Health Management Technology's founder weighs in on how far we've come and how far we've got to go.
Time really does fly when you're having fun.
The story of how this magazine came to be actually begins in the 1960s. I was at Lockheed Missiles & Space Company in Sunnyvale, Calif., when a few adventurous entrepreneurs gathered to consider building a medical information system (MIS) and a business office system (BOS). At some point, I drew the short straw to head up the development of the financial information system. Actually, this set very well with me because our clinical team was sent off to the Mayo Clinic in Minnesota in the dead of winter in 1967 to study the possibilities of an electronic medical record (EMR) and computerized physician order entry (CPOE) system, along with work-flow design and clinical process optimization.
When asked what he has enjoyed the most about his 40-plus years in healthcare,
Childs says, “The very bright and dedicated people I have met along the way;
together we are doing a very good thing.”
We built our financial systems in sunny Mountain View, Calif., and subsequently sold them to nearly 100 hospitals. We sold systems to National Medical Enterprise (NME), which merged with other hospitals and ended up being the billing and A/R system for Tenet some 40 years later. Who would have thought that our early financial system would still be in use by such a large organization all these years later? In fact, several years ago I received a call from a Tenet programmer asking about a piece of machine language code with my name attached to the Cobol program that called the routine.
In 1971, we sold our Lockheed (Healthcare Systems Development) division to Technicon, and the systems became — and are still known as — TDS or E7000 from Eclipsys, which acquired the systems from Alltel around the turn of the century. Does anyone remember Alltel?
It would be a lie to say that selling CPOE and EMR in the '60s and '70s was easy. In fact, only those CEOs who were leading-edge risk takers and understood the ultimate goal attempted such an endeavor. It wasn't until about 1984, when diagnosis-related groups (DRGs) became law, that hospital executives began to think about clinical information systems.
It is a real testament to the skills of the teams that designed, built, implemented and “de-bugged” these early systems that many are still in use today. Examples of current users are Tenet and North Mississippi in Tupelo (for the financial systems) and Trinity Mother of Saint Francis in Tyler, Texas (for the clinical systems). Other hospitals continue to use all or parts of the systems.
In 1971, I played a role in the physician and nurse adoption of the medical information system at El Camino Hospital in what was to become known as Silicon Valley (we achieved a greater than 80 percent CPOE adoption and an 80 percent EMR adoption). I continued on in the clinical space with direction and implementations until late 1979, when I decided to take a break from the constant travel and long hours required for sales, management and implementation of these systems. (I am sure that many of you involved in past and current-day implementation projects can relate.) It was at this time that I became aware of the need to reach out to hospitals and clinics about what information systems could do for patient care, electronic billing and accounts receivable processes.
To that end, Computers in Hospitals magazine was born 30 years ago in Denver, Colo. Today, that publication is called Health Management Technology (HMT).
The magazine started out with six issues and 52 pages, and we progressed to a monthly magazine in 1982. Again, it was leading-edge thinkers that jumped at the opportunity to support the endeavor. I bought a fistful of airplane tickets and visited everyone I could. Early advertisers included Medicus, SMS, Compucare, Technicon, HBO, McDonnell Douglas, AMI/PHS, Tymshare Medical Systems, DATX, NDC (DataStat), The Kennedy Group, Amherst Decision Support Systems, Space Age Computer Systems, Nadacom Health Information Systems, EDS, Medlab, Dilts & Kappeler, Élan, Dynamic Control, and NCR. By the end of the first year, we had changed the title to Computers in Healthcare to expand our reach beyond hospital walls, and our number of advertisers had doubled.
Cover stories included information systems executives from hospitals and clinics around the world, as well as many of the entrepreneurs who built vendor-created systems.
So what two cents can I add about the progress of computer and information-related technologies in healthcare in the last 30 years?
1. Slow progress. Thirty years in the life of the magazine and some 40-plus years as an observer of our business make me wonder why we are not any further along than we are.
2. Defining the “right way.” I do know that the processes of patient care, the practice of medicine, management and reimbursement with information systems are tough tasks at best. I can personally count hundreds who have lost their jobs trying to get it all done the right way. Add to this list that there continues to be debate on what is “the right way.”
3. Agreement on clinical systems best practice. I also know that it is difficult to get a consistent answer for “What is right with a clinical information system?” from those professional clinicians who have been taught all their lives to get to the bottom of “What is wrong?” Physicians, are you listening?
4. Inconsistent system development approaches. For a long, long time many vendors approached clinical or medical information systems design and development the wrong way. Some were bent on protecting their financial systems investments, some were protecting their standalone departmental systems and some were protecting both. Unfortunately, many clinical vendors have looked through the eyes of disciplines other than medicine and patient care. I am also not sure about the long-term impact of all the mergers and acquisitions that have made a few rich but have left many with less than the best in direction, functionality and integration.
5. Ever-increasing rate of change. The field of medicine has been advancing at an incredible rate over the last 100 years, and as we approached the Medicare/Medicaid funding years, it accelerated even faster. My “guesstimate” is that the knowledge base or field is doubling faster than anyone can keep up with. These information systems cost a lot of money and time to design, build and implement correctly — and you're not done even then. Most CIOs estimate that ongoing optimization, process improvement and maintenance will add an FTE level of support that was equal to between two-thirds and three-fourths of the original implementation efforts. For those of you who just want to be done with it, I personally see “NO END IN SIGHT.”
6. Increasing realm of patient care. Patient care takes place throughout a continuum of providers that may include the home, a physician office, hospital and long-term care facilities. Many systems claim to be fully integrated, but most systems are not there yet. Some are on their way, but full integration has been elusive for most provider organizations.
7. Finally, the push for an EHR is on. Beginning with the Bush-era push for computerizing all of healthcare and continuing with Obama's mandate and funding mechanisms to facilitate adoption and “meaningful use,” our business has taken some giant leaps forward. I, for one, believe it is about time. Back in a very early issue of Computers in Healthcare, I stated in an editorial, “Complete implementation of a great clinical information system has the greatest potential to reduce costs and improve the quality of care of anything ever introduced into the field of modern medicine; every other technology (although perhaps more wonderful) was cost-increasing technology.”
8. All of America needs to be included. We still need to find a cost-effective way to bring rural and poor America into fully integrated information systems technology. Tele-health may be part of the answer.
9. Choose with wisdom the right path. We need to be very careful that government mandates assist our efforts and not get in their way. I believe that providers and private-sector entrepreneurs can and will solve the problems at hand. My hat is off to the many nurses, CIOs, CMIOs, PMs, vendors, consultants and others who are making information systems work in healthcare. Most recently, David Blumenthal, M.D., and his team (and before him, David Brailer, M.D., and his team) did a wonderful job moving our mission forward at the national level.
10. Even greater change is coming. And last but not least, I believe we are in for some revolutionary changes in the way care is monitored and delivered, and we are not even halfway done with what we are doing under ARRA, HIPAA 5010, ICD-10 and meaningful use. I would like to address this in a future issue of this magazine, so please stay tuned!
Bill Childs founded Computers in Hospitals magazine in 1980, which was renamed Computers in Healthcare and eventually became Health Management Technology. Childs is currently senior executive, Vitalize Consulting Solutions.
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