Here's the central problem with committing to go out and buy a clinical information system: There really is no such thing, at least in the traditional sense of purchasing IT computer applications.
As many experts will attest, a clinical information system is not a discrete software product to be sought, bought and installed, but rather a broad range of computerized capabilities to be brought together over an extended period of time. "It's a system of systems," says Mac McClurkan, the top information executive at Bronson Healthcare Group in Kalamazoo, Mich.
Just for starters, the range of systems necessary to capture all data in a healthcare organization will be a considerable challenge. Some elements are basic and essential, others not immediately necessary but important further down the line. Some systems, such as those for registration, radiology management or pharmacy operations, probably are already in operation-although some of them are probably too old or obsolete to make it in the clinical big leagues. Other key systems will have to be added at significant expense, time, trouble and probably trauma.
All of this preparation is useless to the cause without the speed, reliability and ready accessibility necessary to serve doctors, nurses and other clinical users. It could mean doubling or tripling the size and strength of whatever existing database is on duty. For the new clinical operation, providers might even need two separate databases. Maybe three.
And a clinical infrastructure won't be accomplished in one grand initiative. There's a logical, phased sequence of projects, and the particular sequence will depend in part on the priorities set ahead of time.
But back to the beginning: Managers can't establish those priorities and chart a sequence without gathering a full spectrum of leadership and gaining consensus. "This is not a journey to be undertaken lightly," says consultant Marion Ball. "If there isn't full support from everyone from the board of directors on down to the janitor, it's not going to be successful."
The planning, prioritizing and feedback will have to be comprehensive both initially and for subsequent initiatives, adhering to a well-established scenario for agreement among disparate clinical interests. Clinical computerization isn't a project to be done once and just maintained but a series of project additions, revisions and subtractions as new technology emerges and provider needs change, says consultant Michael Kreitzer. "It's a process of (IT system) selection that will never, ever end."
Once on that road, realize that the selection process is only the beginning of the expense that goes with clinical computing. Implementation expenses can be double the purchase price, and the new and sophisticated IT operations taken on as part of the bargain will add permanent new costs to the healthcare organization.
This special report on clinical IT adoption issues is being published in two parts. This week's installment explores a logical progression of projects to build a clinical foundation. It also looks at educating the physician community on IT. Next week Modern Healthcare examines in more technical detail the various components of an IT structure and the obstacles to success in creating an accessible and acceptable IT network.