Intermountain Health – A Review of Model Hospital Computer Deployment and Use.

To quote their web-site:

“Intermountain Healthcare is a nonprofit health system based in Salt Lake City, with over 28,000 employees. Serving the healthcare needs of Utah and southeastern Idaho residents, Intermountain's system of 21 hospitals, physicians, clinics, and health plans provides clinically excellent medical care at affordable rates.”

What is special about the integrated delivery system is that it has been at the true leading edge of the use of Health IT to improve the quality and safety of patient care for over 30 years.

For this reason when a detailed report on the current and planned future use of Health IT comes out it is important that it be carefully reviewed.

The following article introduces the report.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070928/FREE/309280002/1029/FREE

The future of EMRs according to Intermountain

By: Joseph Conn / HITS staff writer

Story posted: September 28, 2007 - 5:59 am EDT

Installing a fairly sophisticated, commercially available electronic medical-record system will enable a hospital to significantly improve patient care, but fully implementing a best-of-breed EMR will provide “significant additional benefits,” including both cost reductions and improvements in patient safety and quality of care, according to a recently published study by a trio of healthcare informatics researchers and consultants.

The report, EMRs in the Fourth Stage: The Future of Electronic Medical Records Based on the Experience at Intermountain Health Care, combines a literature search of studies on “third stage” systems available now from commercial vendors and an analysis of what the authors classify as a prototype of “fourth stage” IT systems, the home-grown Health Evolution through Logical Processing, or HELP, and HELP 2 systems that have developed over more than the past two decades at Intermountain Healthcare, an 18-hospital integrated delivery system based in Salt Lake City. The 12-page report appears in the current issue of the Journal of Healthcare Information Management published by the Chicago-based Healthcare Information and Management Systems Society.

The report can be downloaded at the following URL.

http://www.fcg.com/research/serve-research.aspx?rid=338

The perspective on the history of hospital computing is offered is fascinating. The authors suggest there was a first generation (or stage) of systems that commenced development and implementation in the mid 1960’s at a small number of academic hospitals.

This was followed by a second generation of more advanced systems (incorporating the beginnings of clinical decision support and clinical order entry), which were again typically found in academic hospital sector. There were attempts to commercialise some of these systems, but this was often a failure due to the lack of inherent flexibility of these typically highly customised and localised systems.

The third generation of systems were typically commercially developed, much more flexible systems designed to be installed in a wide range of organisations. These systems were provided by Cerner, Eclipsys, Epic,IDX, McKesson, Meditech, Siemens and others, and were built largely upon lessons learned from the academic pioneers described above.

The fourth generation of systems are expected to build on the capabilities for flexible implementation of the third generation systems and add improved information and knowledge management and much improved clinical decision support.

On this framework the article goes on to review the benefits that may be expected from such systems and provides an amazingly complete reference list of possible benefits (167 in number).

I think this is an invaluable paper and commend it to all.

David.