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Backstage at the Medical Revolution

Behind-the-scenes technologies are transforming medicine -- but who's gonna pay?

Who Wants the Tab? continued...

But Brent C. James, MD, executive director for Intermountain Health Care at the Institute for Healthcare Delivery Research, and adjunct professor of family and preventive medicine at the University of Utah School of Medicine in Salt Lake City, tells WebMD that electronic record systems can work when health-care systems are large enough and have the cash, brains, and will to make them work.

The Intermountain Health Care system, which comprises 22 hospitals and more than 100 outpatient facilities, has been working toward an electronic medical information system for more than 35 years. "We passed a point, just in the last couple of years, where it's showing a net return on investment," James tells WebMD.

The keys to success, he says, were designing a system that wouldn't make the jobs of doctors and nurses harder than they already were, and making sure that the system was part of overall efforts to improve the quality of health-care delivery.

"These types of systems, which we call advanced clinical systems, are still only in a minority of hospitals," acknowledges David Classen, MD. "Somewhere between 5% and 8% of hospitals have these advanced clinical systems that can provide lots of clinical information to doctors and to patients and provide the platform to act on that clinical information through things like computerized physician order entry."

Classen, who is vice president of the First Consulting Group in Salt Lake City, tells WebMD that about 40% of hospitals will have such systems in place over the next five years.

In addition to the high initial acquisition cost -- about $8 million per hospital -- health-care systems have been reluctant to invest in advanced clinical systems because early versions of these systems weren't flexible enough to meet the complex needs of individual hospitals or physician groups, and those systems that were tested tended to make more rather than less work for harried doctors and nurses.

But the tide of negative opinion about advanced clinical systems is beginning to turn, Classen says, because employers and health insurers are beginning to demand them, and because hospital administrators and doctors are beginning to realize that "these systems can really reduce a lot of errors, and improve the quality and safety of patient care, " Classen says.

Reviewed on September 26, 2003

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