Behavioral model, physician behavior change, 60–61
Behavior change, and physicians, 60–61, 126
Bertram, Charles, 85, 88–89 Bourke, Michael, 139 Bradley, Bill, 21, 23, 26–27, 32 Bryce, Raymond, 83
C
Central Medical Healthcare System (CMHS)
decision-making roles, 171 disease management program,
171–173
IT programs of, 170–171 values of, 170
Certification
for admissions, 153 for medical necessity, 152
and utilization management (UM), 153–158
Chandler, Ken, 22–25, 27, 30, 32 Change
levels of, 57
negative aspects of, 46–47 resistance to, 130–131 stress related to, 123–124 See also Organizational change Change management, 16–20, 121–134
of clinician behavior, 60–61 core laboratory, transition from
distributed laboratory, 43– 47 elements of, 18, 110–111
integrated information system (IIS), plan for, 110–111
Index
A
Accommodation, and conflict situation, 226
Admissions certification, and utilization management (UM), 151, 153 Ambulatory patient classifications, 152 Anderson, William, 214–217
Anesthesia informatics system OpChart, 81–91
Riverview Perioperative
Computerized Management Suite (RPCMS), 82–83
Antimicrobial utilization program (AUP), 160–169
feedback about, 162–163 future view for, 168 goals of, 161, 165, 168 implementation, 161–163, 167 inappropriate use, control of, 164–
165
and IT solution, 168 leadership aspects, 166–167
preliminary progress report, 163–164 stakeholders related to, 166
structure/functions of, 161–162 surveillance team, 169
Assessment phase, elements of, 19 AtlanticHealth
IT programs at, 191–192 IT strategic plan, 192–195 Average costs, computation of, 140
B
Banting, Fred, 176–177, 181 Bar coding, patient ID labels, 65–68 Bartlett, Bob, 160–164
257
Change management, (cont.) for physician order entry (POE)
system, 123–124 principles of, 16–18, 47 stages of, 18–20, 110
and successful implementation, 57 Chazin, Walter, 93–94, 96
Chief resident, conflict resolution situation, 229–232
Children’s hospital, computers, installation of, 34–41
Clinical Content Consultants (CCC), 179 Clinical data repository (CDR), 49–53
advisory group for, 53 evolution of, 50 functions of, 50
physician use issue, 50–52
Clinical information systems, GEMINI, 7–14
Collaboration, in conflict situation, 226 Committees, Web services, termination
of, 233–237 Communication
improvement, aspects of, 110 of vision, 108, 124
Compromise, and conflict situation, 226 Computer installation for children,
34–41
inappropriate/illegal downloads, 34, 37–38
instant messaging (IM), 38–39 lock down of system, 36–37 logon issues, 36
patient Web pages, privacy issue, 38 purposes of, 34–35
reimaging computers, 35–36 in room setup, 39–40 touch pads, use of, 39 videoconferencing, 40 wiring, 40–41
Computerized incident-reporting system (CIRS), 114–119
benefits of, 114
implementation issues, 116–119 implementation of, 116–117 solutions to issues, 117–119 Concurrent work lists, 157–158 Conflict
defined, 225 healthy, 225
and joint venture proposal, 252–254 and MedCare system, 242–245 poor planning, effects of, 246–249 recognition of, 225–226
as subjective experience, 224–225 and visiting medical officers (VMOs),
238–241
Web committee termination example, 233–237
Conflict management, 226–227 chief resident situation, 229–232 effective, aspects of, 227, 231 in healthcare setting, 225, 254 models for, 226
Continuous quality improvement (CQI), values related to, 115
Core laboratory, transition from distributed laboratory, 43– 47 Cost-benefit analysis
disease management program, 172 measurability problem, 138 uncertainty problem, 138–139 utilization management (UM), 159 Cost-benefit judgments, 139
Cost-benefit rationalization, 138 Costs
average, 140
fixed and variable, 140 marginal, 140
Cox, Chip, 94
Critical care units, types of, 9 Culture of organization
and integrated information system (IIS), 108–109
OpChart issues, 88–89, 91 types of cultures, 109 Cummings, Peter, 96 Cusak, Carl, 66
Cusick, Leonard, 22–23, 26–27
D
Dartmouth-Hitchcock Clinical Microsystems, 143 Data repository, 195
Decision support system (DSS), 195 Deep South Healthcare System
(DSHCS), mission of, 199 Denial, of conflict, 226
Diabetes disease management, 174–175, 179–185
Diagnosis-related groups (DRGs), and cost control, 151–152
