It's ultimately about putting patients first, fixing things that stand in the way of improving patient care, and making it easier for clinicians to execute their responsibilities-not about how many computer functions can be crammed into a software application or whether one information technology product has a feature that a competitor's doesn't.
That's the message communicated by healthcare IT advisers to their hospital clients, but it doesn't always get through. "I don't know that organizations have identified a particular problem to solve before they go out to pick a vendor," says Frank Cavanaugh, a principal with Cardinal Consulting.
The IT selection process involves guaranteeing that technological needs are met at a fair price, but the lead-in to that process and the subsequent approach to implementation can greatly influence how well the people in an organization are served by the technology and whether they contribute productively to its rollout, experts say.
Once a provider organization has committed to a clinical improvement plan, a nontraditional request for vendor proposals can set the tone, says Melinda Costin, vice president specializing in IT implementation with the consulting firm Healthlink. Costin doesn't recommend the typical request for proposals, or RFP, which concentrates on questions about technical components. "You list all the application capabilities ... and the vendor says, `Yes, yes, yes,' after them," she says.
Referring to a recent client's experience, the consulting firm "actually worked with the organization to step back and really analyze where this organization is trying to go, what is the problem they're trying to solve," Costin says, "and then wrote the RFP around that capability."
With patient safety one of those problems, the RFP "asked for the vendor not to respond to how their technology works but `how can your system aid us in addressing patient safety in these particular areas,' " she says. "It was a much harder RFP to respond to from a vendor perspective, but that allowed the customer to weed out right away those vendors that didn't understand the significance of that approach."
To ensure that IT systems operate effectively for clinicians, a proper understanding of total expenses is essential before committing to a purchase, says Michael Kreitzer, an independent healthcare IT consultant. Governing boards and chief financial officers should expect and commit to internal costs of implementation and ongoing annual operational expenses that likely will be double or triple the initial purchase price over time, he says.
At Bronson Methodist Hospital in Kalamazoo, Mich., IT operational expenses represented 1.6% of total hospital expenses as recently as 2000, says Mac McClurkan, vice president and chief information officer of the hospital's parent, Bronson Healthcare Group. That's when the facility started an ambitious IT improvement plan that will culminate in a computerized physician order-entry system in 2006 (July 5, p. 20).
Since then, IT spending has increased to 2.4% of total expenses for 2004, reflecting the extra commitment to keeping the new infrastructure running well and supporting clinicians with more sophisticated information access, he says. That percentage will rise to 2.9% once the next phase of implementation begins.
A high-end suite of applications for everything up to computerized physician order entry-which includes revenue cycle, patient scheduling and nurses' station automation-could cost $10 million to $13 million depending on the systems that are chosen, Kreitzer says. But that's the beginning, he adds: "The hospital's (internal) costs are going to be double that."
Much of that springs from the need to "backfill" all the time taken away from employees' and managers' time: to go to application education classes at the vendor's headquarters, for example, or to help decide on the design and reporting mechanisms of the new systems, not to mention training an entire workforce-during which their duties must be assumed by others, Kreitzer says. Other costs stem from working through the time-consuming effort of using the IT initiative to change clinical and business processes, he adds.
Even for smaller hospitals working with less-sophisticated IT components, Kreitzer estimates an overall commitment of 8,000 to 12,000 hours of employee time, another hefty burden for facilities short on financial resources.
In addition, vendors charge an annual maintenance fee for new software releases and other updating that ranges from 15% to 22% of the list price, even if a hospital negotiated a discount off that price, consultants say. "You figure every five years, you're buying the software again," Cavanaugh says.
Making it loud and clear
Long before the training begins, managers will have to clearly communicate the changes in established processes that IT systems will require. They can say again and again that the IT conversions planned for their organization will change care processes, but it pays to specifically explain well ahead of time how clinicians' routines will be altered forever.
For example, the recent focus on bar-coding systems for bedside medication-checking means drastic changes for nurses, says Randy Thomas, vice president of advisory services for Healthlink.
"Typically nurses go in, administer the medications, write something down on a slip of paper and do their documentation later," she says. "If you're going to be using automatic `five rights' checking with bar-coded meds at the bedside, they have to essentially do 80% of the documentation there as they're wanding the med and the patient and so forth. ... That is a fundamental change in how nurses do their rounds."
It's an example that cuts through the standard managerial phrases, she says. "Everyone is talking about process change, but you need to bring it down to some very specific cases that people can relate to."