Clinical IS on a budget - Digital Perspectives - health care industry and information systems

Healthcare Financial Management, Sept, 2002 by Christine Malcolm, Eric Bartholet

Instead of spending tens to hundreds of millions of dollars on new information systems (IS), many cash-strapped healthcare providers are finding that integrating new applications with existing systems can meet their clinical data access and management needs. Using enterprise application integration (EAI) technologies, software systems designed to simplify the integration of application data and services, along with Internet tools, providers can build clinical portals to provide clinical staff with access to large collections of data on-line, such as laboratory results, dictation, and drug lists.

Changing Needs

Since the early 1970s, healthcare organizations have purchased software applications to manage patient information and accounts and provide support for clinical ancillary departments. The role of the IS department primarily has been to assist in the selection of the software, manage the implementation of the applications, and maintain the systems. However, with the advance of Internet technologies, the role and focus of the IS department is changing. With these new technologies, IS departments can design and build new applications that take advantage of information from multiple information sources across their organization. These new applications can be implemented quickly and cost-effectively As a result, at many organizations CFOs increasingly are relying on IS staffs to evaluate the efficiency of current systems and determine the most effective way to meet growing information demands.

In a Computer Sciences Corporation survey, 62.4 percent of senior healthcare IT executives listed systems optimization as a top issue facing the industry. (a) Other key concerns included organizing and utilizing data, instituting cross-functional information systems, and implementing business transformation initiatives-- all values related directly to driving additional value from existing information systems.

Reasons that organizations increasingly are seeking to improve system optimization are many In an era in which cash is scarce and Federal funding continues to decline, organizations that are under pressure to do more with less may choose to extend the usefulness of existing applications to delay costly upgrades or replacement strategies. Also, investing in costly new systems poses great risk. Many senior executives have observed that previous large-scale technology projects often have alienated physicians, and they are concerned about additional failures.

Staving Off System Replacement

Three approaches can help providers stave off system replacement.

Purchase add-ons that increase the functionality of existing systems and expand current capabilities. Information access is key. Physicians often are frustrated by their inability to retrieve important and timely clinical results. Although this information resides within most organizations existing systems, providers have found it difficult to access.

Most software application vendors provide integrated solutions for access to clinical information, including Web-browser capabilities and support for wireless devices. These advances offer flexibility when designing an IS strategy appropriate for a given organization. Some vendors also have developed sophisticated order-entry capabilities and provide solutions that help clinicians through the clinical decision-making process.

Purchasing add-ons does have some drawbacks, however. Working with existing technology can limit customization. Customization is important because the most effective way to maximize adoption of any new clinical system is to enlist physicians' help in designing systems to meet their specific needs.

Another drawback is that working with existing systems creates long-term reliance on a specific vendor. The ability to change systems vendors over time can allow organizations to take advantage of new advancements in technology and maintain negotiation leverage. Once an organization commits to a single vendor for its clinical IS strategy, change becomes increasingly difficult and costly.

Purchase a new set of solutions from a clinical IS vendor and integrate it with existing systems. A small number of vendors specialize in clinical IS. Typically these vendors have developed enterprisewide IS applications from either ambulatory or ancillary clinical systems. Often they offer sophisticated clinical decision support functionality and highly flexible, user-friendly tools that allow physicians to tailor their programs to meet specific needs. The IS department also can build and deploy customized rules that help support best practices throughout the organization.

Unfortunately, as technologies increase in sophistication, they also increase in complexity and cost. Thus, the new enterprisewide IS applications typically are very expensive and require significant investments of time and leadership to implement and maintain. Moreover, this approach creates significant project risk because implementation is lengthy and early adopters have experienced varied success. Organizations implementing these solutions typically are characterized as market leaders that have both the necessary financial and organizational resources to support implementation, a clinical culture interested in the use of advanced technologies, and a business strategy to be a leader in the deployment of advanced clinical solutions.