Medical Informatics at the HIS Vendor: Issues and Opportunities

1. Medical Informatics at the HIS Vendor: Issues and Opportunities Donald W. Rucker, MD VP & Chief Medical Officer SMS/Siemens

2. Topics • Differing environments – Corporate, University • Differing informatics problems • Hybrid environments and transitions • Shared issues • Shared opportunities

3. Differing Environments The Corporate Informatics Environment Customer driven, specific targets in mind Customers drive conformity Mediated by CIO’s not clinicians Product line pressures Often driven by government policy, externalities Y2K Team environment Radical changes, buyouts, change of heart

4. Differing Environments The University Informatics Environment In addition to new intellectual questions, • great flexibility on projects • driven by academic trends • driven by research agencies (IAIMS, UMLS) • sometimes driven by the affiliated medical center Who innovates more?

5. Differing Problems Corporate Solutions => • Both financial and clinical • Address large integration issues • Address large migration issues (data is valuable) • Have to solve at least one problem completely • Can have big impact: physician order entry • Software tools and hardware choices drive whole market position – can be huge

6. Differing Problems Corporate systems also have to: • Be debugged • Solve nitty gritty issues • Networks, printers, response times • Version control, installs, training • Fundamentally need to be scalable (and you wondered why mainframes were still around – the ASP model & SMS)

7. Differing Problems University informatics projects tend to be: • Exciting and fun • Clinical • Diagnostic (is this the issue for doc’s?) • Decision-making flavor, AI flavor • Tools, scale, delivery not an issue • Implementation uncommon - Regenstrief

8. Differing Problems • However university projects can: • Address only part of a problem – Mycin • Assume data exists! • Ignore bandwidth – Palm, multimedia • Ignore whether something is a true problem - graphing

9. By the way – big company, little company Corporate size matters >> • Big companies have very different environments • Different personalities working • Legacy system issues • Availability of data – on every level • Time to make mistakes • Small companies • Innovation if quick and cost-effective • Much more random understanding of markets • Disinterested VC investors, poor management

10. Hybrid Environments and Transitions • Some university informatics shops are rather corporate • Homegrown IS systems, secret local knowledge • Puts the academic informaticians under pressure • Town-gown collaborations • Difficult transitions • Small problem • Isolated solution, no ties to data • No understanding of sales channel

11. Profound shared issues • Fundamentally has health informatics worked? • Support for a probabilistic world • Often lack of clarity of core strategy or question • The evaluation problem – aka “ROI?” • Who enters the data?

12. Data In / Data Out The biggest issue in informatics • Who enters the data? • Data entry by clinician – “point of sale” • Corporate systems can finesse this • Academic systems, being more clinical, shouldn’t

13. Data Entry and Usability • Usability • Opportunity cost is the issue • $2 per minute • Every screen flip, list to read • Can you read it from the doorway? • Usability is a war – pixel by pixel

14. Some shared opportunities • Clearly the Internet offers immense opportunities to all – the thin client • XML beyond HL7 • New modes of data entry • New tools to address workflow • Integrating imaging into clinical decision making

15. Conclusions • Some clear differences • Both need to think about the premise/market • Both need to think about evaluation/ROI • Both absolutely need to think about how data enters the system

16. Innovative Clinical Solutions Leading Information Solutions Medical Solutions That Help