Diminishing marginal productivity meaning of, 140–41
measurement of, 141
Disease management program, 171–173 cost-benefit analysis, 172
funding for, 171–173
DNA donation project, 214–217 pilot project, 216
task force activities, 214–216
E
E3 (being electronic by 2003), 143–149 clinical visioning group goals, 145–146 goals of, 144
ROI analysis, 148–149 StarChart, 145 StarNotes, 147
StarPanel, 145, 147–149 StarScan, 147
Economic aspects
antimicrobial utilization program (AUP), 160–169
cost-benefit analysis, 138 cost-benefit judgments, 139 cost-benefit rationalization, 138 costs, types of, 140
disease management program, 171–173
E3 (being electronic by 2003), 143–149 hard and soft costs, 138–39
marginal analysis, 141
ROI analysis, 148–149, 153–159 utilization management, 150–159 VAMPIRE, funding for, 92–93, 95–96 Electronic medical record (EMR),
diabetes management, 174–175, 179–180
Emergency department information system (EDIS), 69–80
buy versus build decision, 72–73 components assessment, 75 design of system, 74–77 goals/outcomes for, 78 interface components, 75–76 needs assessment for, 71–73
project criteria, Phases I/II evaluation, 79–80
team members, 71
timeline for project, 70, 76
whiteboard versus Web-based board, 76–77
Emotional intelligence, and leaders, 189–190
Empowerment
and change management, 17, 18 and organizational structure, 17 Erwin, Janet, 65–66
Evans, Carol, 215
F
Failure of IT systems causes of, 59, 125
GEMINI system, 7, 11–13
prediction, with force field analysis, 126–129
Fairview Valley Regional Hospital, pharmacy ordering system, 197–198 Faulk, Suzanne, 27–28
Fixed costs, 140
Force field analysis, 126–29 hospital forces, types of, 128 Founding Fathers Health Corporation
(FFHC), 250–255 IT programs of, 250–251 joint venture proposal, 251–254
G
Gates, Steve, 177 GEMINI, 7–14
cost of, 10
deimplementation of, 7, 13 functions of, 8
implementation of, 9–11 problems of, 11–13
Genetics, DNA donation project, 214–217
Gibson, George, 88 Graham, Charlotte, 67
Great Plains Healthcare, clinical data repository (CDR), 49–53 Guarini, Jane, 27
H
Hall, Dennis, 97 Hammer, Paul, 209–211
Hammill, Thomas, 101, 103–106, 109 Harrier, Pamela, 176, 179, 184 Hauk, Ed, 178–179, 181
Haustus, F., 171–173 Hays, Steve, 88
Health care expenditures
and diagnosis-related groups (DRGs), 151–152
growth of, 151
Health Insurance Portability and Accountability Act (HIPAA)(1996), 38, 81, 152, 210, 219
High-performance computing, VAMPIRE (Vanderbuilt
multiprocessor integrated research engine), 92–99
HomeBase Hospital Organization (HBO), picture archiving and communications system (PACS), 200–206
Hudson University Medical Center (HUMC), DNA donation project, 214–217
Hunt, Matthew, 35, 40– 41 Hyde, Fred, 162–163
I
ID bracelets, patient, and bar coding, 65–68
Implementation
of antimicrobial utilization program (AUP), 161–163, 167
change management, importance of, 57
of computerized incident-reporting system (CIRS), 116–117
emergency department information system (EDIS), 70, 76, 79–80 of GEMINI system, 9–11
integrated information system (IIS), 103
of laboratory information system (LIS), 45–46
managing change. See Change management
of OpChart, 85–90
of patient ID labels, bar coded, 68 success, principles of, 57–62 termination, example of, 12–13 VAMPIRE system, 92–99 Incident reporting
computerized incident-reporting system (CIRS), 114–119
elements of, 114 importance of, 114 Information systems
clinical data repository (CDR), 49–53 computerized incident-reporting
system (CIRS), 114–119
emergency department information system (EDIS), 69–80
failure, reasons for, 59 implementing systems. See
Implementation
integrated information system (IIS), 101–112
laboratory information system (LIS), 44–47
MedCare, 242–245 OpChart, 81–91
patient ID labels, bar coding, 65–68 pharmacy ordering system, 197–198 physician order entry (POE) system,
122–134
picture archiving and communications system (PACS), 200–206
VAMPIRE (Vanderbuilt
multiprocessor integrated research engine), 92–99
Web center, 21–33
Information systems coordinator, job of, 219–220
Innovation, diffusion of, 58–59 Instant messaging (IM), 38–39 Integrated advanced information
