Sometimes the best strategy for extracting value from information systems is to stop trying.
That's what happened at CareGroup Healthcare System, a Boston system of six hospitals and dozens of physician practices that brought 146 computer applications into the asset mix.
It was too much for John Halamka, M.D., who was hired in December 1998 as chief medical information officer. "If you asked me what kind of clinical system they had, I would say, `Yes,' " he deadpanned.
To feed its information-hungry care processes, the organization already had spent $10 million to integrate and reorganize the scores of applications so they could support clinicians in their work. Halamka says the idea was expensive, time-consuming and beside the point.
Serving the current care process was more important than making the existing technology work, he says.
And though the "melange of best-of-breed systems" could deftly execute special tasks for one clinical discipline or another, Halamka says it was more important to integrate information across the network than to preserve top-line niche applications for all.
CareGroup's original plan called for spending $30 million during three years to achieve the level of integration it wanted, but Halamka canceled the project after the first year. "It becomes an endless construction project."
Instead of trying to mesh the different systems at the once independent facilities, CareGroup plowed the budgeted funds into standardizing information systems serving the same purposes at each facility. Between that and "massive retirements" of small niche systems, the organization slimmed down to a mere 15 applications.
Then it launched an ambitious effort to tie the applications together and open wide avenues of data exchange with its thousands of clinicians using Internet technology.
That same Internet-based infrastructure enabled CareGroup to begin injecting key managed-care considerations into clinical decisions--information on a patient's insurance coverage and eligibility for treatment that helped doctors manage financial risk.
Those investments in new computerization were the result of studying the most important needs for technology rather than optimizing the technology CareGroup had to work with, says Halamka.
A "process map" delved into the inpatient and outpatient roles of physicians, nurses, clerks and administrators and the ways in which they all interacted with patients.
Early in 1998, CareGroup launched a reorganization of doctors and hospitals into accountable groups capable of better managing medical care and handling financial risk (Feb. 23, 1998, p. 42). Timely and comprehensive information exchange was crucial to successful management.
The managed-care business process was especially important to support, because about 45% of CareGroup's revenue was in the form of capitated payments, he says.
Besides focusing on contractual authorizations and limitations, the process mapping helped identify the most important clinical information needed by the accountable groups to improve their quality and efficiency.
That information now is extracted from information systems using Internet retrieval techniques and compiled into about 100 reports that establish benchmarks and foster changes in physician behavior. The leader of each accountable group disseminates the information to prompt discussion on how to improve, Halamka says.
In another Internet-based deployment, CareGroup developed its own two-way communication system between caregivers and patients. Through secure Web pages, patients are able to review medications, arrange for referrals to specialists, receive appointment reminders, access their medical records and exchange messages with physicians or their delegated office staff.
The Web pages, started in April, attract 2,200 hits per day, Halamka says. Total exchanges between doctors' offices and patients as of July had reached 12,000.
Benefits of the new plan include capital and operational savings, Halamka says. The capital budget for 2001 is $5.5 million, compared with $30 million in 1999. Now that the systems have been reduced and standardized, the information systems department is down to 160 full-time-equivalent workers from 283 two years ago.