Biomedical Informatics 4th Edition by Edward Shortliffe, James Cimino

Exercise 5

Sect. 6.3.3.2 . Hospital A had been using information systems for many years, dating back to when some researchers in the cardiology department built a small system to integrate data from the purchased laboratory and pharmacy information systems. Over time, the infection control group for the hospital began using the system, and contributed efforts to expand its functionality. Other departments began developing decision support rules, and the system continued to grow. Eventually, the institution made a commitment to redevelop the infrastructure to support a much larger group of users and functions, and named it A-Chart. Satisfaction with the system was high where it had been initially developed, and with other related specialties. However, over time there was disproportionate development in these areas, and clinicians in other specialties complained about the rudimentary functions, especially when compared to existing vendor systems for their specialty. As a result, the organization decided to purchase a new vendor system. This made the other specialties happy, but was a big concern to the groups that had been using A-Chart for years. These clinicians feared that they would have to reconfi gure their complicated decision support rules with a new system, or worse, that functionality would no longer be supported. To alleviate concerns, representatives from each department were asked to participate in both drafting a Request for Proposals and then reviewing the proposals from four different vendors. Many clinicians liked System X, but in the end the hospital chose System Y, which seemed to have most of the same functions but was more affordable. However, System Y did not include a laboratory system, so the hospital purchased a separate laboratory system and built interfaces to connect it with the core EHR. Integrated Delivery System (IDS) B had a different history of its EHRs. Years ago, it existed as a separate system of hospitals and clinics. Shortly after the merger of these institutions, both the hospitals and clinics purchased separate EHRs, InPatSys and CliniCare. At the time, the institution felt that each would be best off with a best - of - breed system, to support the different workflows, and there was no system that both sides of the organization could tolerate. Years later, as IDS B began to integrate care between the hospitals and clinics, the clinicians and administrators became increasingly frustrated at how different the InPatSys and CliniCare systems were, and that they had to use two separate systems to care for the same patients. A team was formed to evaluate the options, and the CliniCare system was eventually replaced by OutPatSys, the outpatient version of InPatSys. To prevent losing data as they moved from one system to the other, the IDS IT department prepared the OutPatSys system by loading existing laboratory results and vital sign measurements from CliniCare. Then they purchased CCOW software to allow single sign-on between systems during the first 6 months of OutPatSys implementation, while they transformed the other data from CliniCare. Community Hospital C (CHC) had various niche information systems throughout its organization, but no EHR to organize it all together. With the availability of Meaningful Use incentives, the hospital determined it needed to fi nally acquire a commercial EHR. A leadership team of four people visited six different hospitals to look at how various EHRs were used. Finally, the hospital made a decision to purchase eCompuChart, because it was among the best systems and seemed best adapted to their community size. CHC hired a new chief information offi cer who had recently implemented eCompuChart at a community hospital in a neighboring state. They also promoted Dr. Jones, who had recently moved from another hospital that had also used eCompuChart, to chief medical information offi cer (CMIO). Then they contracted with DigiHealth, a consulting company with experience in implementing EHRs, to plan and coordinate the implementation with the new CMIO and CIO. Based on DigiHealth's recommendations, all existing overlapping systems were replaced with modules from eCompuChart, to simplify maintenance. Hospital D has recently decided to purchase eCompuChart as an overall clinical information system strategy. eCompuChart has award - winning software for the emergency department and intensive care units. However, there were strong complaints about its capabilities for labor and delivery management and radiology. After considering capabilities of best-of-breed options and their ability to integrate with eCompuChart, Hospital D eventually made a split decision. The labor and delivery module for eCompuChart was purchased becaus other systems with more elaborate functionality could not integrate data as well with the overall EHR. On the other hand, a separate best-of-breed system was purchased for radiology, because interfaces between the systems were seen as an acceptable solution for integrating data
-Reread the case studies in Sect. 6.3.3.2 .
(a) What are the benefi ts and advan tages of the different approaches to development and acquisition among the scenarios?
(b) What were the initial costs for each institution for the software? Where will most of the long-term costs be?