest hospital group. The organization includes two of the city's major academic hospitals -- Massachusetts General (MGH) and Brigham and Women's -- as well as smaller community hospitals, clinics and even individual doctors' offices. The two hospitals have been among the earliest adopters of medical information systems. Some of their doctors have been using the electronic medical records for 15 years, and the overall adoption rate is about 70 percent within Massachusetts General and Brigham and Women's hospitals. The rest of the community lags far behind, however. Excluding the large hospitals, the adoption rate for the rest of the Partners network is only 10 percent. One of Partners' top goals over the past two years has been to bring on board these users, a group of approximately 2,000, who are mostly physicians in private practices affiliated with one or more of the hospitals in the Partners system.

EMR systems provide many benefits. In addition to cutting claims and billing costs, they improve patient care by significantly reducing medication or lab test errors that result from sloppy physician handwriting. Such systems also check for drug allergies and adverse interactions with existing prescriptions, and they can advise physicians on what test or procedure is most appropriate.

Even so, they're a hard sell. Many physician practices have only a handful of doctors -- some only one or two -- and they don't always see the financial point of investing in the EMR system. Between networking costs, converting paper records to electronic records, linking or replacing existing office systems and some lost productivity while everyone learns how to use it, installing the system costs somewhere between $US5,000 and $US10,000, according to Glaser. That's a lot of money for a small office, and while EMRs will eventually boost productivity, even Glaser admits that there isn't an ROI. "In our best case it is right on the edge of break even," he says. "Our hope is that the vision is enough to push it over the edge."

But every time something goes wrong with the system, that vision of the future moves farther away and Glaser's job gets harder. The CIO is the first to acknowledge that solving the mystery behind the recurring EMR system slowdowns and restoring the faith of doctors and administrators was a major test of leadership for him. "If (a problem) goes on too long, it erodes the trust that your community has in you," Glaser says.