Chock-full of change. Opportunities, and perils, abound as industry continues to evolve

Tighten your belt and hold onto your wallet: Another year of change looms for healthcare. In a 1999 outlook report, our staff tells all about Medicare cutbacks, managed-care turbulence and a looming crisis in skilled nursing. And everyone is braced for the appearance of that ugly year-2000 computer bug.

Clinical informatics: 2000 and beyond

Healthcare has begun to flounder in the mounting flood of data available from automated monitoring equipment, microprocessor controlled life-support equipment, such as ventilators, ever more sophisticated laboratory tests, and the myriad of minor technological wonders that every hospital and clinic seem to collect. It is no longer enough to merely display the data in a large spreadsheet or on a complex, colorful time-sequence graph. The next generation of healthcare information systems must help the clinician to assimilate the myriad of data and to make fast and effective decisions. The following is a list of features that the next generation of computer systems will have to include if they are to have a significant impact on the quality of patient care: data acquisition, data storage, information display, data processing, and decision support. By automating or streamlining repetitive or complex tasks, correlating and presenting complex and potentially confusing data, and tracking patient outcomes, the computer can augment clinicians' skills to improve patient care.

Y2K compliance countdown

The new century brings unique challenges--especially Y2K compliance. This article presents nurse managers and executives with an overview of the issues and action steps to keep their organizations on track.

Year in review--1998

If adversity tests our strength, healthcare got a real workout in 1998. Sore spots included HMO losses, bankruptcies, whistleblower lawsuits and failed mergers. Here's a look back at the major events that shaped the industry in 1998.

Trends in assessment of IT-based solutions in healthcare and recommendations for the future

State-of-the-art assessments of IT-based solutions in Healthcare is discussed in this paper. Special emphasis is placed on the human and organisation-centred perspective at the development of IT-based solutions. Based on this and basic conditions for system analysis and design reported in the literature, requirements for a methodology for user-driven, constructive assessment during the entire life-cycle of the IT-based system are synthesised. Finally, the outcome is discussed in the light of the presentations on technology assessment during the MIE 97 Congress and other related literature.

The state of the computer-based patient record

Value, experiments, promises, disappointments, hype, compromises, and change all characterize the status of the computer-based patient record (CPR). An industry expert offers some perspective on where the CPR has been and where it's going.

[Medical cooperation on the internet]

Post-1999, the economically united EEC will pose new challenges to European business, industry and citizen. It is a key objective that in the domain of European "infostructure" these problems are challenged and overcome, and that "advanced communications technologies and services" (ACTS) become the cement which binds the Community together. Within ACTS, 130 different projects are building new services. The consortium Emerald develops a telemedicine platform, setting up teleworking with teleconference, computer supported co-operative work (cscw, joint editing), demonstration and teleteaching for radiology, cardiology, nuclear medicine and radio surgery working environments.

Connectivity and control in the year 2000 and beyond

By now, most executives are familiar with the famous Year 2000 problem--and many believe that their companies have the situation well in hand. After all, it seems to be such a trivial problem--computer software that interprets "oo" to be the year 1900 instead of the year 2000. And yet armies of computer professionals have been working on it--updating code in payroll systems, distribution systems, actuarial systems, sales-tracking systems, and the like. The problem is pervasive. Not only is it in your systems, it's in your suppliers' systems, your bankers' systems, and your customers' systems. It's embedded in chips that control elevators, automated teller machines, process-control equipment, and power grids. Already, a dried-food manufacturer destroyed millions of dollars of perfectly good product when a computer counted inventory marked with an expiration date of "oo" as nearly a hundred years old. And when managers of a sewage-control plant turned the clock to January I, 2000 on a computer system they thought had been fixed, raw sewage pumped directly into the harbor. It has become apparent that there will not be enough time to find and fix all of the problems by January I, 2000. And what good will it do if your computers work but they're connected with systems that don't? That is one of the questions Harvard Business School professor Richard Nolan asks in his introduction to HBR's Perspectives on the Year 2000 issue. How will you prepare your organization to respond when things start to go wrong? Fourteen commentators offer their ideas on how senior managers should think about connectivity and control in the year 2000 and beyond.

Time pacing: competing in markets that won't stand still

Most companies change in reaction to events such as moves by the competition, shifts in technology, or new customer demands. In fairly stable markets, "event pacing" is an effective way to deal with change. But successful companies in rapidly changing, intensely competitive industries take a different approach. They change proactively, through regular deadlines. The authors call this strategy time pacing. Like a metronome, time pacing creates a rhythm to which managers can synchronize the speed and intensity of their efforts. For example, 3M dictates that 25% of its revenues every year will come from new products, Netscape introduces a new product about every six months, and Intel adds a new fabrication facility to its operations approximately every nine months. Time pacing creates a relentless sense of urgency around meeting deadlines and concentrates people on a common set of goals. Its predictability also provides people with a sense of control in otherwise chaotic markets. The authors show how companies such as Banc One, Cisco Systems, Dell Computer, Emerson Electric, Gillette, Intel, Netscape, Shiseido, and Sony implement the two essentials of time pacing. The first is managing transitions--the shift, for example, from one new-product-development project to the next. The second is setting the right rhythm for change. Companies that march to the rhythm of time pacing build momentum, and companies that effectively manage transitions sustain that momentum without missing important beats.

Information systems support for emergency medicine

Information needs for emergency medicine research and for practice are closely related. A well-developed information system can serve both, allowing data gathered in one setting to be used for the other. To produce the best environment for emergency medicine research, providers should support data standards, promote education in data analysis, and understand the informational structure of emergency medicine practice.

The power of virtual integration: an interview with Dell Computer's Michael Dell. Interview by Joan Magretta

Michael Dell started his computer company in 1984 with a simple business insight. He could bypass the dealer channel through which personal computers were then being sold and sell directly to customers, building products to order. Dell's direct model eliminated the dealer's markup and the risks associated with carrying large inventories of finished goods. In this interview, Michael Dell provides a detailed description of how his company is pushing that business model one step further, toward what he calls virtual integration. Dell is using technology and information to blur the traditional boundaries in the value chain between suppliers, manufacturers, and customers. The individual pieces of Dell's strategy--customer focus, supplier partnerships, mass customization, just-in-time manufacturing--may be all be familiar. But Michael Dell's business insight into how to combine them is highly innovative. Direct relationships with customers create valuable information, which in turn allows the company to coordinate its entire value chain back through manufacturing to product design. Dell describes how his company has come to achieve this tight coordination without the "drag effect" of ownership. Dell reaps the advantages of being vertically integrated without incurring the costs, all the while achieving the focus, agility, and speed of a virtual organization. As envisioned by Michael Dell, virtual integration may well become a new organizational model for the information age.

[Computers in general practice of the established gynecologist: market status--electronic data processing solutions--electronic data processing problems--future perspectives]

Since the end of the seventies a great change of edp-use in gynecological private practice took place. Many applications (for example ICD-coding) are not feasible in short time. In medicine, the electronic data processing is not as practicable as the technical progress permits. In only a few programs we can find gynecological specific electronic data processing solutions, networks between private practices, hospitals and Internet access. It is necessary to claim edp-solutions for gynecological private practice and define standards for programming electronic data processing in medicine.