management system (IAIMS), 102 Integrated information system (IIS),
101–112
change management plan, 110–111 communication with staff about, 110 and culture of organization, 108–109 and developmental stage of
organization, 109–110 implementation phases, 103 and IT vision, 108
needs assessment aspects, 102–108 problems/issues of, 108–111 stakeholders for, 107–108 success, factors in, 111–112 Intensive care units (ICUs)
admittance, reasons for, 9 financial factors, 9
and GEMINI system, 8–14
Internet
and institutional branding, 25, 32 Web center, 21–33
J
Jackson, Doreen, 22, 24–25, 27 Jirjis, Jim, 147, 149
Johnson, Kelly, 192–193 Joint venture proposal, 251–254
conflict situation, 252–254 Jones, Scott, 163
K
Kay, Risi, 67–68 Knowles, Phillip, 83 Koehler, Sarah, 83
L
Laboratory information system (LIS), 44–47
implementation of, 45–46 training program for, 44–45 Lawler, Brett, 174–176, 179–180, 183 Leadership
and antimicrobial utilization program (AUP), 166–167
conflict management, 229–232 defined, 189
DNA donation project, 214–217 and emotional intelligence, 189–190 importance of, 188
information systems coordinator, 219–220
IT strategic plan, 192–195 Physicians Group Practice IT/IT
merger, 210–213
picture archiving and communications system (PACS), 200–206
traits of effective leader, 189–190 Leasing system, picture archiving and
communications system (PACS), 201
Legendary Health System
computerized incident-reporting system (CIRS), 114–119 continuous quality improvement
(CQI), 115
Legislation, Health Insurance Portability and Accountability Act (HIPAA), 38, 81, 152, 210
Lewin, Kurt, force field analysis, 126–
129 Limbird, Lee, 97
Limited Medical Systems users group (LUG), 174, 178–183
Lockhart, Jess, 175, 177, 179, 183 Lorenzi, Nancy, 96, 145
Lukas, Shirley, 45
M
Magnuson, Mark, 96
Management risk, shifting to hospitals, 151–152
Marginal analysis, utility of, 141 Marginal costs, computation of, 140 Marginal productivity, diminishing,
140–41 Matt, Chris, 67 MAUI, 93
McPeak, Doug, 83, 88–89
Measurability problem, cost-benefit analysis, 138
MedCare, 242–245
annual satisfaction survey, 244 enhancements procedure, 242–244 Med Ed Group, 174, 177–178 Medical necessity
certification, rules for, 153 definition of, 150–151 Medicare
diagnosis-related groups (DRGs), 151–152
and utilization management (UM), 158
Memorandum of understanding (MoU), 207, 212–213
purpose of, 212
Mergers, Physicians Group Practice IT/IT merger, 210–213
Metropolitan College Hospital, Web center, 21–33
Mission Valley Medical Center (MVMC), Physicians Group Practice, Inc. (PGP), 207–213 Modest, Steve, 218–220
Moore, Jason, 92–96, 98
N
Nelson, Lauren, 215 Nightingale, Teresa, 177
O
Observation patients, 152
Oklahoma Health Division (OHD), 218–220
information systems coordinator, job of, 219–220
IT needs, 218–219 O’Malley, Tom, 161, 163 Omega System, 44–47 OpChart, 81–91
cultural issues, 88–89, 91 first uses of, 84
functions of, 83–85 implementation of, 85–90 technical issues, 89–91 user complaints about, 86–87 user training, 84–86
OpenPBS, 93
Organizational change
clinical data repository (CDR), 49–53 computers, installation for children,
34–41
management of. See Change management
Web center, 21–33
Organizations, phases in development of, 109–110
Overhill, Leah, 116–119
P
Pakyz, Amy, 163 Perkins, Susan, 104
Pharmacy ordering system, 197–198 Physician behavior
and availability bias, 12–13 modification of, 60–61
Physician order entry (POE) system, 122–134
change management, 123–124, 126, 130–131
computing council, role of, 123 force field analysis for, 126–129 issues related to, 125–126 physician needs for, 124
Physicians Group Practice, Inc. (PGP), 207–213
funding of, 208 IT programs, 209–210
memorandum of understanding (MoU), 207, 212–213
organizational features, 207–208 PGP IT/IT merger, 210–213 services of, 208–209
Picture archiving and communications system (PACS), 200–206
adoption issues, 201–205 adoption solutions, 205–206 development committee, 200 functions of, 200, 203 leasing system, 201 Planning
ineffective, effects of, 246–249 strategic planning for IT, 192–195 Posch, David, 143–149
Power issues
and information systems projects, 61–62
sources of power, 61–62 Web center, 31–32
