Release 0.0: Clinical Information Technology In The Real World

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Abstract
PROLOGUE: Participants in the explosion of clinical information technology often refer to being at the “bleeding edge” of technology development—a takeoff on the phrase “leading edge” that graphically evokes the pain that often accompanies the progress. The demand for health care data—on the part of consumers, providers, employers, government, and health plans—is insatiable. Many of the new information technologies coming down the pike demand even more of health plans and physicians, who struggle with the compatibility, transferability, and confidentiality issues that have plagued health data developers and users from the outset. In this paper J.D. Kleinke describes the “numerous and often mind-numbingly complex problems associated with gathering and standardizing information on medical care,” drawing his real-world examples from his tenure as an executive for HCIA, a leading health information technology producer. The industry's developmental woes are magnified by its high profile on Wall Street. “In the crucible of American capitalism,” Kleinke writes, “there are few problems that investment money will not try to solve.” Expectations remain high, even as the industry's fortunes fluctuate with the changing market. More troublesome, however, are Kleinke's findings that technology's “ready-made solutions” often fail to live up to these expectations and, in many cases, have not even been tested in the “real world.” Kleinke is chairman of Health Strategies Network, a health information technology research company in Denver, Colorado. He is the author of Bleeding Edge: The Business of Health Care in the New Century (Aspen, September 1998). The industrialization of medical care delivery, compelled by fifteen years of reimbursement reform, has given rise to a commercial health information technology (HIT) industry. Well financed by Wall Street, the HIT industry offers a variety of ready-made solutions designed to transform a health care organization's raw data resources into useful clinical information. Many of the resulting clinical decision–support products are encumbered by numerous insurmountable intellectual and technical problems and, as a consequence, meet with cultural resistance from physicians. The long-awaited but costly implementation of electronic medical records (EMRs) will make these pioneering but flawed efforts obsolete, if EMR development successfully exploits recent technological breakthroughs and the ongoing consolidation of health care organizations.

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