Table Of ContentLTFPR 10/11/2004 8:31 AM Page i
Health Informatics
(formerly Computers in Health Care)
Kathryn J. Hannah Marion J. Ball
Series Editors
LTFPR 10/11/2004 8:31 AM Page ii
Health Informatics Series
(formerly Computers in Health Care)
Series Editors
Kathryn J. Hannah Marion J. Ball
Dental Informatics
Integrating Technology into the Dental Environment
L.M. Abbey and J. Zimmerman
Ethics and Information Technology
A Case-Based Approach to a Health Care System in Transition
J.G. Anderson and K.W. Goodman
Aspects of the Computer-Based Patient Record
M.J. Ball and M.F. Collen
Performance Improvement Through Information Management
Health Care’s Bridge to Success
M.J. Ball and J.V. Douglas
Strategies and Technologies for Healthcare Information
Theory into Practice
M.J. Ball, J.V. Douglas, and D.E. Garets
Nursing Informatics
Where Caring and Technology Meet, Third Edition
M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas
Healthcare Information Management Systems
A Practical Guide, Second Edition
M.J. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas
Clinical Decision Support Systems
Theory and Practice
E.S. Berner
Strategy and Architecture of Health Care Information Systems
M.K. Bourke
Information Networks for Community Health
P.F. Brennan, S.J. Schneider, and E. Tornquist
Informatics for the Clinical Laboratory
A Practical Guide
D.F. Cowan
Introduction to Clinical Informatics
P. Degoulet and M. Fieschi
Behavioral Healthcare Informatics
N.A. Dewan, N.M. Lorenzi, R.T. Riley, and S.R. Bhattacharya
(continued after Index)
LTFPR 10/11/2004 8:31 AM Page iii
Nancy M. Lorenzi Joan S. Ash
Jonathan Einbinder Wendy McPhee
Laura Einbinder
Editors
Transforming
Health Care Through
Information
Second Edition
With 11 Illustrations
LTFPR 10/11/2004 8:31 AM Page iv
Nancy M. Lorenzi, PhD Joan S. Ash, PhD Jonathan Einbinder, MD,
Professor of Biomedical Division of Medical MPH
Informatics Informatics and Outcomes Corporate Manager, Quality
Assistant Vice Chancellor for Research Data Management
Health Affairs Oregon Health & Science Clinical Informatics Research
Vanderbilt University University School of and Development
Medical Center Medicine Partners HealthCare System
Informatics Center Portland, OR 97201, USA Wellesley, MA 02481, USA
Nashville, TN 37232, USA
Wendy McPhee, MA, MITHI Laura Einbinder, MBA
Director, Health Informatics President
Education Einbinder & Associates
Monash Institute of Health Medfield, MA 02052, USA
Services Research
Monash University
Clayton, Victoria 3168
Australia
Series Editors:
Kathryn J. Hannah, PhD, RN Marion J. Ball, EdD
Adjunct Professor, Department of Vice President, Clinical Solutions
Community Health Science 2 Hamill Road Quadrangle 359 West
Faculty of Medicine Healthlink, Inc.
The University of Calgary Baltimore, MD 21210
Calgary, Alberta T2N 4N1, Canada and
Adjunct Professor
The Johns Hopkins University
School of Nursing
Baltimore, MD 21205, USA
Cover illustration: Bek Shakirov/images.com
Library of Congress Cataloging-in-Publication Data
Transforming health care through information / Nancy M. Lorenzl . . . [et al.], editors.—2nd ed.
p. ; cm.—(Health informatics)
Includes bibliographical references and index.
ISBN 0-387-21447-X (alk. paper)
1. Health facilities—Administration—Data processing—Case studies. 2. Medical care—Data
processing—Case studies. 3. Information storage and retrieval systems—Medical care—Case studies.
4. Medical informatics—Case studies. 5. Organizational change—Case studies. I. Lorenzi, Nancy M.
II. Series.
[DNLM: 1. Health Facilities—organization & administration. 2. Medical Informatics—organization &
administration. 3. Organizational Case Studies. 4. Organizational Innovation. WX 26.5 T772 2005]
RA971.6.T74 2005
362.11¢068—dc22
2004056534
ISBN 0-387-21447-X Printed on acid-free paper.
© 1995, 2005 Springer Science+Business Media, Inc.
All rights reserved. This work may not be translated or copied in whole or in part without the written permis-
sion of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA),
except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar method-
ology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not
identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to pro-
prietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going to press,
neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omis-
sions that may be made. The publisher makes no warranty, express or implied, with respect to the material con-
tained herein.
Printed in the United States of America. (BS/EB)
9 8 7 6 5 4 3 2 1 SPIN 10967171
springeronline.com
LTFPR 10/11/2004 8:31 AM Page v
Robert T. Riley PhD
June 26, 1937–January 18, 2003
Bob Riley was not only one of the original editors of the first edition of Transforming
Health Care Through Information: Case Studies, he was the managing editor! In that
role he personally edited all the cases and ensured that they were more readable and
had a sense of balance and humor.
