When providers charged for care and payers covered the bill, it made sense for computers to assemble charges for payment quickly and efficiently.
Computer systems mirrored those business needs when hospitals first started using financial and patient-accounting information systems in the 1970s. As hospital laboratories, pharmacies and radiology departments matured into revenue centers, they, too, became targets of computerization to better capture charges and the medical basis for them.
But starting in the 1980s, the whole premise of a charge-based business changed-and healthcare computerization has struggled to keep up with the changes ever since. First Medicare switched to fixed fees based on primary diagnoses instead of reimbursing charges. Private insurers negotiated their own fixed prices for treatments and procedures, reducing most charge-based information systems to irrelevance and forcing retrofitting to reflect myriad models of payment. The limits on payment also forced providers to manage their care-delivery costs, but the only clinical information available to managers was the rudimentary set of billing codes for medical treatments and procedures.
Information system vendors devised upgrades in billing systems to reflect contracting complexity and to exploit more efficient technology. And a new class of clinical information systems, offering far more management potential than earlier systems, began to attract attention and sales in the new millennium.