Despite a strong perception that information technology must improve to prepare for healthcare reform, respondents to the fourth MODERN HEALTHCARE/Coopers & Lybrand/Zinn Enterprises survey say change begins at home, not at some distant vendor's door.
They acknowledge that when information systems don't measure up, it's partly because the organization doesn't get the most out of a system's capabilities, not just because technology falls short.
But the capability of existing information systems is the rest of the problem, once technology is taken as far as it will go.
Asked about barriers preventing use of patient-care and clinical systems, nearly 50% of survey respondents cited inadequate training. That ranked highest among all impediments, ahead of such technical problems as inability to tie information together or poor design of screen functions and instructions.
The lesson learned from those negative results is that it takes internal commitment to get the most from information systems, said Tim Zinn, president of Zinn Enterprises.
Strong user commitment was the reason most often cited for achieving benefits from information systems, and strong commitment from chief executive officers wasn't far behind (See chart, this page). By comparison, such positives as aggressive data-processing commitment and outside assistance were considered less critical.
Another indication that systems aren't being used effectively is reflected in the amount of routine clinical information that respondents said they are getting from current computerization, said Mr. Zinn. Nearly 65% reported their current patient-care system supplies less than a quarter of the required routine clinical information.
Nearly 90% now use computers to review test results, and just over half use information systems to get detailed clinical data. But only a third of respondents use computers to evaluate or determine care plans, and only 15% compare clinical care against practice norms.
Hospitals may be getting less than they should out of their existing computer base, but that shortcoming also shows that today's computerization can't handle some of the fundamental storage and connectivity needed for an age of clinical accountability, said Frank Cavanaugh, a healthcare consultant with Coopers & Lybrand.
Most current systems "were created for a different purpose from which we intend to use them now," he said. Those missions revolved around administrative and billing functions, not clinical tracking are porting.
Most clinical information that's now gathered covers only what's billed, not every procedure performed. The inability to capture all medical actions makes even simple cost accounting difficult. But healthcare is trying to go several steps beyond that, accounting for care not just in the hospital but in multiple settings-beyond the assumptions of most current hospital software, Mr. Cavanaugh said.
In addition, storage capabilities of clinical systems were designed around patient stays, which have a beginning and an end, and with it an assumption that data could be purged at a given date after discharge, he said. Emerging healthcare networks not only have to keep data after discharge for an ongoing patient record, but their existing systems must accept and process data that doesn't originate in the hospital.
Hospitals will need to assess how their clinical feeder systems accept data from outside the inpatient track and what their storage capabilities are, Mr. Cavanaugh said.
The convergence of connection and storage problems with existing systems is part of what's driving development of clinical repositories.
Besides operating as a hub to integrate disparate systems' operating languages, these repositories can take the burden off feeder systems that need to operate on discharge dates, he said. A repository is a duplicate source of storage that can receive data from clinical systems and keep the information long after it's been purged from the source system, Mr. Cavanaugh said.