Karys A
InterQual, Marlborough, MA, USA.
J Healthc Inf Manag. 1998 Fall;12(3):25-32.
As this article has shown, advances are beginning to put an end to the technology paradox that has hindered the industry's efforts to manage care better. Whereas in the past the management side of the healthcare industry has been slow to adopt new technologies, recent years have seen an explosion in the development and use of new tools for managing care. Most of these tools have traditionally focused on managing the administrative and financial aspects of providing care; however, that has also begun to change. Software systems incorporating clinical decision support criteria permit healthcare professionals to make clinical decision-making part of the care management process conveniently and efficiently. Clinical decision support criteria are also helping to change the focus of managed care. At the beginning of the managed care era, insurers and managed care companies concentrated primarily on reigning in costs, in many cases by restricting the types and duration of care provided to their members. Although these restrictions succeeded in conserving resources, they also helped foster an uneasy atmosphere between payers and providers, many of whom felt that their clinical judgment was too often overruled by the "bean counters." At the same time, many healthcare consumers grew to distrust both managed care professionals and providers, feeling that medical decisions were often made for the wrong reasons. However, as managed care companies have acknowledged that the most efficient way to provide care is to provide appropriate care, the focus has begun to move toward the clinical side of healthcare. Although healthcare organizations are still relying on financial management tools, they are also looking for systems that can make the clinical decision-making process more efficient and effective. The end result is that the healthcare industry is able to assure the best, most appropriate treatment while conserving resources. With the constant stream of new technologies into the healthcare management arena, healthcare professionals will have access to new tools to make the management process even more efficient. The healthcare industry's technology paradox will soon be a thing of the past.
如本文所示，种种进步正开始终结阻碍医疗行业更好地管理医疗服务的技术悖论。过去，医疗行业的管理层面采用新技术的速度一直很慢，但近年来，用于管理医疗服务的新工具在开发和使用方面出现了爆炸式增长。传统上，这些工具大多专注于管理提供医疗服务的行政和财务方面；然而，这种情况也已开始改变。纳入临床决策支持标准的软件系统使医疗专业人员能够方便、高效地将临床决策纳入医疗管理流程。临床决策支持标准也有助于改变管理式医疗的重点。在管理式医疗时代之初，保险公司和管理式医疗公司主要专注于控制成本，在很多情况下是通过限制向其成员提供的医疗服务类型和时长来实现。尽管这些限制成功地节约了资源，但它们也在支付方和医疗服务提供方之间营造了一种不安的氛围，其中许多人觉得他们的临床判断常常被“精打细算的人”否决。与此同时，许多医疗消费者开始不信任管理式医疗专业人员和医疗服务提供方，觉得医疗决策往往是出于错误的原因做出的。然而，随着管理式医疗公司认识到提供医疗服务的最有效方式是提供恰当的医疗服务，重点已开始转向医疗保健的临床方面。尽管医疗保健组织仍在依赖财务管理工具，但他们也在寻找能够使临床决策过程更高效、更有效的系统。最终结果是，医疗行业能够在节约资源的同时确保提供最佳、最恰当的治疗。随着新技术不断涌入医疗管理领域，医疗专业人员将能够使用新工具，使管理过程更加高效。医疗行业的技术悖论很快将成为过去式。
