Robert Cooke

A clinical information system (CIS) can clearly improve health care by making patient data readily available. A CIS can make an additional contribution, however, by issuing reminders and warnings to clinicians at the point of care. It can enhance the speed and reliability of routine processes, and it can bring the relevant medical literature to the attention of the busy physician. It can also measure that clinician’s effectiveness and, over time, accumulate the data needed to conduct clinical research.

The strategies vital to implementing and making full use of a CIS and the computer-based patient record are presented by Greg Walton and H. Stephen Lieber beginning on page 4. Both are officers of the Healthcare Information Management Systems Society (HIMSS), and they report that the CIS represents the best means of achieving the quality-related goals that drive information technology in health care. Using the results of HIMSS surveys, they analyze the current state of CIS adoption and use, as well as predict the future course of health care information systems.

At Intermountain Health Care, Salt Lake City, the CIS has been in development for nearly half a century. As Scott P. Narus, PhD, senior medical informaticist, and Paul D. Clayton, PhD, chief medical informatics officer, report beginning on page 7, the groundbreaking efforts of Homer Warner, MD, laid the groundwork for the field of medical informatics in the 1950s. From this position at the head of the pack, Intermountain Health Care has gained unparalleled CIS experience. Its system is now used by 12,000 hospital-based clinicians and 700 clinic practitioners per day, and use rates continue to climb (with clinic data entry by physicians nearly doubling in 2001). CIS recently has been credited with decreasing postinfarction cardiac mortality and improving the control of diabetes patients’ blood-glucose levels.

J. Marc Overhage, MD, PhD is senior scientist, Regenstrief Institute for Health Care, Indianapolis, and associate professor of medicine, Indiana University School of Medicine. He explains the untapped potential of the CIS beginning on page 11, stating that the improvements in access to both medical knowledge and clinical data attributable to CIS use can enhance the quality and efficiency of health care. Cost reduction and quality improvement are best served by nonintrusive intervention at the time of individual treatment decisions, and the CIS is the ideal tool for this job.

Beginning on page 15, the payoff for health care informatics is evaluated by Judith V. Douglas and Marion J. Ball, EdD. They note that the evidence supporting the financial value of CIS is accumulating. For example, computerized physician-order entry (CPOE) has produced savings of 10% of a hospital’s annual budget at the community-hospital level and an annual return on investment (ROI) of approximately five to one for a major teaching institution. Where a CIS was linked to a patient-safety database that provided physicians with alerts and prompts, the ROI was 20 to one. Savings aside, CPOE may no longer be optional for some organizations; a coalition of major purchasers of health care now requires its use in the institutions that treat its covered employees. Measuring ROI for CIS is demanding, as Douglas says, but it is essential to the improvement of quality and the control of costs.

As always, Agfa stands ready to help hospitals pursue those two goals, and it is pleased to support the publication of this Intelligence Report.

Robert Cooke is vice president, Impax Solutions, Global, Agfa Corporation, Ridgefield Park, NJ