The potentially lucrative health care market for information integration has attracted both telecommunications and systems integration companies to enter the business. As both infrastructure and networking experts, the Regional Bell Operating Companies (RBOCs) have aggressively pursued this opportunity. Pacific Bell has created a 100-member health care marketing group targeting improvements in telecommunications and administrative services. Ameritech, also with more than 100 members in its Health Connections Group, is involved in implementing regional and enterprise wide health networks. NYNEX develops infrastructure, software applications, and telemedicine systems. The remaining RBOCs (Bell Atlantic, BellSouth, US West, and Southwestern Bell) all have significant health care systems activities. All of the RBOCs have been operating in their own regions as restricted by law. However, recently passed telecommunications legislation permits them to expand their services to other domestic geographies when certain conditions are met.
Information-solution suppliers & systems integrators
3 M Health Information Systems, IBM Healthcare Solutions, Science Applications International Corporation (SAIC), and the EDS Healthcare Division have identified information systems integration for health care as a major business thrust. Industry teams are being created with hardware, software, network, and imaging system partners that can provide fully integrated, open systems. Many consumer-oriented software vendors, such as Microsoft, are introducing products specifically designed for the health care information systems market.
Historically, the health care industry has not invested as high a share of revenue in information technology as other information-intensive industries such as banking and finance. This, despite the fact that there is a tremendous need for integrated information technologies and information management tools. For example, many of today's paper-driven processes add significantly to health care costs and inefficiencies. Between 20 percent and 30 percent of our national health care expenditures are associated with informational paperwork for the hundreds of millions of transactions that take place every month (Woolhandler 1993). A recent grant solicitation from the Commerce Department's Advanced Technology Program (ATP) indicated that in one site alone, physicians spent 35 percent of their time, and nurses 50 percent of their time, doing paperwork (DOC 1994b). Some estimates suggest that as many as 13 percent of the one billion to two billion claims filed annually are returned for error correction (NJIT and Edison 1994). The Workgroup for Electronic Data Interchange (WEDI 1993) has estimated that half of all existing paper-based medical records are either missing or contain incomplete data.
Other indicators also point to the need for information systems integration. Often, important information is unavailable or inaccessible because it is spread across multiple information systems and/or organizations with differing systems. This can result in poor care and increased illness and mortality. Concerns about rising costs, accountability, and quality have resulted in more reporting and documentation requirements. This has led to an increase in both administrative costs and errors. The Institute of Medicine has reported that 11 percent of laboratory tests must be reordered because of lost results and that 30 percent of treatment orders are not documented at all. The Advanced Technology grant program has estimated that diagnosis results are not recorded 40 percent of the time.
The advent of managed care has also stimulated the need for systems integration. In fact, a survey of health care information executives by the Health Information and Management Systems Society (HIMSS) and Hewlett-Packard (HP) indicates that the number one reason for chief information officers (CIOs) of health organizations to adopt integrated information systems is the movement toward managed care (HIMSS/HP 1995). The need to integrate existing information systems to provide usable administrative, clinical, and quality/performance data will increase as cost-containment and the move toward capitation take greater hold. Other significant drivers for systems integration, according to the same survey, are the need to collect comparative outcomes data, develop clinical practice guidelines, and create a computer-based patient record.