Editor’s Note: This is the second installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, originally called Computers in Hospitals. This article appeared in the March/April 1981 issue.
In the early 1970’s, a significant number of firms began to offer systems in response to the automation needs of laboratories; relatively few of these companies are extant today. One cause of this high attrition rate derived from the specificity of the early vendor-designed systems; they were often virtually “tailor-made” for individual hospitals; developmental costs were high, but system transportability often proved to be low.
Those suppliers who were able to develop successful turnkey laboratory data-management systems found themselves, by the late 1970’s, in competition with manufacturers of hospitalwide systems. Additionally, the availability of large-scale computer systems impacted upon the selection process. Traditionally, the laboratory manager had exercised autonomy in the selection of a dedicated laboratory system; the introduction of hospitalwide systems, however, necessitated that the decision-making process become the responsibility of hospital administration.
Hospital administration was confronted with a complex decision, made more difficult because information concerning the capabilities and limitations inherent in the different system approaches was often lacking, and adequate documentation was unavailable. Hospital management often inaccurately perceived a much greater degree of overlap between the two types of systems than actually existed. Thus, administration viewed choices as either the selection of a hospitalwide computer system with a patient-tracking orientation and a lesser emphasis on intradepartmental applications, or the installation of dedicated systems that would provide better departmental support but have only limited institutionwide functions. In many cases, the result was to postpone the decision-making process indefinitely, rather than risk a costly mistake.
Not only hospital management, but the system supplier as well, has generally viewed the selection of a hospital computer system as an either/or proposition and the systems that have been developed have reflected this view. Only a few of the hospitalwide and dedicated computer systems currently available have been designed to allow for the easy exchange of information.
For example, a lab order generated through a hospitalwide system cannot always be accessed online by a dedicated system. Similarly, lab reports that have been stored in a departmental laboratory computer are not available online through the large-scale system. Thus, the data-handling capabilities of both types of systems have been negatively impacted.
Today, it has become evident that a clarification of the respective roles of dedicated and hospitalwide computer systems is needed and that the responsibilities accruing to each supplier be clearly delineated. The increasing need for and uses of automation are mandating that the systems be designed to complement, rather than compete with, each other.
To achieve this end, it will be necessary for a supplier to follow one of two courses. It must either develop an integrated system utilizing both dedicated and hospitalwide computers or must modify existing systems by means of standard interfaces that have been designed to be compatible with other computer systems.
No single system can meet all of the data-handling needs of an institution; therefore, it is neither necessary nor desirable to view the two types of systems as mutually exclusive approaches to achieving automation in the laboratory. As information handling costs and requirements continue to increase, hospital administrators will need to consider a third alternative – the implementation of compatible systems designed to meet both the intra- and interdepartmental needs of the institution. System vendors must be prepared to offer systems that will be responsive to those needs.
When this article was published in 1981, Dr. Kennedy was president of The Kennedy Group, a management consulting firm with offices in Chicago and Menlo Park, Calif.
