Enthusiasm for Reengineering Systems Slow to Catch On
By Carolyn Dunbar, January 2010
Editor's Note: The is the sixth installment on our year-long 30th anniversary "Pioneers in Healthcare IT" celebration, featuring articles from past issues of Health Management Technology, formerly called Computers in Healthcare. This article appeared in the June 1993 issue. When this piece was printed, Carolyn Dunbar was editor of Computers in Healthcare.
The results of two recent surveys show that information professionals and top healthcare management remain cautious — and even pessimistic — over the speed with which a truly computer-based patient record will be implemented. Interest in open-systems solutions, however, is up sharply.
Healthcare Information and Management Systems Society (HIMSS) conference attendees — 571 of them — stopped in the San Diego Convention Center hallway to take the fourth-annual HIMSS/Hewlett-Packard Leadership Survey. According to the response, the notion of reengineering information systems in healthcare has not caught on. Only 19 percent of respondents reported that the total quality-management movement had done anything to spur systems reengineering for increased productivity at their institutions.
Interest in and work toward success with open-systems integration has increased from last year. In the 1992 HIMSS/HP survey, 40 percent said that integrating existing systems to share information across departments would be their top I/S priority for the coming two years. In 1993, however, almost 60 percent said they have embraced an open-systems strategy that is now heavily influencing purchases of hardware, software and networking technologies.
Of note, the HL7 application-level standard for computer communications is not perceived as having any significant effect on healthcare I/S. Twenty-one percent of survey respondents said they spent money on HL7-compatible systems but have not yet seen any measurable benefit. Thirty-six percent said they will not invest in HL7-compatible systems because they believe the HL7 standard isn't ready.
Point-of-care or bedside systems continue to be regarded with similar wariness. Six in 10 of those who have not yet invested in bedside systems said they are not convinced of the return on this technology. The growth in the market was somewhat up from last year, according to the survey, when only 17 percent of respondents said they had invested in a bedside system for some combination of critical care or medical/surgical applications. In 1993, 25 percent had gone with bedside systems.
When asked to rank which emerging application areas have the greatest potential to improve the quality of patient-care delivery, more than 60 percent of the respondents chose clinical decision support. Coming in a distant second was multimedia (17 percent). Telemedicine technology and hand-held computers were tied for third place with 10 percent each.
The HIMSS/HP survey results showed that the national goal to transform all paper-based medical records to electronic form — a computer-based patient record — is gaining favor. Most respondents said they now believe the CPR will be ready to implement within five years. Last year, respondents said this goal was still 10 years away.
Despite this recent optimism, however, few hospitals are embracing the core telecommunications technologies — fiber-optic networks or integrated services digital networks — to the degree needed to fully deploy the CPR. Thirty percent of the respondents have no fiber-optics capability. Sixty percent have not implemented ISDN.
The savings aspect of the CPR is paramount. Recent estimates from the Blue Cross and Blue Shield Association indicate a potential $40 billion annual savings, if physicians are able to access patients' computerized treatment histories, according to the HIMSS/HP survey executive summary.
Eighty percent of respondents think President Clinton's healthcare reforms, and particularly their slant toward managed competition, will speed IT advances in healthcare. More than 60 percent said the greatest force driving increased healthcare automation is government and payer pressure to control costs.