Power strategy, in conflict situation, 226
Privacy issues legislation, 38 patient Web pages, 38
Public health programming, Oklahoma Health Division (OHD), 218–
220
R
Radiology, picture archiving and communications system (PACS), 200–206
Rapid response laboratories (RRLs), 43–44
RDI Systems Corporation, 102–3 Residency
chief resident and conflict resolution, 229–232
resident team, 230 Return on investment (ROI)
StarPanel analysis, 148–149 and utilization management (UM),
153–159
Riverview Perioperative Computerized Management Suite (RPCMS), features of, 82–83
Riverview University Medical Center (RUMC), OpChart, 81–91 Roberts, Susan, 45–46
Rogers, Everett M., 58
S
Sadler, Helen, 34–41 Schneider, Lynn, 171 Schrimpf, Ron, 94, 96–97
Scientific computing center (SCC), VAMPIRE (Vanderbuilt
multiprocessor integrated research engine), 92–99
Scott, John, 22
Self-awareness of leaders, 189 Self-management of leaders, 189 Sheldon, Paul, 92, 94, 96–99 Shue, Lawrence, 50, 52 Silas, Rupert, 209 Slack, Warner, 60–61 Smith, Jarrod, 96
Social awareness, of leaders, 189 Social skills, of leaders, 189 Solomon, Richard, 104–109 StarChart, 145
StarNotes, 147
StarPanel, 145, 147–149 StarScan, 147
Stead, William, 143 Stevens, Scott, 21–29, 32–33 St. Peter’s Health System (SPHS),
laboratory information system (LIS), 44–47
Strategic planning for IT, 192–195 approaches to, 193
issues related to, 192 IT task force questions, 194 readings related to, 194–195 Surgerical monitoring, OpChart, 81–91 SWOT analysis, 194–195
T
Tackett, Alan, 93, 95, 97 Thorp, 104
Touch pads, 39 Training
for laboratory information system (LIS), 44–45
Med Ed Group, 174, 177–178 of physicians, 126
U
UA Pharmaceutical, Inc., 171–173 Uncertainty problem, cost-benefit
analysis, 138–139
University of Central State Medical Center, antimicrobial utilization program (AUP), 160–169 University Children’s Hospital,
computer installation for children, 34–41
University Hospital, bar coding, patient ID labels, 65–68
University South Medical Center, utilization management (UM), 152–159
Utilization management (UM), 150–159 admissions certification process, 151,
153
components of, 151–152
concurrent work lists feature, 157–158 costs and benefits, 159
cost of system, 159 current work flow, 154 direct benefits of, 154–158 functions of, 150–151 indirect benefits of, 158
management risk, shifting to hospitals, 151–152
return on investment (ROI) information, 153–159
V
VAMPIRE (Vanderbuilt multiprocessor integrated research engine), 92–99 current size/scope of, 98–99
development committees, 96–97 development of, 93–94
funding for, 92–93, 95–96 future plans, 98–99
success, reasons for, 94–95, 99 users of, 97
Vanderbuild University Medical Center (VUMC)
E3 (being electronic by 2003), 143–
149
profile of, 144–145
Vanderbuilt University, VAMPIRE (Vanderbuilt multiprocessor integrated research engine), 92–99 Variable costs, 140
Vesalius Health System (VHS), 174–185 diabetes disease management,
174–175, 179–185
disease management group, 176
Vesalius Health System (VHS), (cont.) electronic medical record (EMR),
174–175, 179–180 entities under, 174 IT division, 175–177
IT project solutions, 181–185
Limited Medical Systems users group (LUG), 174, 178–183
Med Ed Group, 174, 177–178 structural issues at, 180–181
Vesalius Service Division (VSD), 174, 177
Videoconferencing by patients, 40 Vision
clinical visioning goals, example of, 145–146
communication of, 108, 124
vision-orientation and change, 18, 57 Visiting medical officers (VMOs),
238–241
conflicts with, 239–241
W
Walker, Greg, 95, 97 Web center, 21–33
creation of, 22
governance board, role of, 26–27 and health sciences library content, 26 marketing content, 24–25, 32
power issues, 31–32 problem areas, 23–24, 26, 28 purposes of, 22–23
recommendations for success of, 32–33 strategy issues, 29–31
users of, 27–28 Weber, Mark, 104, 109
White Mountain University Health System, integrated information system (IIS), 101–112
Y
Y2K compliance, 12 and MedCare, 242–245
Health Informatics Series
( formerly Computers in Health Care)
(continued from page ii)
Patient Care Information Systems Successful Design and Implementation
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