Technologies in other industries can save dollars in healthcare - healthcare providers must fund their own clinical information systems

Gone are the government grants, capital pass-throughs and Hill-Burton dollars that once paid for costly technology investments. Today, funding for a clinical information system (CIS) must come from a healthcare provider's own bottom line.

In past years, providers often conducted elaborate return on investment (ROI) analyses to justify a CIS multimillion dollar cost. However, under capitated payment, hospitals no longer have the time or money to conduct protracted "time and motion" studies.

Investing in an integrated CIS is no longer an option, but a mandatory minimum requirement for healthcare delivery networks to achieve economies of scale. Managed care reforms demand that providers eliminate the omnipresent duplication of effort uncovered by ROI studies. Providers must demonstrate low cost and high quality clinical outcomes when competing for fixed fee HMO and third-party payer contracts. Payers like USHealthcare, Aetna and Cigna are building sophisticated clinical information systems to identify the most cost-effective course of treatment, and they are inviting member physicians to use their client/server CIS products at the point of care.

Using proven technologies from other industries can save the healthcare industry millions of dollars in malpractice claims and productivity gains. Among those technologies are cellular telephone communications, radio frequency transmission, voice recognition, robotics, handheld personal digital assistants (PDA) and bar coding.
Access to online drug databases via a CD-ROM reader on PC workstations holds out the promise of alerting physicians to proper doses, potential interactions and generic drugs that offer equivalent therapeutic efficacy at the point of initial order entry. Those same universal workstations, or even cellular phones and pagers, can receive laboratory, diagnostic imaging and other results to alert caregivers to life-threatening patient conditions-if the CIS is capable of communicating time-critical values.

Commitment to savings

Health networks must be committed from the outset to the benefits realization process in order to achieve tangible and intangible savings after CIS implementation. As a case in point, JFK Medical Center in Edison, N.J., is committed to tracking critical success factors (CSFs) for its enterprisewide CIS projects, each on a one-page spreadsheet. JFK's CIO, Louis Hermans judges each CIS project by its CSFs. Hermans says: "No CIS project should be implemented without identifying from the beginning the quality, accountability and responsibility of those impacted." JFK prefaces each implementation with an abbreviated ROI study based on HBO & Company, Atlanta, benchmarks. JFK disciplines itself to monitor quarterly each project's status by phase and calculates the percentage completed, ROI attained and variance between capital dollars spent vs. budgeted.

Examples of critical success factors are reducing report loss and turn-around time, making clinical information available for several caregivers at various locations at any given time, reducing overtime hours spent charting and meeting regulatory requirements.

To identify measurable CSFs for each major application/project, cost should be considered, but value should be foremost. Because CSFs can differ by department, consider the following questions:

* Which functions can be automated to improve efficiency?

* Can repetitive processes be streamlined to reduce/eliminate bottlenecks?

* What current tasks can be discontinued?

* Which process improvements will instill good management practices? Which can cut costs?

Do it simply, but do it right

CIS investments are too large-and their impact too far-reaching-to not consider whether their cost better enables the enterprise to achieve its strategic plan. To make certain the CIS empowers caregivers as intended, providers must:

* align the CIS Plan with the healthcare network's strategic plan,

* itemize CIS features that facilitate ROI payback,

* identify measurable critical success factors,

* initiate a focused ROI study to collect baseline measures to validate the CIS vendor's benchmarks