Bob was a tenured faculty member at the University of Cincinnati, College of Busi-
ness Administration, until he founded Riley Associates, a successful international con-
sulting and training firm. He was nationally and internationally acclaimed for his
presentations, his management development seminars, and his consulting skills. He
authored several books and numerous articles on management and on managing tech-
nological change.
Bob was known for his humor, his constant quest for new knowledge, his ability to
understand and solve problems, his ability to make friends, and his ability to teach
others. Bob was active in the early stages of planning this book. Tragically on January
18, 2003, he lost his two-year battle with cancer. We miss his presence very much.
Nancy M. Lorenzi
Joan S. Ash
Jonathan Einbinder
Wendy McPhee
Laura Einbinder
LTFPR 10/11/2004 8:31 AM Page vi
To all those who realize that informatics
is transforming health care
and
to those who soon will
LTFPR 10/11/2004 8:31 AM Page vii
Series Preface
This series is directed to healthcare professionals who are leading the transformation
of health care by using information and knowledge. Launched in 1988 as Computers
in Health Care, the series offers a broad range of titles: some addressed to specific pro-
fessions such as nursing, medicine, and health administration; others to special areas of
practice such as trauma and radiology. Still other books in the series focus on inter-
disciplinary issues such as the computer-based patient record, electronic health records,
and networked healthcare systems.
Renamed Health Informatics in 1998 to reflect the rapid evolution in the discipline
now known as health informatics, the series will continue to add titles that contribute
to the evolution of the field. In the series, eminent experts, serving as editors or authors,
offer their accounts of innovations in health informatics. Increasingly, these accounts
go beyond hardware and software to address the role of information in influencing the
transformation of healthcare delivery systems around the world. The series will also
increasingly focus on “peopleware” and the organizational, behavioral, and societal
changes that accompany the diffusion of information technology in health services
environments.
These changes will shape health services in the next millennium. By making full and
creative use of the technology to tame data and to transform information, health infor-
matics will foster development of the knowledge age in health care. As coeditors, we
pledge to support our professional colleagues and the series readers as they share
advances in the emerging and exciting field of health informatics.
Kathryn J. Hannah
Marion J. Ball
vii
LTFPR 10/11/2004 8:31 AM Page ix
Preface
Thorough understanding of, and careful attention to, people and organizational issues
are essential for successful healthcare information technology initiatives. Despite this,
very few case studies about healthcare information technology—either successes or
failures—have been published. For instance, the case collections at Harvard Business
School and the Darden School of the University of Virginia contain virtually no cases
about healthcare information technology. As a result, students and faculty have turned
to other sources, though these vary considerably in content, length, format, and suit-
ability for use in the classroom. One of the more frequently cited examples is
Massaro’s1 description of a difficult order entry implementation. In 1995, Lorenzi and
colleagues2 published a book of case studies—the first edition of Transforming Health
Care Through Information.
At the same time, rapid and groundbreaking developments in information technol-
ogy, presentation, and processing have translated into an increased interconnection
between business and policy issues and healthcare informatics. As a result, the value
of informatics is becoming recognized outside traditional departments, and informatics
trainees are assuming positions outside academic settings.
Case studies may be useful for many readers but are particularly valuable in the
classroom where learners can become active participants in the learning process by
experiencing thought-provoking discussions with their colleagues. The case study
method uses reports of “real-life” experiences “to narrow the gap between theory and
practice,” pressing students to analyze real situations, come to conclusions, and defend
these conclusions among their peers.3 The purpose of the second edition of Trans-
forming Health Care Through Information is to continue to fill this gap in the health-
care informatics literature.
Jonathan Einbinder
References
1. Massaro TA. Introducing physician order entry at a major academic medical center. I. Impact
on organizational culture and behavior. Academic Medicine 1993;68(1)20–25.
2. Lorenzi NM, Riley RT, Ball MJ, Douglas JV, eds. Transforming Health Care Through Infor-
mation: Case Studies. New York: Springer-Verlag, 1995.
3. Ash JS,Anderson JG, Gorman PN, Zielstorff RD, Norcross N, Pettit J,Yao P. Managing change:
analysis of a hypothetical case. Journal of the American Medical Informatics Association
2000;7(2):125–134.
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Acknowledgments
Many thanks to all those who made contributions to this book. Many were graduate
students who submitted case studies as group projects. As the health informaticians of
the future, we support your continued efforts in this profession.
A special thanks to Lisa Miller, Tom Campion, and Alayne Ford of Vanderbilt Uni-
versity, Lynne Schwabe of the Oregon Health Sciences University, and Michelle M.
Schmitt of Springer for their support in this endeavor.
To those who have waited for the publication of this book, we thank you for your
continued interest and support.
Special acknowledgment is made to Marion Ball and Judith Douglas who were both
instrumental in the inception of the first casebook on medical informatics and were
encouraging of this new direction.
Special acknowledgment also is made to Laura Einbinder who so very capably
managed the entire process. If not for Laura, this book would not have been published.
Nancy M. Lorenzi
Joan S. Ash
Jonathan Einbinder
Wendy McPhee
Laura Einbinder
xi
