It's tough enough to visualize and decide on the scope of a community health information network, especially in an eight-county metropolitan expanse with 100 hospitals and a raft of other sites.
The next step-evaluating and choosing the CHIN's developer-is a potential nightmare of endless vendor presentations, dizzying technology claims and fractious jockeying for an "in" with decisionmakers.
But the Metropolitan Chicago Healthcare Council got around all that through a bidding process that put the onus on vendors to study the CHIN's requirements, evaluate one another, form partnerships and come to the council's CHIN steering committee ready to prove they could deliver the goods.
The strategy on vendor selection is one of a number of structural and technical issues hashed out during the initial stages of a pioneering attempt to connect hospitals, physicians and other healthcare interests to a commonly held, not-for-profit computer network.
Supported thus far by 77 hospitals and the state's medical society, the initiative expects to reach the one-year mark in November with the project defined and the developers on board, said William Lewis, the metropolitan council's senior vice president.
That year's worth of planning offers some of the first practical lessons for would-be developers of comprehensive CHINs, which seek to distribute all the clinical and business information needed to end duplication and fill data gaps among providers, employers, insurers and public health agencies in a region.
Taming the contestants. It's a task that dozens of information-system vendors and advanced technology companies are positioning themselves for. "When we first got started with this, we were contacted by half the Western world," Mr. Lewis said.
But once the scope of the Chicago CHIN was decided, through a series of information blitzes and focus groups (May 9, p. 56), "we realized that no one (company) could do it all," he said. And that meant hiring a range of contractors, each specializing in a piece of the puzzle or in fitting the puzzle together.
But rather than handpick each player, the council decided to "let the market decide the dynamics" by putting the task in the hands of a prime contractor, Mr. Lewis said. "We are not a system integrator. We would rather defer to someone who does that for a living and have them choose their partners."
As a result, potential developers coalesced into competing partnerships addressing the hardware, software, data management, system integration and telecommunications capabilities necessary to cover all the bases (See chart).
Late last month, the CHIN steering committee selected three finalists, represented by prime contractors Shared Medical Systems, Ameritech and Health Communications Services (Aug. 29, p. 12). But about 20 of the 40 companies that showed up for a July 13 bidders meeting are still in the running, positioned as subcontractors in the coalitions, Mr. Lewis said.
After presentations to the council membership in mid-September, the finalists will be subject to reference checks, site visits and analysis of the cost information in their proposals.
A fine-tuned estimate of the system's cost won't come until a detailed business plan is completed at year-end. A prime contractor is expected to be chosen in mid-October and will work with the council to establish the business plan and its cost, Mr. Lewis said.
A business plan will be necessary to establish everything from financial feasibility to legal relationships among users to the method of charging for the system's use, he said.
Defining ownership. The venture will be owned equally by the hospital council-which itself is owned by its hospital membership-and the Illinois State Medical Society.
Ownership and governance issues took longer than expected, and that may have been partly because of a lack of understanding among chief information officers about the hospital council's role, Mr. Lewis said. The council had dealt mainly with chief executive officers at its member hospitals over the years, but CIOs were the key executives involved in the CHIN's planning.