A Boston-area healthcare system is anticipating more than the usual benefits of replicating the innovative computer system of one of its hospitals at other facilities in the network.
Poised to reap the practical insights from that process is a small Florida company that wants to exploit the technology commercially.
The delicate procedure is the first attempt to transplant a sophisticated clinical information system outside the environment of Brigham and Women's Hospital, where it was born and bred specifically for that provider's needs.
Beginning later this summer, Partners HealthCare System plans to regenerate that system at other sites in the regional network, including Massachusetts General Hospital and Dana-Farber Cancer Institute, said John Glaser, the network's vice president and chief information officer.
Assisting in the operation will be Integrated Healthcare Solutions, a Delray Beach, Fla.-based company composed of information technology specialists anxious to profit from the lessons learned.
Brigham had thought on and off throughout the 1990s about commercializing the system and had fielded business inquiries before, said Glaser, who was the hospital's CIO before it affiliated with Massachusetts General in 1994 to form Partners.
The difference this time around was twofold, Glaser said.
For one, he said he was impressed with the reputation of IHS President Harvey Wilson as an innovator. Wilson, a co-founder of Shared Medical Systems in 1969, is getting back into healthcare after a 12-year absence.
And for the first time, Glaser is faced with moving portions of the in-house system into multiple settings. That requires additional technical talent and a different implementation challenge.
In effect, IHS will serve as the implementation force to expand the information system throughout the Partners network, Glaser said. In return, IHS specialists will be able to put their implementation experience to use in adapting the clinical system for the general market, he said.
IHS marketers will have Brigham's cutting-edge cachet to help them promote what's become a decorated example of healthcare computerization in technical circles. The latest praise was collected in May at the Computer-based Patient Record Symposium in Washington, and the system also was singled out for awards within the past two years by the Smithsonian Institute and by CIO Magazine.
Development of Brigham's in-house clinical information system began soon after Glaser joined the hospital as its top information executive in 1988.
Seven years later, a staff of about 30 programmers has produced nearly 90 software applications.
An additional 14 technical staffers were needed in 1993 during the peak implementation period of the system's centerpiece, an order entry procedure designed for physicians.
Other major components of the system take the entered information and compare it with existing medical knowledge and patient history stored within. This helps provide possible ways to modify the current direction of care to prevent errors and adverse events, reduce the cost of treatment and adhere to accepted standards such as critical paths.
At a time when the hospital industry was just waking up to the potential of putting patient data and medical reminders in front of caregivers, Brigham was producing thousands of computer interactions a day and documenting operational savings (Oct. 10, 1994, p. 40).
The hospital said it's saving at least
$5 million a year in better productivity, increased accuracy of orders, prevention of medical errors and reduction in the cost of some care processes.
The cumulative investment in software development, composed largely of salaries, stands at between $20 million and $25 million, Glaser said.
That figure doesn't include the cost of more than 6,000 computer workstations, of which about 15% are in ambulatory areas, physician clinics and other locations outside the Brigham complex, he said.
The expense of expanding the system to other facilities still is being analyzed. As of now, the Dana-Farber operation is expected to receive virtually the complete package developed so far, while Massachusetts General's implementation will be more selective.
For example, some superior components of the Massachusetts General laboratory clinical system will be merged with Brigham's to form a third version combining the best of both, Glaser said.
A Massachusetts General practice-management system developed by IDX Systems Corp. and a cost-accounting system developed by Transition Systems also will be retained and eventually expanded to Brigham, he added.
Transition Systems is another example of a commercial enterprise spun out of computer innovation at a Boston-based academic medical center.
New England Medical Center launched Transition Systems in 1985 to market cost-accounting and decision-support software, eventually gaining 700 customers. The medical center sold its interest earlier this year to a venture capital firm, netting $88.6 million (Jan. 29, p. 22).
That transaction came under fire when the software company disclosed that Jerome Grossman, M.D., former chairman and chief executive officer of the medical center, stood to make $10 million from an 8% ownership stake purchased for $8,000 when the company was founded.
Glaser said Partners has a minority share of IHS, but no individual has a stake in the venture. Asked if the Transition Systems incident provided any lessons, he said, "I think that certainly was not lost on anyone."
Wilson declined to disclose terms of the agreement with Partners.