The Information Revolution: Are You Ready?
Wednesday, Aug. 10, 8-9: 30 a.m.
There are two information revolutions under way in healthcare delivery.
And hospital leaders are advised to learn their survival roles in each, according to two university hospital executives paired to point the way at the American Hospital Association's annual meeting in Dallas.
The first revolution is in response to the movement to managed care and its emphasis on payment by the enrollee instead of by the procedure.
That movement puts a premium on timely, accurate and immediately available data, and makes it "apparent that information and computer technology is increasingly the coin of success," said Don E. Detmer, M.D., vice president of health sciences at the University of Virginia in Charlottesville.
The second revolution is an explosion of both raw capacity and refined capability that computer software and hardware makers have brought to healthcare information technology.
The advances in technology are finally making transactions fast enough and reliable enough to fulfill the longstanding promise of an on-line, computerized patient record that doubles as a clinical tool easily used by physicians and nurses, said Edward Schwartz, chief executive officer of 301-bed University of Nebraska Medical Center in Omaha.
The improvements in computing speed amount to the difference between a two-second wait and a retrieval "faster than the blink of an eye," Mr. Schwartz said. "That's relevant when you're trying to get the surgeon and the internist to use the computer. They don't want to wait."
The improvements in reliability bring within financial reach the capability to "back up" information processing and storage so the system never goes down, he said.
Also being perfected are technical components that allow thousands of transactions to be processed at the same time and make it possible to manage hundreds of information inquiries simultaneously, he said. And "the capacity for machines to remember" is improving to the point that the entire patient record can be computerized without pressure to purge older data.
For healthcare executives, an immediate challenge is to plan for the effective operation of integrated delivery networks. That effort must include a means of moving a patient's record among the sites of a network and also transferring new information back and forth instantaneously, Mr. Schwartz said. "You can't be driving the record all over town in minivans."
But there's more to the revolution than hardware and software challenges, said Dr. Detmer. The shift to computerized communication also will challenge an executive's ability to manage resulting changes in behavior of employees and patients, he said.
Communication by computer screen can greatly improve efficiency but also remove a dimension of human give-and-take, an opportunity for inflection and elaboration that adds to the message. Managers already are dealing with the shortcomings of computer communication as they pierce the work culture with electronic mail.
E-mail behavior is different from voice mail or meeting behavior, Dr. Detmer said. "There's something about the technology that seems extremely personal and private, and disarming to the user," he said. While it ends the frustration of "phone tag" and increases opportunities for communication, it has a bluntness on the screen that can offend, and it discourages conversation that can iron out possible misinterpretation on the spot.
Lessons learned about E-mail etiquette should be taken into the developing computerized healthcare work place along with the technical issues, Dr. Detmer said. "Obviously, organizations are made up of individuals who bring their emotions as well as intellect to the table," he said. "I don't think we've quite thought through it."