Information Systems Prescribed

The information revolution has only just begun in the health-care industry.

The pressure to cut costs is driving health-care providers to manage themselves more efficiently. The result will be a boom in information systems. Such changes herald enormous opportunities for information systems vendors.

Today, these systems mainly support clerks and administrators, but in the future the focus will shift to nurses, doctors and chief executives. The change will be gradual at first, but in perhaps five years the pace will accelerate. Information systems now represent about 3% of health-care organizations’ budgets. By the year 2000, they likely will account for 5% to 8%, with a large hospital spending more than $5 million per year on information systems.

One of the most dramatic forces for change will be a shift in the way health care is evaluated. The federal government and private insurers are moving toward payment based on quality and performance. Instead of payment based on costs or diagnosis, health-care providers will have to demonstrate results. We see this now in some areas of psychiatric treatment and in alcohol and drug rehabilitation programs that are required to document their effectiveness.

Providers will also be asked to document the process of treatment. Again, this is happening already, notably in intensive care units where very expensive operations, such as organ transplants, must be thoroughly documented before payments are allowed. The demand for documentation will work its way down through the health-care system.

Extensive electronic documentation and more bedside computing will be necessary. Doctors, nurses and therapists will use information systems to document and support their decisions. The new routines will require the development of uniform guidelines and protocols; vendors who lead in developing them will be well positioned to benefit.

Virtually every decision a health-care professional makes will be aided or recorded in an electronic transaction or report. For instance, when a physician uses a computer to order a test that is not part of the standard practice for a diagnosis, a little window will pop up to remind him or her to document the reasons for that test. Computers will also automatically generate a checklist of procedures to follow for a given diagnosis. The increased emphasis on nursing care information systems is a good bet for the future.

Ultimately, the health-care industry will evolve into a more finely tuned network of shared resources and information. Small hospitals and managed-care organizations will be linked to larger hospitals, and large hospitals to each other. Among the big challenges ahead will be the standardization of patient databases.