Enterprise-Wide System Integration: Unanticipated Benefits and Limitations

Abstract presented at the 1994 AMIA Spring Congress

Authors

Richard Rathe, MD^; Maggie Downey*
Pam LaFrentz, MA^; John Cuddeback, MD, PhD*
University of Florida^; Shands Hospital*; Gainesville, Florida

Introduction

The University of Florida Health Science Center includes a 500 bed acute care hospital and multi-specialty clinics that receive 25,000 inpatient and 200,000 outpatient visits per year. We have used a network based relational database to integrate more than a dozen clinical and administrative systems including patient registration, scheduling, laboratory, radiology, transcription, and other ancillaries. The database, while integrated, is by no means comprehensive. A terminal based application called the On-Line Medical Record (OLMR) provides enterprise-wide access to these data. There is no direct entry by clinicians.

Results

The use of the OLMR has steadily increased over the past year. During the month of October 1993 over 800 individuals retrieved more than 58,000 reports from the system. However, only 20% of these users accounted for 80% of the queries. Roughly two thirds of these were adminis-trative or clerical employees who do not directly support patient care. User surveyıs have identified the incomplete database holdings and lack of direct data entry as major barriers to increased use by clinicians. To gauge the impact of the system on data availability for patient care we analyzed every patient encounter in a major clinical area for a one week period. We found that while there was greater than 95% chart availability, 37% of dictated clinic notes were only available electronically through the OLMR. An equal number existed only in hand-written form.

Conclusions

  1. While the focus of the project has been on patient care, a large percentage of actual use has been administrative.
  2. The administrative value of the system is directly related to its clinical content.
  3. The system has had a significant positive effect on data availability for patient care in certain areas.
  4. The clinical value of the system is directly related to the comprehensiveness of the database.
  5. Direct data entry by clinicians will be essential to increase the utility of the system for patient care.
  6. Funding for clinical systems should reflect the significant benefits realized by non-clinical areas.
Created on 3/13/95