A year ago, the idea of a "seamless" healthcare delivery network was considered unlikely to catch on anytime soon, although everyone agreed it was needed.
Within months, aided by a burst of market reaction to President Clinton's embrace of managed competition, the goal of integrating services cradle to grave became a given.
Look for 1994 to be the year that information systems integration takes on the urgency network-building assumed in 1993. One issue follows the other: Mush-rooming networks are integrated in name only unless they develop the information sharing and coordination that makes such diverse organizations work in unison.
Responding to the urgency will require CEOs to quickly evaluate their installed base of computerization and then build a strategy for information systems development in concert with an overall business strategy. That will make computerization one of the few boom areas in healthcare spending, likely eclipsing the 40% increase by 1996 that was forecast before Mr. Clinton's September healthcare speech.
Purchasing decisions will depend not only on what a provider has and doesn't have, but also on where a hospital or group of hospitals plans to be in a year or two. For example, a sophisticated, centralized data base may be a wasted purchase for a smaller network if it contemplates merging with a larger network that's developing its own nerve center.
Besides integrating within a network, healthcare organizations will be designing or retrofitting their technology to communicate the network's sum and substance to outside interests such as employers and the government. The momentum behind establishing regional electronic information networks to carry clinical and payment data is expected to accelerate in 1994, prodded by payer pressures to compare performance.
Data collection efforts will get a touch of sanity, though, as the healthcare industry begins to resist multiple mandates for all manner of data from payers and government. Providers are questioning the expense of collecting information vs. the value of what's collected. Outside interests are beginning to appreciate the costs of requiring laundry lists of information, much of which still must be abstracted from individual charts.
The tide already is turning. The issue of cost vs. benefit is making headway in Florida as government officials outline how they'll make hospitals accountable for care under the state's new managed-competition framework.
New information systems promise to capture much more information as a byproduct of care documented by caregivers, not by tracking down data later. But decisionmakers dazzled by such potential will begin to realize human considerations greatly affect that potential.
The success of comprehensive information-transfer networks will depend on their acceptance by clinicians. That's a big change from relying on data-entry workers and skilled technicians, the traditional users, whose jobs revolve around the computer.
Physicians and nurses will be called upon to enter orders, call up reports and arrange for care in coordinated fashion. But those functions are a small part of their overall job, which is patient care. And if they can't tap into a terminal easily, hardware and software investments may be squandered.
So-called "graphical user interfaces," the pictures and menus made popular by Apple Macintosh and Microsoft Windows, are making the computer screen look friendly to their intended clinical clientele. And they're being combined with touch screens, light pens and bar codes for authorized but unintimidating access by clinicians.
"Healthcare leaders must work with the information and management systems profession to identify innovative, substantive, cost-effective solutions to improving the delivery system. That will mean challenging long-held views of how healthcare operates. Once that's understood, the widespread implementation of communications technology will be prudent and help provide long-promised returns of improved quality and access at lower cost."
-John A. Page,
Healthcare Information and
Management Systems Society,
"Those of us who have experienced the challenge of leading information systems were always certain of one dimension-change. Regardless of the final outcome of healthcare reform, the dimension of change is more certain as our business changes. The foreseeable future shows more concentration on integration of networks and electronic data interchange to various constituencies."
-Albert A. Sinisi Jr.,
system vice president,
Henry Ford Health System,
"Information is a healthcare provider's most important asset. Reform will require providers to change the way information is collected and used. The movement of patients and their information across state lines and the emergence of automated data banks and networks creates a compelling need for federal legislation to protect confidentiality."
-Kathleen A. Frawley,
director, Washington office
American Health Information