Early in his career as a healthcare chief executive officer, Joel Allison learned the hard way about how not to approach investments in information technology.
When he arrived at a hospital in Corpus
Christi, Texas, as the new CEO, nurses
working near the laboratory had two computers
at their stationone for a recently
installed laboratory system and another for
the hospitals billing system. The problem:
The information systems staff couldnt integrate
the two systems.
The staff had to enter the information
twice. You cant have two systems. It was
duplicating and doubling up the work rather
than being more efficient, says Allison, who
eliminated the lab system.
While hes moved on to other institutions
since then, the lessons from that frustrating
experience have stayed with him. You learn
that you have to do a lot more upfront organizational
readiness, choosing wisely your
vendors and partners. You have to have the
right people around the table, have dialogue
and really investigate the interoperability of
the new technology, Allison says. Its also
important for the technology to add value
to the organization and the patients.
That mindset is clearly guiding an ambitious,
seven-year, $140 million effort launched
last year at 17-hospital Baylor Health Care System
in Dallas, where Allison was named CEO
in 2000, promoted from chief operating officer
and senior executive vice president.
Called Clinical Transformation, the result
will be a fully electronic medical record and
computerized physician order-entry system.
While many hospitals are moving toward
integrated clinical information systems, Baylors
approach is unusually comprehensive. It
plans to redesign all of the major clinical
processes first and implement a standard suite
of clinical software second.
The idea is to figure out the most efficient
and safest way for clinical tasks to flow, incorporating
evidence-based protocols. Through
this redesign, nurses and doctors should gain
time to spend with patients. The new
processes will be tested in a care-improvement
laboratory, which combines live patient
feeds displayed on monitors in a training
room flexible enough to be set up like a
patient room in intensive care, emergency or
The current space, which is used primarily
for training nurses, will be expanded to
accommodate both lab and training functions.
After testing, the new work processes will be
rolled out to one hospital; others will follow.
Baylors commitment to process redesign is
huge. Of the $140 million investment in Clinical
Transformation, $46 million covers technology
costs while $96 million covers process
redesign costs and the salaries of 18 people
assigned to the project full time.
The value of investing in information
technology is not the value that accrues from
features and functions. Value is created from
the ability of technology to support workflow,
says Peter Dysert, a pathologist and
chief medical information officer at Baylor.
We are not going to improve quality if we
erode productivity. High quality is the result
of efficient processes and productive people.
As an example of this process-based
approach to improving the efficiency and
quality of patient care through automation,
Dysert points to electronic patient-registration
The process debuted in October 2004 at the
health systems breast-imaging center at Baylor
University Medical Center.
With a swipe of a drivers license or credit
card, patients register themselves and are
immediately added to a computerized queue
that imaging technologists tap into to find
the next patient. Gone are the days when
technologists scrambled to find charts and
read patients handwritten paperwork.
The center has reduced paper and printing
costs by more than $18,000. Patient
check-in time has been slashed from 12 minutes
to nine minutes for patients first visit to
the center and to just three minutes for subsequent