Medical informatics at the his vendor issues and opportunities
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Medical Informatics at the HIS Vendor: Issues and Opportunities. Donald W. Rucker, MD VP & Chief Medical Officer SMS/Siemens. Topics. Differing environments – Corporate, University Differing informatics problems Hybrid environments and transitions Shared issues Shared opportunities.

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Medical informatics at the his vendor issues and opportunities l.jpg

Medical Informatics at the HIS Vendor: Issues and Opportunities

Donald W. Rucker, MD

VP & Chief Medical Officer


Topics l.jpg

  • Differing environments – Corporate, University

  • Differing informatics problems

  • Hybrid environments and transitions

  • Shared issues

  • Shared opportunities

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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

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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?

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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

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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)

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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

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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

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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

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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

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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?

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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

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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

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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

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  • 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

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Innovative Clinical Solutions

Leading Information Solutions

Medical Solutions That Help