Chin H L, McClure P
Kaiser Permanente, Portland, Oregon, USA.
Proc Annu Symp Comput Appl Med Care. 1995:717-21.
Decisions about information system implementation are often justified through a cost-benefit analysis. The ability to improve efficiency and outcomes while decreasing costs through information systems--by allowing for multiple and instant simultaneous access to information, through data monitoring and altering, through automation of protocols, and by collecting information for population-based health care as opposed to individual illness-care--are all potential benefits of a comprehensive clinical information system. Measuring the quantitative impact of these system improvements, however, is difficult. Doing a complete cost-benefit analysis of a comprehensive clinical information system is unrealistic due to the many assumptions necessary and the multiple confounding factors that are involved. In our Clinical Information Systems deployment in Kaiser Permanente, Northwest Region, we have elected not to do a detailed cost-benefit analysis. Instead, we have done an evaluation, based on success criteria, of a pilot implementation of a vendor-supplied system. This evaluation is based on clinician acceptance, system usage, technical factors, and quantitative effects on physician productivity. We also considered qualitative factors such as relationship with and responsiveness of the system vendor. We are moving ahead to regionalize this clinical information system based on such an evaluation of our pilot project. This paper outlines the approach that we have taken in evaluating our implementation of this system. It may provide some guidance for organizations on how to make a decision about whether or not to regionalize a clinical information system based on the evaluation of a pilot-site implementation.
关于信息系统实施的决策通常通过成本效益分析来证明其合理性。信息系统能够提高效率和改善结果，同时通过多种方式降低成本，如允许对信息进行多次即时同步访问、通过数据监测和变更、通过协议自动化以及通过收集基于人群的医疗保健信息而非个体疾病护理信息等，这些都是综合临床信息系统的潜在益处。然而，衡量这些系统改进的量化影响却很困难。由于需要诸多假设且涉及多种混杂因素，对综合临床信息系统进行完整的成本效益分析是不现实的。在我们位于西北地区的凯撒医疗机构（Kaiser Permanente）部署临床信息系统时，我们选择不进行详细的成本效益分析。相反，我们基于成功标准对供应商提供的系统进行了试点实施评估。该评估基于临床医生的接受程度、系统使用情况、技术因素以及对医生工作效率的量化影响。我们还考虑了一些定性因素，如与系统供应商的关系以及供应商的响应能力。基于对试点项目的此类评估，我们正推进该临床信息系统的区域化。本文概述了我们在评估该系统实施过程中所采用的方法。它可能为各组织在如何基于对试点实施的评估来决定是否对临床信息系统进行区域化方面提供一些指导。
