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IT star status depends on increased revenues by George Spain CCIT Technical Publisher Information technology (IT), a highly promising star of the business productivity improvement show, played to packed houses in the 1990s. Today, while the audience is still growing, industry leaders are looking for the significant return on the IT investment (ROI). “In the last decade, some returns were realized, but they were marginal; this was particularly true in health care,” said Frank C. Clark, MUSC’s new chief information officer (CIO). “Even with economies of scale in IT, the returns were still disappointing. You can’t squeeze productivity improvement out of automation alone, you need improved workflow and processes.”  Information technology is not the antidote for flawed processes and bad workflow. “We paved over a lot of cow paths thinking we would get superhighways,” Clark said. “The road might look new and glitzy, but in the foundation it’s bumpy, full of holes, and requires lots of rework.” Upon his arrival at MUSC last summer, Clark created the Office of the Chief Information Officer (OCIO), a new entity that oversees and coordinates IT activities across the MUSC enterprise.  Clark's background lies in mathematics, and he has served two tours as CIO in academic medicine and large care delivery systems centers in Tennessee and Kentucky. The  University of Georgia graduate is keen to squeeze more efficiency from MUSC's IT operation and to pump up its ROI. In business terms, Clark is asking, “What are we getting from our significant IT investments?’” His mantra: IT should assist in boosting productivity in knowledge discovery, knowledge transfer, improving patient safety and clinical quality. “Automate a bad manual system or process and you’ll get a faster bad system or process,” Clark said. How exactly do Clark and the OCIO plan to glean additional benefits from IT? They’ll start by consolidating similar systems/technologies, eliminating duplication of technologies and maximizing the use of existing functionality. Another way is to coordinate and oversee the purchase and proliferation of smaller, departmental systems that may have a positive fiscal impact on the specific department but may not be “scalable” across the enterprise. “We have many different departmental systems now; some appear to be duplications. I am not sure it is fiscally prudent to have a document imaging technology for the hospital and a different one for the university. Also, why multiple, distinct financial systems? Let’s see if we can’t adopt broad technologies that can be used across the MUSC enterprise.”  As a way of promoting vendor consolidation, the Medical University Hospital Authority (MUHA) has issued a request for proposal (RFP) in an attempt to select a single vendor partner for advanced point-of-care clinical information systems. These core clinical information systems have patient safety as the central theme and seek to reduce adverse drug events. An RFP evaluation committee is expected to select a primary partner or primary partner consortium for the multi-million-dollar systems and to recommend it to the Board of Trustees in early spring.  The RFP is aimed at consolidating and automating several areas: Inpatient point-of-care clinical systems orders management results reporting clinical documentation medication administration physician expert orders Automated pharmacy system pharmacy robotics bar coding services pharmacy supplies Medical/surgical and distribution phased replacement of other clinical systems outsourcing of IT staff. Because of the significant cost involved, the RFP for these systems and services seeks a partnership between MUSC and the vendor or consortium with the winning bid. In other words, “we” implement this initiative using “your” technology and “our” health care expertise, and together we can design a model care delivery process that is very safe and highly efficient.  “With this care delivery model, MUSC becomes a flagship for demonstrating the potential of a consolidated approach to improving patient safety and gaining efficiency through process redesign and automation,” Clark said. Some of the world’s largest health care IT providers responded to the RFP: GE Healthcare Information Solutions, IDX, McKesson, Siemens/SMS, a consortium of Perot/Cerner/Amerisource, and Dinmar (Oasis) Consulting.  In the meantime, Clark and his small staff oversaw some cost-cutting measures on a smaller scale, such as the consolidation and restructuring of annual maintenance contracts.  Two announcements from the Office of the CIO include plans for a restructuring of a contract with Cisco, a networking equipment supplier, that allows MUSC to pay the same amount in annual maintenance fees as last year, “but also to obtain much needed upgrades to our network,” said Melissa Forinash, controller in the OCIO. Also announced was an arrangement with Microsoft to consolidate MUSC’s many purchases of operating systems and desktop software into a single agreement covering the entire enterprise. The agreement is expected to save thousands of dollars. Not every consolidation, even if it would lead to maintenance efficiency, leads to cost savings. For example, eliminating one of the two major e-mail systems on campus (IMAP and GroupWise) sounded like a ripe area for cost reduction. However, when an OCIO- sponsored team ran the numbers, the savings turned out to be minimal and primarily internal to the IT department. The group concluded that the return would not be worth the pain to the end users.  “If we were sitting around looking for things to do, we might take a closer look at this,” Clark said, “but there are many more important things ahead of us right now to keep us busy.”  Another path towards cost reduction is vendor standardization. It’s a lot easier to negotiate with one software company than with dozens. It’s also a lot easier to train employees how to use one set of standard software versus many. Finally, it is much cheaper to maintain a single set of standard-compliant resources. This single-vendor approach is more easily accomplished in the clinical settings, where standards are routinely imposed. Clark acknowledges it’s a tougher sell in the academic arena, where individual initiative and academic freedom are not only expected but also encouraged. “To better coordinate the standards issue in the academic setting, we’ll focus on common infrastructure needs such as information transport (voice, data, video), common storage and back up processes, and operating systems, rather than on individual user things,” he said.  Clark, a longtime Macintosh user, points out that the choice of an individual’s computer should not be the issue.  “We want to provide an infrastructure for our community that allows our users to attach most devices, as long as they meet certain minimum network and security requirements. Authorized users should be able to attach quickly and securely to our network and should require little in the way of maintenance and support.”     Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.