During a recent meeting of the Medical Intranet Forum (MIF), in Dallas, Texas, CIOs and physician executives representing several dozen integrated delivery systems (IDSs) from around the country were asked to identify what they considered to be the key success factors for medical intranet development. The principal success factors these IDS leaders identified were careful analysis of user needs and identification and analysis of the specific business challenges that these networks should address.
Like the 1997 and 1998 annual surveys by the Healthcare Information and Management Systems Society, the MIF survey found that "communicating with outpatient physicians" was the number-one goal for a medical intranet (see Exhibit 1). Careful analysis of this goal raises several issues that may affect medical intranet user needs and expectations and, thus, network success.
A successful medical intranet is one that is used. Intranet use is, in turn, tied directly to perceived user value. Thus, IDS executives struggle with the issue of which data and services should be made available to users and in what order. They need to determine, for example, whether access to information from inpatient sources has priority over access to outpatient information, and whether the need for clinical data is greater than the need for information,on eligibility and benefits, or authorization and referrals.
Forward-thinking organizations, however, step back from the challenge of setting priorities on medical intranet content and focus first on issues related to network constituencies. For example, with the goal of communicating with outpatient physicians in mind, many IDS leaders may pose the question, "What do the physicians want to see on the medical intranet?"
A more germane initial question, however, would be, "Will physicians be the principal users of this medical intranet, or will it serve primarily as an administrative tool in the near term?" The answer to this question alone has profound implications with respect to setting medical intranet priorities.
Prospective Evaluation of Medical Intranet Use
Organizations such as ScrippsHealth, Baylor Health Care Systems, and Catholic Healthcare West have engaged physicians and physician office administrators in surveys and focus groups to determine, among other things, their current patterns of computer and network use, desires for online services, and intent to utilize these services.
The activities of these organizations are further evidence that the development of medical intranets can become integral to healthcare organizational strategies and, at times, healthcare politics. These organizations have used this network design process to create true partnerships with key physician groups to devise and implement medical intranets that not only improve clinical and administrative data flow, but also provide support for key physician initiatives.
Assessing Current Computer Use
A 1998 mail survey of 2,000 Southern California physicians focusing upon their current computer use yielded an overwhelming response rate of more than 50 percent.(a) Notable survey findings included a high degree of Internet use by physicians (60 percent) and a surprising number of physicians who consider themselves competent in the use of a computer keyboard (95 percent).
Most physicians, however, did not report using computers for clinical purposes. The computer/network uses most often cited by physicians were accessing news and continuing medical education resources, managing personal finances, and word processing. About 60 percent of respondents reported using e-mail, but, as with other computer applications, few respondents reported using e-mail for clinical purposes.
Many physicians placed high value on electronic access to clinical data, but the survey also identified a number of obstacles to physician use of computers for clinical purposes, centering on cost, time constraints, and the lack of a meaningful clinical network (see Exhibit 2). Ironically, however, 40 percent of physician respondents confirmed that they probably would not use computers or networks for clinical purposes even if training were provided and the services were made available free or at a very low cost.
By contrast, survey results from outpatient office administrators working with the Southern California physicians cited above show that nearly all physician office managers use computers and want to access more timely and accurate clinical and administrative data online. Administrative staff regard information inefficiencies as the number-one obstacle to increasing office productivity, improving patient service, and providing more effective clinical care delivery. Their priorities for improving information flow include gaining online access to referrals, authorizations, claims status, and outpatient laboratory/radiology results and transcriptions.
Conclusion
Providing tools for outpatient physicians clearly remains an important long-term objective for most IDSs. But focusing the initial implementation of medical intranets on the needs of physician office staffs will allow IDSs to take advantage of opportunities for short-term wins.
Healthcare executives who are analyzing, designing, or beginning to roll out physician-focused medical intranets can learn from the results of surveys by organizations such as the MIF and ScrippsHealth. But they also should identify, and implement their own formal methods of gathering information. The use of provider focus groups, interviews, joint design sessions, and surveys can help guide initial medical intranet design and define clearly immediate network challenges and priorities unique to individual organizations.
Successful prioritization of network applications and services will yield enhanced network use, improved return on investment, and an expanded sense among physicians and their office staffs that the organization sponsoring the medical intranet is in tune with outpatient provider needs.
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