University of Iowa links rural providers - Cover Story

Health Management Technology, August, 1994 by Carolyn Dunbar

Wagner started in 1971 as a computer operator during his graduate school days at the University of Iowa. Now he heads an Information Systems department of 113 people, manages a complex system that handles 1.7 million transactions every day and shepherds an annual I/S budget of $7.5 million.

He's now preparing for the roll out of a newly won $7.3 million contract from the National Library of Medicine that, among other things, is set to establish UIHC as one of the nation's premiere "laboratories" for the study of rural telemedicine via a statewide fiberoptic communication network.

Wagner's I/S department is organized well enough to now devote 70 percent of its time to developing new applications, with only 30 percent of its time required to service current implementations. He also says he has excellent support from both staff and top management. In fact, Wagner says the UIHC has stable leadership who share a vision for what technology can do within the healthcare delivery process.

"I'm seeing here at the UIHC now in that even when we're making cutbacks in other departmental areas throughout the hospital, top administration is recognizing that the best investment of their limited resources is in the information systems area. And so we're seeing additional staff being allocated to us in times when other departmental areas are facing some cutbacks," says Wagner.

Evidently, Jim Wagner has a few reasons to smile.

Wagner has both mastered and guided the almost exclusively homegrown INFORMM system that has expanded to more than 2,000 terminals hanging off an IBM 3090-500J mainframe. The system now boasts 2,000 unique application functions. "INFORMM" is an acronym for Information Network for Online Retrieval and Medical Management, according to Wagner.

Although he virtually grew up with the system--he has worked at UIHC for 23 years, 11 of them as I/S director--Wagner still faces enormous management challenges.

"I say that serving as a health-care CIO in today's environment is a little like the task in that 'I Love Lucy' segment," Wagner explains. "Remember where she's trying to box up the pies as they roll off the assembly line? It seems to me that if everything goes perfectly, then it's theoretically possible to do the job. But as new demands, such as healthcare reform and technological advances, come at you so fast, if you have even one little misstep, then you can quickly have a major disaster on your hands."

Wringing every last drop

The University of Iowa Hospitals and Clinics is a comprehensive tertiary healthcare center and teaching institution with 891 beds, 234 specialty clinics, 597 staff physicians, 681 residents and fellow physicians, 1,562 professional nurses, 1,504 other professional staff and 3,244 other supporting staff. Nearly six million laboratory procedures and more than 200,000 radiographic examinations are performed at UIHC each year. In 1993, UIHC physicians treated more than 466,000 ambulatory clinic patients.

Such a large, complex healthcare organization has a large and complex information system to match. In fact, as director of UIHC's Information Systems department, Jim Wagner is known among some of his peers for his ability to wring the ultimate capability out of his mainframe shop of thousands of homegrown application functions. He's particularly proud that they all have a singlesystem feel to them.

His INFORMM system applications are set up in four separate divisions: administrative, clinical, financial and technical. The idea is to collect information about patients when they first encounter the hospital. That information is stored in a central database repository and shared with authorized users via the fiber-optic net.

The INFORMM system is so well entrenched that Wagner and his I/S staff have been able to implement refinements that assess performance, incentivize productivity and encourage user feedback. Wagner says his goal is for staffers to want to use the system.

During the past year, he has developed what he calls a "Hospital Information System Performance Score Card," which he has modeled after the graphically colorful USA Today weather map. It's a layered, colored presentation posting the various components of his system operations--for example, subsecond response time, promptness in producing reports, tracking the availability of the training network and development network--and monitoring those against what the department has set as acceptable performance levels. Acceptable levels appear as green. Any deviations are red. Productivity and compliance can be taken in at a glance.

These Performance Score Cards are posted in several strategic areas throughout the hospital to let everyone know that the I/S department is going to adhere to certain standards of quality in terms of the services it provides. "And we're going to be accountable for those," Wagner says.

Although Wagner does not characterize hospitals in general as leaders in quality improvement, he says he has a strong personal commitment to that area in terms of information systems. Wagner's team has reached out to its vast user community with what amounts to an electronic suggestion box, called "INFORMM US." It's an online function ready to accept user notes and comments. The notes flow to an electronic mailbox checked daily by one of Wagner's project assistants.