Information Technology Infrastructure, Management, and Implementation: The Rise of the Emergent Clinical Information System and the Chief Medical Information Officer
The use of information technology will continue to play a large role in improving the quality of care, controlling costs, and boosting efficiency in all industries. Health Information Technology (HIT) is being sought as one of the key tactics to streamline the process of providing healthcare to improve quality and harness costs. It is believed that HIT will lead to a more cost-efficient healthcare system than the current one. Surprisingly, there is no agreed definition of HIT in academic literature or government documentation. HIT refers to a broad base of information technologies used in healthcare from robotics surgery to chronic disease home monitoring devices. However, there is a consensus on the purpose of HIT as the use of computers for the management of information in order to ensure that it is available to the right person at the right time and place. HIT is the basis for a more patient-centered and evidence-based medicine with the real-time availability of high-quality information and the potential to perform broad-scale analytics.
Despite the various interpretations of the scope of HIT, all healthcare stakeholders agree that it is the premise on which a twenty-first-century healthcare system must be based. Key challenges remain, including: Vendors don’t have the ability to introduce it into old technologies; Vendors don’t have the financial incentive because their customers aren’t asking for it; Institutional solutions architecture also know as Clinical Enterprise Resource Panning systems (CERP) are not flexible enough to satisfy local needs both for initial deliverables and subsequent adaptations. Unfortunately, coalface clinicians have rarely more than token participation in the selection process of HIT. The health organization has historically had a propensity for installing CERP systems as a strategy for serving the data collection and management functions of the whole organization. The CERP methodology has often been touted as a whole of organization solution without accounting for variable contexts within the organization. This has led to CERP solutions that lack adaptability being imposed on clinicians at the coalface of care with conviction from the administration that it would solve data collection and management problems, but unwittingly worsening their productivity. Adaptability is to be understood here as the ability of a HIT system to be adapted efficiently and quickly to change clinical circumstances. An adaptive system is therefore an open system that is able to adjust readily and inexpensively its behavior according to changes in its environment or in parts of the system itself.
The Emergent Clinical Information System (ECIS) is an adaptive system that is proffered herein as an alternative paradigm and architecture that supports user-controlled design and rapid development and immediate adaptability. Its technical implementation is described and assessed through a case study of building and assessing an emergency department information system (denoted NEDIMS). The multi-best-of-breed system characteristics of the ECIS architecture points to separating the roles of clinical service information systems and clinical care information systems, and a repurposing of EMR solutions to that of a clinical data warehouse with ECIS acting as their service agent for clinical care departments that are patient-facing.
Although many experts tout the perceived benefits of HIT, formal evaluations and evidence regarding its successful implementation are generally lacking. Proponents often do not understand the conditions that exist where innovative HIT has worked, nor are they aware of the perverse financial incentives that discourage healthcare providers from adopting such technologies. Also missing is an honest discussion of experiences with actual HIT systems and the problems engendered by poorly designed systems. There has also been little discussion of the potential problems that might arise if the technology is imposed from the top down. The ECIS architecture presented in this chapter demonstrates that a minimum of 40 % improvement in clinical efficiency is attainable by the ECIS architecture and implementation.
KeywordsInformation technology Clinical information systems Enterprise wide systems Intra-operability Patient safety Implementation
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