Friedman B A
University of Michigan Medical School, Ann Arbor, USA.
Radiol Manage. 1997 Nov-Dec;19(6):30-6.
Articles in both business and healthcare literature make frequent reference to the need for integration in healthcare organizations. In healthcare, the term horizontal integration can refer to the purchase of one hospital by another in the same geographical area, particularly where the hospitals' services overlap. Services might be consolidated in this example or one hospital may totally shut down the acquired one. Vertical integration refers to a hospital exercising control of its inputs or outputs. In one sense, patients referred to a hospital can be considered inputs. A hospital that purchases physician practices or integrated delivery systems is an example. Purchasing a nursing facility by an integrated delivery system (IDS) is another. This article focuses on organizational or holographic integration, where an organization is understood and embedded--like a hologram--in each of its smaller components, and each operating unit has knowledge about the whole system in which it is embedded. Conceptually, a hospital can achieve organizational integration relatively easily. One way is to assign administrative responsibility for two departments, radiology and pathology, for example, to one person who will handle billing, budgeting and human resources issues. Organizational integration breaks down turf barriers between distinct functional areas (often known as stovepipes or the silo mentality) because the result is less energy expended to solve problems. Organizational integration must include the merging of information technology (IT) into a single computer system that can report results across several departments, for example, in order entry, result reporting, resource scheduling or billing. At the University of Michigan Health System, technical and organizational integration are taking place across the information systems of the radiology and pathology departments. Deployment of an intranet-based architecture for ancillary information systems will provide the means to achieve high level integration across previously heterogeneous and non-integrated department-based clinical information systems.
商业和医疗保健领域的文献中经常提到医疗保健机构整合的必要性。在医疗保健领域，横向整合一词可指同一地理区域内一家医院收购另一家医院，特别是在两家医院服务重叠的情况下。在这个例子中，服务可能会合并，或者一家医院可能会完全关闭被收购的医院。纵向整合是指医院对其输入或输出进行控制。从某种意义上说，转诊到医院的患者可被视为输入。例如，一家收购医生执业机构或综合医疗服务体系的医院就是一个例子。综合医疗服务体系（IDS）收购一家护理机构则是另一个例子。本文关注的是组织或全息整合，即一个组织被理解并像全息图一样嵌入其各个较小的组成部分中，并且每个运营单元都了解其所处的整个系统。从概念上讲，医院相对容易实现组织整合。一种方法是将两个部门（例如放射科和病理科）的行政管理职责交给同一个人，由其处理计费、预算和人力资源问题。组织整合打破了不同职能领域之间的地盘壁垒（通常称为竖井式或筒仓思维），因为这样做能减少解决问题所耗费的精力。组织整合必须包括将信息技术（IT）整合到一个单一的计算机系统中，以便能够跨多个部门报告结果，例如在订单录入、结果报告、资源调度或计费方面。在密歇根大学医疗系统中，放射科和病理科的信息系统正在进行技术和组织整合。部署基于内联网的辅助信息系统架构将为实现跨以前异构且未整合的基于部门的临床信息系统的高度整合提供手段。
