Problem: Management Decision

Jumping on the Health-Tech Bandwagon-or Not71 Not long ago, patient records were stored in manila charts lined up on vast walls of shelving. Any coordination between different clinics involved sending paper records. Doctors scrawled notoriously illegible prescriptions, often faulted when pharmacists misfilled an order. But the way medical information is managed is rapidly changing, and your company is one of many vying to be at the center of the change. What steps should you take to digitize your information management system? Digitization is widely thought to hold a lot of potential benefit. Digitally stored medical records can be accessed anywhere via a networked system or even the Internet. Computerized orders and automated prescription filling systems claim to reduce errors and potential harm to patients. Treatment software guides doctors to the best and least costly treatment alternatives and allows them to track a patient's treatment. Digital medicine promises less paper, instant and universal access, and fewer errors. In addition to the promise are the incentives. On top is the $19.6 billion federal stimulus to computerize health care. And your company is not the only one tempted to clamor for that money to develop and implement technology; General Electric, Intel, and IBM are all climbing on the health-tech bandwagon.

You can't afford to be behind. What's more, the government plans to cut Medicare reimbursement for health-care companies that aren't completely digital by 2015. With all the promise and the hefty incentives (both positive and negative), why is your decision so difficult? Why isn't health care already digital? Only one in fifty hospitals has a digital system, and only 17 percent of doctors use any form of digital record. Well, the answer is mainly that digital management systems for health information are not (yet) all they're cracked up to be. The systems are very expensive to begin with. Plus, most are mass-produced, which means further hefty expense in money and time to customize them. What's more, it is questionable whether the currently available systems actually reduce error and increase patient safety. One hospital began to see several errors a week after implementing its system, and staff had to resort to verifying prescriptions with the pharmacy over the telephone to ensure accuracy. A study in the Journal of the American Medical Association found twenty-two new types of prescription errors, and staff at Children's National Medical Center found an eightfold increase in errors with high-risk medications.

Questions: 1. In light of the heavy incentives and the significant problems, what advantages are there to being a first mover in digitized medicine?

2. If you were to build your own system rather than purchasing and customizing a system that is already on the market, what features would it have? Think about the characteristics and costs of useful information discussed in the text and apply them to this situation.

3. How would you protect the security of medical records in your system?