The IBM View of Clinical Transformation: Interview with Ivo Nelson

Everyone knows IBM. But in healthcare IBM has made a significant push into supplying consulting services to augment up its hardware and software. Ivo Nelson, the Healthcare Industry Leader of IBM Global Business Services, leads around 2,500 people. Previously Nelson ran Healthlink, the 500-person consulting firm IBM bought in 2005.

Nelson sees the major challenge for providers as being clinical transformation, with revenue cycle and supply chain management being secondary. That transformation not only changes the clinical process as records move from being paper- to computer-based but also "changes the way doctors interact with data, and it changes the role of IT." Providers must deal with cultural along with process changes – "not to mention handling the substantial amount of money that has to be spent." After all, Nelson notes, "the dollars are an amount they've previously only seen in building projects."

So where are we as an industry in that process? "I guess it depends on how you define 'beginning'? If this was a hundred-yard dash, we're not at the twentieth yard yet. Many providers are realizing how difficult it can be. Providers are now in 'get real' mode and are dealing with tactical issues." Some have stopped because they're not happy with the software, or because they haven't scaled hardware, or haven't figured out physician adoption issues.

Are we seeing any results from this transformation?

The hospitals that are far enough down the path that they are using the system are seeing results. But it's likely to take five to six years for a typical community integrated delivery system to see payback. "To get completely automated will be a ten-year process."

So why does Nelson's phone ring?

Frequently it's just not having enough skilled people who understand the software. The needs are very specific. A nurse who understands IT is not enough; the client might need a nurse who's done an implementation for a particular vendor's eMAR (electronic medication administration record) system.

Meanwhile, the integration issue has also driven hospitals towards single-vendor solutions, as the best-of-breed solutions from the 1990s have too many points of failure. Nelson sees the integration solutions are really being for the larger hospitals. Large academic medical centers will be looking for portals that give a single view of information from different systems. This is not a new concept. "But going through the Y2K efforts, we found that that even for a small hospital there can be 80 different applications; for the big ones it might be 1,000. For the typical community integrated delivery system, it's more likely that they're going to use one core system."

There will be a market for those SOA-type integration applications. But there are challenges, "especially that MUMPS (Massachusetts General Hospital Utility Multi-Programming System) is still the premier application language -- the systems work but they're using technology that's 25 years old." Integration also needs a lot of cooperation from the application vendors to move to the open-systems environment – "they're not necessarily always inclined to be that cooperative, so the realities of getting integration done have not proven to be so easy."
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