"The board believed our strategic direction was to use I.T. and redefine health care in northwest Indiana," she explains. "That direction was built around integration."
At the same time Parkview Health kicked off a project to select a primary vendor in 2000, the organization began improving its telephone and local and wide area networks. Thompson oversaw the parallel tasks, with the vendor search running through 2002.
A paramount need
Many integrated delivery systems have duplicated Parkview's efforts in recent years. As provider organizations form new governance arrangements to deliver expanded ranges of care across a community or across state lines, the need to share information at all points becomes paramount.
While integrated delivery systems report different strategies for enabling enterprisewide access to clinical, financial and administrative data, they agree it can only be done with a cohesive I.T. plan. And deep pockets: the cost of tying systems together with I.T. ranges from tens to hundreds of millions of dollars.
There are more than 460 integrated delivery systems in the United States, and that number is growing, says Charles Bracken, managing director for ACS Healthcare Solutions, a Dearborn, Mich.-based consulting firm. As their numbers continue to climb, so will the need to lean on I.T.
"There is a long way to go, but we are definitely in a round of upgrades, integration and information system advancement, all since 2000," he says. "Most of the integrated delivery systems we work with are on the journey. They are committed to the next level of upgrade, to advancing clinical information systems through a core vendor strategy."
Many are on the road to fully integrating their organizations with I.T., but there are obstacles ahead.
"More integrated delivery systems are implementing I.T. than selecting," Bracken adds. "And many who are implementing have yet to aggressively pursue the operational changes associated with their goals."
How these organizations coalesce has changed over the two decades since integrated delivery systems began forming to compete for managed care contracts.
For example, the 1990s modus operandi of employing group practice-based physicians is giving way to integrated delivery systems looking for ways to tie in doctors without putting them on the payroll, says Laura D. Jantos, principal with ECG Management Consultants Inc., Seattle. That's leading to a more complex problem when it comes to implementing I.T.
Ground-up I.T. strategy
"When a physician is not on the payroll, management can't just say, `Use this system,' " Jantos says. "Management needs an I.T. strategy built from the ground up. And they need a cohesive vision and governing structure."
Parkview Health's vision was putting patient data in the hands of clinicians where they need it-hospital, office or home-in order to truly integrate the integrated delivery system. It was achieved by the decision to standardize on IDX Systems Corp., Burlington, Vt., as the core vendor.
That strategy was a goal, rather than a mandate, Thompson explains. "We conducted a prime vendor search for 18 months. It included specific criteria like any RFP process. We acknowledged we were not looking for one vendor to provide all solutions, but we wanted them to participate in bringing in other vendors for lab, radiology and document imaging. We wanted a partner."
One of Parkview's first steps was a three-month process review to understand how care was being delivered and how to make the most of the Last Word application from IDX.
Last Word became the foundation for the vendor's Carecast system that includes clinical documentation, a single database for a patient's lifetime longitudinal record and bar code-based medication charting.
Carecast also serves as the central connection to all other major information systems, including document imaging, radiology, admission-
discharge-transfer and master patient index. It is the gateway to the long-time financial system from McKesson, which was the original "core" database system, Thompson says.
The document imaging system, from LanVision Systems Inc., Cincinnati-which has an alliance with IDX-was implemented in 2002 and rolled out across the organization. That reflected a decision made early in the integration process to deploy any new applications across the integrated delivery system, regardless of what might be in place at other locations.
Document imaging helped produce early positive results for 1,200 physicians, giving them access to older paper records in their offices and homes, Thompson notes, along with any paper documents for patients going forward.
Data for doctors
The presence of a competing health care delivery system in Fort Wayne is part of Parkview's motivation to continue improvements, she says. Doctors that practice at both delivery systems know patient data is available at Parkview to help them make decisions.
"The critical part is making data available," Thompson says. "That's the challenge with CPOE and evidence-based medicine. We're using data to support physicians and other clinicians, and doing so without interrupting what they do."
Computerized physician order entry isn't in place yet, but some steps have been taken to prepare order sets. Parkview likely will pilot CPOE software sometime next year, Thompson adds.
Parkview Health's I.T. infrastructure investment target from mid-2001 to mid-2005 was $75 million. The organization has stayed within that budget, which was set down by its governing board at the outset.
As noted by CIOs and other observers, bringing these large health care organizations together typically requires: collaboration from the CEO level on down; evaluating and changing processes; and elaborate I.T. infrastructures.
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