According to one view, investing too much too early in the raw power of network technology can divert resources from the delicate integration of information sources and other fine-tuning of data delivery.
"Unfortunately, the computer industry has created this mind-set of this technology race, that you always have to chase technology," says Andrew Rushmere, president of Aviant Information, a healthcare network design and implementation company.
"The only thing of real value a (healthcare) system has is its information," Rushmere says. "All these other things are secondary."
But some executives who have dived into the development of big-time electronic networks are pleased with how they're positioned to exploit technology productively.
"Technology investments are becoming the bricks and mortar of the 21st century," says David Selman, vice president and chief information officer of Toledo, Ohio-based ProMedica Health Systems. "We needed to make the investment in the building of our house."
ProMedica invested $3.5 million in a network infrastructure foundation based on the fastest and most expensive technology available, Selman says. "We are very agile now in beginning to add layers to the upper levels of our house"-and at lower incremental expense than if the network were built gradually and conservatively, he says.
For example, ProMedica is testing a project to add full-motion video transfer to the network, with no incremental effort to support it, he says. "The pure technology layer is in today's terms very similar to installing electricity and water in a building," he says, noting it costs more to go back and add infrastructure later.
Beyond the scope of the average telephone line, a whole range of options exists-at widely varying prices and speeds-for conveying messages electronically. At the top of the heap these days is a conveyance called asynchronous transfer mode, or ATM (not to be confused with the acronym for automated teller machines).
ATM also costs the most, and it's a big project that effectively delays the delivery of any benefit until it can be built, says Jim Klein, research director for healthcare technologies with the Wakefield, Mass., healthcare division of Gartner Group, an information technology research firm.
Klein recommends starting smaller and getting immediate results. "I have seen lots of cases where the real business problem is one of information integration that can be attacked by low-level solutions," he says.
"Everyone says ATM, but they have to recognize that ATM is still expensive and should be used where voice, video and imaging are all required," says Dan Vogel, program director for healthcare with Meta Group, a Stamford, Conn.-based information technology research firm.
But the ability to send multiple types of information over the same transmission line is what makes ATM so appropriate, says Patrick Carney, vice president for information services at Staten Island University Hospital in New York. "I don't know how you're going to separate voice, video and data," Carney says. The alternative, he says, is to run dual networks.
Consultant Mike Gorsage says many clients still have separate networks for voice, video, imaging or data transmission, but they're moving to multiple-use, all-in-one networks.
That strategy has the benefit of bringing information in its multiple forms and software applications to a practitioner or manager over the same line to the same computer, says Gorsage, senior manager in the Atlanta office of First Consulting Group.
"While it is expensive, it's cheaper than doing it four or five separate times," he says. Besides, "the cost of technology . . . is declining while the reliability and value are going up."
CIOs who have implemented such capabilities enjoy the latitude they now have to add clinical services and respond to opportunities for still higher performance.
"Infrastructure is becoming an enabler for new business," Carney says. For example, the Staten Island system is planning a radiology facility off campus to handle an expanding reach into other boroughs of New York. "For the first time, I can put a radiology clinic somewhere else in the community and not have to locate it at the hospital," he says.
The cost-benefit analysis of sending radiology images electronically takes up several pages of spreadsheets, he adds, but the healthcare system sees lower costs in addition to better access to images for clinicians. The savings in film alone will total $1 million a year, Carney says.
The network connections also allowed Staten Island to give 130 physicians in a dispersed practice an electronic link to a central billing office last summer as part of the healthcare system's rollout of a physician practice management information system.
The practice, called University Physicians Group, is closely affili-ated with Staten Island, and its physicians hail from about 35 remote sites. The healthcare system is preparing to deliver the office automation features of the practice information system to those sites soon, Carney says.
At ProMedica, Selman says that with the deregulation of telecommunications, he's considering a partnership with a local cable television operator to send transmissions over cable lines-at a 10-fold increase in speed and volume compared with the leading-edge performance of the current network. That's something he could not do without ATM technology as the feed-in, he says.
The cable company has launched a $120 million project to build a Toledo-area network that will make it a competitor of Ameritech in the voice and data transmission business. The network employs a technology called SONET that's faster and more flexible than ATM, says Jerry Jaiven, ProMedica's director of network services.
Connecting to that network eventually will enable ProMedica to use emerging cable modem technology to get images to remote physician offices or even their homes, Jaiven says.
For now, the health system has acquired an ability to get scanned images of charts between its two main campuses situated eight miles apart. Fully 64% of physicians on staff at ProMedica go back and forth, Selman says.
In addition, a physician practice building is now on the ATM backbone, allowing independent specialists in their offices to complete records electronically-saving time and improving their practice.
"We are focused on clinical integration, because that is where we feel the highest benefit can be achieved," he says.